Pinto V, Grandy J, Zambrano P, Corta B, Salas P, Salgado I, Santander J, Salgado C, Chadid J, Iñiguez R
Exequiel González Cortés Hospital, Metropolitan Southern Health Service, Pediatric Department, University of Chile School of Medicine, Santiago, Chile.
Transplant Proc. 2008 Nov;40(9):3261-4. doi: 10.1016/j.transproceed.2008.03.127. Epub 2008 Jun 30.
Human parvovirus B19 (PVB19) is the etiologic agent of erythema infectiosum (fifth disease), a common childhood exanthema. Immunocompromised patients risk developing chronic infections leading to pure red blood cell aplasia. Herein we have reported our experience with two pediatric renal transplant recipients who had severe pure red cell aplasia in the early period after surgery, accompanying PVB19 infection.
A 6-year-old boy underwent pro emptive living-related renal transplantation in September 2006. On day 4, he developed abdominal discomfort and diarrhea. After transplantation, he began an asymptomatic drop in hematocrit without reticulocytosis, which was unresponsive to recombinant erythropoietin. Diarrhea also persisted. Polymerase chain reaction (PCR) was positive for cytomegalovirus (CMV) in the gastrointestinal tract. PVB19 was confirmed by PCR on a bone marrow sample. He was transfused with packed red cells and treated with ganciclovir and intravenous immunoglobulin (IVIG). His hematocrit increased and diarrhea ended. Six months later anemia recurred requiring a second infusion of IVIG. Subsequently he has done well.
A 15-year-old boy received a living-related renal transplant in October 2006, after 2 years on automated peritoneal dialysis. One month later he developed a progressive, nonregenerative anemia. A bone marrow aspirate confirmed a PVB19 infection by PCR. He received a blood transfusion and IVIG with a favorable response.
The presence of persistent anemia in immunocompromised hosts with a low reticulocyte count suggests PVB19 infection. IVIG therapy is effective to treat chronic PVB19 infections.
人细小病毒B19（PVB19）是传染性红斑（第五病）的病原体，这是一种常见的儿童疹病。免疫功能低下的患者有发生慢性感染导致纯红细胞再生障碍的风险。在此，我们报告了两名小儿肾移植受者的情况，他们在术后早期出现严重的纯红细胞再生障碍，并伴有PVB19感染。
一名6岁男孩于2006年9月接受了亲属活体肾移植。术后第4天，他出现腹部不适和腹泻。移植后，他的血细胞比容开始无症状下降，无网织红细胞增多，对重组促红细胞生成素无反应。腹泻也持续存在。胃肠道的巨细胞病毒（CMV）聚合酶链反应（PCR）呈阳性。骨髓样本的PCR证实存在PVB19。他接受了浓缩红细胞输注，并接受了更昔洛韦和静脉注射免疫球蛋白（IVIG）治疗。他的血细胞比容升高，腹泻停止。6个月后贫血复发，需要第二次输注IVIG。随后他情况良好。
一名15岁男孩在进行了2年自动腹膜透析后，于2006年10月接受了亲属活体肾移植。1个月后，他出现进行性、非再生性贫血。骨髓穿刺液的PCR证实存在PVB19感染。他接受了输血和IVIG治疗，反应良好。
免疫功能低下宿主中存在持续性贫血且网织红细胞计数低提示PVB19感染。IVIG治疗对慢性PVB19感染有效。
