Zerbini M, Gentilomi G A, Gallinella G, Morandi R, Calvi S, Guerra B, Musiani M
Department of Clinical and Experimental Medicine, University of Bologna, Italy.
Prenat Diagn. 1998 Jun;18(6):599-606.
B19 fetal infection has been associated with hydrops or fetal death. We report four cases of meconium peritonitis in hydropic fetuses with laboratory diagnosis of B19 infection. Parvovirus B19 DNA was detected by in situ hybridization both in cord blood and in amniotic cells in three fetuses, while in one case only cord blood was available and proved positive. Signs of active or recent B19 infection in maternal serum samples were documented only in two cases, which proved positive for specific IgM antibodies anti-B19. Maternal B19 infections were asymptomatic and fetal anomalies were observed during a routine ultrasound scan. A common feature of the hydropic fetuses was the presence of abdominal ascites concomitant with or preceding alterations, suggesting meconium peritonitis. The four pregnancies had a preterm outcome: in two cases infants recovered following surgical treatment, in one case spontaneously, and the other one was stillborn. Since vascular inflammation has been documented in B19 infection and congenital bowel obstruction results from vascular damage during fetal life, our observation suggests the need for investigating B19 infection in the presence of meconium peritonitis for a better understanding of the pathogenetic potential of B19 parvovirus in intra-uterine infection.
B19 胎儿感染与胎儿水肿或死亡有关。我们报告了 4 例水肿胎儿发生胎粪性腹膜炎且实验室诊断为 B19 感染的病例。通过原位杂交在 3 例胎儿的脐血和羊水中均检测到细小病毒 B19 DNA，而在 1 例中仅脐血可用且检测呈阳性。仅在 2 例孕妇血清样本中记录到活跃或近期 B19 感染的迹象，这 2 例针对抗 B19 特异性 IgM 抗体检测呈阳性。孕妇 B19 感染无症状，胎儿异常是在常规超声检查时发现的。水肿胎儿的一个共同特征是存在伴有或先于病变的腹腔积液，提示胎粪性腹膜炎。这 4 例妊娠均早产：2 例婴儿经手术治疗后康复，1 例自然恢复，另 1 例死产。由于已证明 B19 感染存在血管炎症，且先天性肠梗阻是由胎儿期血管损伤所致，我们的观察结果表明，在存在胎粪性腹膜炎的情况下有必要调查 B19 感染，以便更好地了解 B19 细小病毒在宫内感染中的致病潜力。
