Soliman Othman El-Sayed, Abd El-Aal Hegazi Hasan Moustafa, El-Ashry Rasha, Zaghloul Mohammad Hosam Eldeen, Kora Bothina
Clinical Pathology Department, Mansoura Faculty of Medicine, Mansoura University Children's Hospital, Mansoura, Egypt.
J Pediatr Hematol Oncol. 2009 Mar;31(3):173-6. doi: 10.1097/MPH.0b013e3181983b2d.
Oncology patients are at particular risk for parvovirus B19 infection, which may cause severe, persistent, usually nonspecific illness in this group.
This study was designed to assess the prevalence and impact of parvovirus B19 in pediatric oncology patients receiving chemotherapy, and to define the optimal diagnostic tests in such patients.
Fifty-nine children under chemotherapy (39 with acute lymphocytic leukemia and 20 with solid tumors) with mean age of 4.96+/-1.94 years, in addition to 30 healthy children of matched age and sex, were enrolled in this study. Clinical and laboratory data were collected by examination and from patients' records. Specific parvovirus B19 immunoglobulin (Ig) M and IgG antibodies were assessed by enzyme-linked immunosorbent assay, and parvovirus DNA was detected by nested polymerase chain reaction (PCR) for all patients and controls.
Parvovirus DNA was detected in 16 (27.1%), IgM in 3 (5.1%), and IgG in 36 (61%) patients. IgM had sensitivity, specificity, and accuracy of 18.75%, 100%, and 77.9%, respectively, whereas those of IgG were 81.25%, 53.4%, and 61%, respectively. PCR-positive patients had significantly higher frequency of unexplained anemia, red blood cell transfusions, and longer hospital stay than PCR-negative patients (P<0.001). Multiple linear regression analysis showed that unexplained anemia and multiple red blood cell transfusions were the most important variables that can predict PCR positivity.
Parvovirus B19 is not an uncommon problem in pediatric oncology patients who exhibited weak antibody response and nonspecific clinical features. Screening of these patients with PCR rather than serology is recommended when infection is suspected.
肿瘤患者感染细小病毒B19的风险尤其高，该病毒在这一群体中可能导致严重、持续且通常是非特异性的疾病。
本研究旨在评估细小病毒B19在接受化疗的儿科肿瘤患者中的流行情况和影响，并确定此类患者的最佳诊断检测方法。
本研究纳入了59名接受化疗的儿童（39名急性淋巴细胞白血病患儿和20名实体瘤患儿），平均年龄为4.96±1.94岁，此外还纳入了30名年龄和性别匹配的健康儿童。通过检查和患者记录收集临床和实验室数据。采用酶联免疫吸附测定法评估特异性细小病毒B19免疫球蛋白（Ig）M和IgG抗体，并对所有患者和对照进行巢式聚合酶链反应（PCR）检测细小病毒DNA。
在患者中检测到细小病毒DNA的有16例（27.1%），IgM阳性的有3例（5.1%），IgG阳性的有36例（61%）。IgM的敏感性、特异性和准确性分别为18.75%、100%和77.9%，而IgG的敏感性、特异性和准确性分别为81.25%、53.4%和61%。PCR阳性患者不明原因贫血、红细胞输血的发生率显著高于PCR阴性患者，住院时间也更长（P<0.001）。多元线性回归分析表明，不明原因贫血和多次红细胞输血是预测PCR阳性的最重要变量。
细小病毒B19在儿科肿瘤患者中并非罕见问题，这些患者抗体反应较弱且临床特征不特异。当怀疑感染时，建议对这些患者采用PCR而非血清学进行筛查。
