jofinЖурнал инфектологииJournal Infectology2072-6732IPO “АIDSSPbR"10.22625/2072-6732-2024-16-4-13-22jofin-1705Research ArticleОбзорReviewПарвовирусная B19-ассоциированная пурпуро-петехиальная экзантема. Дифференциальный диагноз с васкулитами неинфекционной природыParvovirus B19-associated purpureo-petechial exanthema. Differential diagnosis with non-infectious vasculitisХалиуллинаС. В.HaliullinaS. V.

Халиуллина Светлана Викторовна – профессор кафедры детских инфекций Казанского ГМУ, д.м.н., профессор.

Казань; тел.: 8(843)267-80-06

Kazan

svekhal@mail.ruАнохинВ. А.AnohinV. A.

Анохин Владимир Алексеевич – заведующий кафедрой детских инфекций Казанского ГМУ, д.м.н., профессор.

Казань; тел.: 8(843)267-81-00

Kazan

anokhin56@mail.ruЛутфуллинИ. Я.LutfullinI. Ya.

Лутфуллин Ильдус Яудатович – доцент кафедры пропедевтики детских болезней и факультетской педиатрии Казанского ГМУ; доцент кафедры педиатрии и неонатологии им. профессора Е.М. Лепского Казанской государственной медицинской академии – филиала Российской медицинской академии непрерывного профессионального образования, к.м.н.

Казань; тел.: +7-904-766-54-28

Kazan

lutfullin@list.ruДолговсковаД. Е.DolgovskovaD. E.

Доловскова Дарья Евгеньевна – заведующий отделением.

Казань; тел. +7-960-094-88-5

Kazan

Dash.alatyreva25@yandex.ruНазароваО. А.NazarovaO. A.

Назарова Ольга Александровна – доцент кафедры эпидемиологии и доказательной медицины Казанского ГМУ, к.м.н.

Казань; тел.: +7-917-877-88-02

Kazan

nazarovaoa76@mail.ruКазанский государственный медицинский университетРоссияKazan State Medical UniversityRussian FederationКазанский государственный медицинский университет; Казанская государственная медицинская академия – филиал Российской медицинской академии непрерывного профессионального образованияРоссияKazan State Medical University; Kazan State Medical Academy – branch of the Russian Medical Academy of Continuous Professional EducationRussian FederationРеспубликанская клиническая инфекционная больница имени профессора А.Ф. АгафоноваРоссияRepublican Clinical Infectious Diseases Hospital named after Professor A.F. AgafonovRussian Federation2024150120251641322Copyright © Халиуллина С.В., Анохин В.А., Лутфуллин И.Я., Долговскова Д.Е., Назарова О.А., 20242024Халиуллина С.В., Анохин В.А., Лутфуллин И.Я., Долговскова Д.Е., Назарова О.А.Haliullina S.V., Anohin V.A., Lutfullin I.Y., Dolgovskova D.E., Nazarova O.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.niidi.ru/jofin/article/view/1705

Клинические проявления парвовирусной В19 инфекции разнообразны и зависят от возраста, гематологического и иммунного статуса инфицированного. Классическими проявлениями болезни считают инфекционную эритему у детей, артриты/артралгии у взрослых, тяжелые анемии у больных с нарушением эритропоэза и неимунную водянку плода при внутриутробном заражении. Кроме того, описаны различные варианты экзантем, ассоциированных с парвовирусом В19. К ним относят синдром папуло­пурпурных перчаток и носков, PPGSS; пурпуро­-петехиальную сыпь, ассоциированную с парвовирусом В19, PAPPE; акропетехиальный синдром; асимметричную перифлексуральную экзантему детей и пр. Во всех случаях кожные проявления характеризуются геморрагической сыпью. Определённую сложность представляет дифференциальный диагноз подобных вариантов парвовирусной В19 инфекции с васкулитами неинфекционной природы, в первую очередь с наиболее распространенным IgA васкулитом (пурпура Шенлейна – Геноха) и кожным васкулитом мелких сосудов (cutaneous small vessel vasculitis (CSVV). Связь васкулитов с инфекцией в ряде случаев очевидна и подтверждается эпидемиологическими наблюдениями. Инфекции могут играть роль триггера для развития васкулита или являться его непосредственной причиной (васкулит в таком случае может быть классифицирован как васкулит, связанный с вероятной этиологией в системе номенклатуры Chapel Hill Consensus Conference 2012). С учетом того, что природа васкулитов до конца не ясна, вопрос возможной связи их появления с инфицированием PVB19 требует дальнейшего изучения. С клинической точки зрения, дифференциальный диагноз геморрагической экзантемы, ассоциированной с PVB19 и васкулитами, крайне важен в первую очередь из-­за необходимости немедленного лечения последних. С точки зрения эпидемиологии это важно, поскольку больные с PPGSS или PAPPE заразны весь период высыпаний.

По-видимому, дополнительные исследования и, в первую очередь, гистологические, достаточное количество образцов от пациентов с пурпуро-­петехиальной сыпью и серологически доказанной острой парвовирусной В19 инфекцией позволят решить эту задачу.

Clinical manifestations of parvovirus B19 infection are varied and depend on the age, hematological and immune status of the infected person. Classic manifestations of the disease include infectious erythema in children, arthritis/ arthralgia in adults, severe anemia in patients with impaired erythropoiesis and non­immune hydrops fetalis in case of intrauterine infection. In addition, various types of exanthema associated with parvovirus B19 have been described. These include “papular­purpuric gloves and socks syndrome, PPGSS”, “purpuro­petechial rash associated with parvovirus B19, PAPPE”, “acropethechial syndrome”, “asymmetric periflexural exanthema of children”, etc. In all cases, skin manifestations are characterized by a hemorrhagic rash. A certain difficulty is the differential diagnosis of such variants of parvovirus B19 infection with vasculitis of non­infectious origin, primarily with the most common IgA vasculitis (Henoch­Schonlein purpura) and cutaneous small vessel vasculitis (CSVV). The connection of vasculitis with infection in some cases is obvious and is confirmed by epidemiological observations. Infections can act as a trigger for the development of vasculitis or be its direct cause (vasculitis in this case can be classified as “vasculitis associated with a probable etiology” in the nomenclature system of the Chapel Hill Consensus Conference 2012). Considering that the nature of vasculitis is not completely clear, the question of a possible connection between their occurrence and infection with PVB19 requires further study. From a clinical point of view, the differential diagnosis of hemorrhagic exanthema associated with PVB19 and vasculitis is extremely important primarily because of the need for immediate treatment of the latter. From an epidemiological point of view, this is important, since patients with PPGSS or PAPPE are infectious throughout the period of the rash.

Apparently, additional studies, primarily histological, of a sufficient number of samples from patients with purpuric­petechial rash and serologically proven acute parvovirus B19 infection will help solve this problem.

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The authors declare that there are no conflicts of interest present.