Atypical course of parvovirus B19 infection with combined infection (clinical observation)

The article describes a clinical case of atypical severe course of parvovirus B19 infection, similar in its manifestations to meningococcal infection, with combined infection with Meningococcus, Hemophilus bacillus, influenza A virus.  

A patient hospitalized with acute respiratory disease and toxicoderma had new symptoms within 24 hours: headache, hemorrhagic rash, decrease in blood pressure to 80/50 mm Hg, fever up to 39.8 0C. Based on the symptoms, a preliminary clinical diagnosis was made: “Meningococcal infection, generalized form – meningococcemia, severe course. Infectious-toxic shock of the 2nd degree.”  

During laboratory examination of clinical samples of the patient by bacteriological, serological and molecular genetic methods, there was no growth of bacterial microflora in liquor, blood and smears from the pharynx and nose. Genetic material (DNA and RNA) of Neisseria meningitides, Haemophilus influenza and influenza A/H3N2 was detected in a smear from the nasal cavity.  

At the same time, parvovirus B19 DNA was isolated in the patient’s cerebrospinal fluid and blood in a high viral load (Ct 21.1 and Ct 4.9, respectively). The patient was found to have not only IgG, but also IgM antibodies to parvovirus B19, which is a confirmation of acute parvovirus B19 infection. A pronounced allergic reaction was confirmed by a high index of total IgE (1068 units/ml). Thus, we have described an atypical case of laboratoryconfirmed parvovirus B19 infection in the presence of bacterial-viral mixed infection and an allergic reaction in the patient. 

1. Skripchenko N.V. Actual problems of infectious diseases of the nervous system in children / N.V. Skripchenko, M.V. Ivanova, G.P. Ivanova, V.N. Komantsev, A.A. Vilnits, E.Y. Gorelik, N.F. Pullman, V.V. Karasev, N.V. Morgatsky, E.A. Piskareva, K.O. Shevchenko, D.A. Golyakov // Pediatrics. – 2007. – Vol. 86, No. 1. – P.101-113. https://pediatriajournal.ru/files/upload/mags/262/2007_1_1145.pdf

2.

3. On the state of sanitary and epidemiological welfare of the population in the Russian Federation in 2020: State Report. Moscow: Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, 202. – 256 p.

4.

5. Shishov A.S. «Masks» of acute neuroinfections and markers of differencial diagnosis / A.S. Shishov, I.S. Petrova, P.V. Boytsov, V.G. Leva, V.E. Malikov, S.A. Rusanova, A.V. Surovikina, I.A. Blank // Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. – 2018. – Vol. 118(1).- P.82-91. (In Russ.). https:// doi.org/10.17116/jnevro20181181182-91 https://www.mediasphera.ru/issues/zhurnal-nevrologii-i-psikhiatrii-im-s-s-korsakova/2018/1/downloads/ru/1199772982018011082

6.

7. Nikishov O.N., Parvovirus infection – contemporary issues in epidemiology and clinical medicine / O.N. Nikishov, А.А. Kuzin, A.Yu. Antipova, I.N. Lavrenteva // Epidemiology and Vaccinal Prevention (Èpidemiologiâ i vakcinoprofilaktika) (In Russ.). – 2015. – Vol. 14, No. 4 (83). – P.29 – 35. https:// cyberleninka.ru/article/n/parvovirusnaya-infektsiya-sovremennaya-problema-v-epidemiologii-i-klinicheskoy-meditsine/viewer

8.

9. Jones M. S. New DNA viruses identified in patiens with acute viral infection syndrome / M. S. Jones, A. Kapoor, V. Lukashov [et al.] // J. Virol. – 2005. – Vol. 79. – Р. 8230 – 8236.

10.

11. Shchedrina A.Yu. The role of parvovirus B19 in the development of inflammatory cardiomyopathy / A.Yu. Shchedrina, A.A. Skvortsov, K.A. Zykov, A.A. Safiullina, S.N. Tereshchenko // Rational pharmacotherapy in cardiology (In Russ.). – 2013. – Vol. 9 (5). – P.542-550. https://elibrary.ru/item. asp?id=21561202

12.

13. Pattabiraman C. Identification and Genomic Characterization of Parvovirus B19V Genotype 3 Viruses from Cases of Meningoencephalitis in West Bengal, India / C. Pattabiraman, P. Prasad, S. Sudarshan, A.K. George, D. Sreenivas, R. Rasheed, A. Ghosh, A. Pal, S.K.S. Hameed, B. Bandyopadhyay, A. Desai, R/ Vasanthapuram // Microbiol Spectr. – 2022. – Vol.10(2).- P.e0225121. doi: 10.1128/spectrum.02251-21. https://www. ncbi.nlm.nih.gov/pmc/articles/PMC9045363/pdf/spectrum.02251-21.pdf

14.

15. Barah F. Neurological aspects of human parvovirus B19 infection: a systematic review / F. Barah, S. Whiteside, S. Batista, J. Morris // Rev Med Virol. – 2014. – Vol. 4(3). – P.154– 168. https://doi.org/10.1002/rmv.1782. https://journals.asm. org/doi/epub/10.1128/spectrum.02251-21

16.

17. Meningokokkovaja infekcija. Klinicheskie protokoly MZ RK [Meningococcal infection. Clinical protocols of the Ministry of Health of the Republic of Kazakhstan] – 2019. https:// diseases.medelement.com/disease/менингококковая-инфекция-2019/16183.

18.

19. Sklavounou-Andrikopoulou1 A., Oral manifestations of papular-purpuric ‘gloves and socks’ syndrome due to parvovirus B19 infection: the first case presented in Greece and review of the literature / A. Sklavounou-Andrikopoulou1, M. Iakovou, S. Paikos, V. Papanikolaou, D. Loukeris, M. Voulgarelis // Oral Diseases. – 2004. – Vol. 10. – P.118–122. https://onlinelibrary.wiley.com/doi/epdf/10.1046/j.1354-523X.2003.00986.x

20.

21. Taro Fukuta, Diagnosis of Peripheral Facial Palsy Associated with Parvovirus B19 Infection by Polymerase Chain Reaction / Taro Fukuta, Yoshihiko Kawano, Maiko Ikeda, Junichi Kawada, Yoshinori Ito, Shinya Hara // Case Reports in Pediatrics.- 2022.- Vol.2022, Article ID 4574640.- 3 P. https://doi. org/10.1155/2022/4574640

22.

23. Das P. Evolutionary aspects of Parvovirus B-19V associated diseases and their pathogenesis patterns with an emphasis on vaccine development / P. Das, K. Chatterjee, N.R. Chattopadhyay, T. Choudhuri // Virus Dis. – 2019. – Vol. 30(1). – P.32–42. https://pubmed.ncbi.nlm.nih.gov/31143830/

24.

25. Bonvicini F. Meningoencephalitis with persistent parvovirus B19 infection in an apparently healthy woman / F. Bonvicini, G. Gallinella, M. Musiani, M. Zerbini, G. Marinacci, M.C. Pajno // Clin Infect Dis. -2008.- Vol. 47(3).- P.385–7. https:// doi.org/10.1086/589863

26.

27. Bilenchi R., Papular-purpuric “gloves and socks” syndrome / R. Bilenchi, M. De Paola, S. Poggiali, S. Acciai, L. Feci, P. Sansica // G Ital Dermatol Venereol. – 2012. – Vol.147(1). – P.119-21.

28.

29. Paltsev M.A., Avtandilov G.G., Zairatyants O.V., Kaktursky L.V., Nikonov E.L. Pravila formulirovki diagnoza. Chast’ 1. Obshhie polozhenija [Rules of diagnosis formulation. Part 1. General provisions]. – Moscow: 2006. – 88 p. https:// perm-pb.ru/upload/file/Правила%20формулировки%20 диагноза.%20часть%201_2006.pdf