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CORRESPONDENCE
Year : 2015  |  Volume : 142  |  Issue : 1  |  Page : 88-89

Real time PCR reconfirmed three novel clinical associations of parvovirus B19: Non-occlusive bowel gangrene, amegakaryocytic thrombocytopenia & myositis


Division of Virology, Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226 014, Uttar Pradesh, India

Date of Web Publication4-Aug-2015

Correspondence Address:
Janak Kishore
Division of Virology, Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226 014, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-5916.162132

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How to cite this article:
Kishore J. Real time PCR reconfirmed three novel clinical associations of parvovirus B19: Non-occlusive bowel gangrene, amegakaryocytic thrombocytopenia & myositis. Indian J Med Res 2015;142:88-9

How to cite this URL:
Kishore J. Real time PCR reconfirmed three novel clinical associations of parvovirus B19: Non-occlusive bowel gangrene, amegakaryocytic thrombocytopenia & myositis. Indian J Med Res [serial online] 2015 [cited 2018 Sep 19];142:88-9. Available from: http://www.ijmr.org.in/text.asp?2015/142/1/88/162132

Sir,

Human parvovirus B19 (B19), a single-stranded DNA virus belonging to the genus erythrovirus in the family Parvoviridae is an emerging virus [1],[2] causing a wide range of clinical infections depending on the patient's immunological and haematological status [3],[4] . However, the entire range of infections is not yet known. Earlier we reported three novel clinical associations of B19 namely, non-occlusive bowel gangrene, amegakaryocytic thrombocytopenia and myositis complicating erythema infectiosum [5],[6],[7] based on the detection of B19 specific IgM antibodies and B19 DNA by in-house PCR (VP1-VP2 common region primers) and in-house nested-PCR (VP1 unique region primers) besides other clinical and haematological features. To reconfirm that B19 infection caused these three clinical manifestations of B19 virus, the stored DNA (at- 20° C) or samples (at -70° C) which were positive for B19 virus were re-tested with more specific test namely, B19 real-time PCR kit (ZJ Bio-Tech Shanghai, China) wherein real-time PCR amplified (Corbett Rotor-Gene 6000, Australia) (from a different genomic region) sequences of B19 were hybridized with a B19 specific DNA probe making a double check on genomic sequences of B19.

Gangrene of stomach or intestine owing to non-occlusive bowel infarction (NOBI) has an unknown aetiology [8],[9],[10],[11] with no further information after our report [5] , and same is the status for amegakaryocytic thrombocytopenia due to B19 infection. However, there are couple of reports and a review article on myositis induced by B19 that supports our finding [12],[13],[ [14] . Results of previously reported cases of NOBI had shown B19 genome in serum samples of all eight cases (in three cases resected bowel tissues also) besides anti-B19 antibodies and thrombus in gastric vessels [5] . The second study was on a nine months old male child who had purpura, epistaxis and intra-cerebral haemorrhage and bone marrow showed absence of megakaryocytes. B19 specific IgM, IgG antibodies in serum and B19 DNA in both serum and bone-marrow were detected [6] . The third study was on a nine years old female child who presented with fever, anaemia and generalized erythematous rash later developed arthralgia, myalgia and calf tenderness (myositis) and was unable to walk despite any neurological deficit. Her creatine phosphokinase (CPK) was highly elevated (twice) while Parvovirus B19 specific IgM antibodies and DNA were detected in the serum [7] .

On re-testing these positive samples by B19 real-time PCR, consistently positive results were observed and reported here. In cases of bowel gangrene (NOBI) the mean copy numbers of B19 virus were lower in biopsy tissues which ranged from 2.7 to 3.9 x 10 [3] in comparison with 1.8 to 7.6 x 10 [4] virion/ml in the serum. In the case of myositis due to B19 the virus copy number was little higher 8.3 x 10 [4] in serum but the bone-marrow sample from amegakaryocytic thrombocytopenia case had much higher virus load of 3.3 x10 [7] virion/ml. This again showed that B19 genome was present in patients suffering from these three novel clinical associations of B19 besides anti-B19 IgM antibodies and other clinical and histological features described earlier [5],[6],[7] . It may be noted that in acute B19 infection intense viraemia occurs and virus titres may range from 10 [10] to 10 [12] /ml. The lower limit of B19 DNA detection by our in-house PCR was previously determined to be 2.4 x 10 [3] virion/ ml [15] . Further, bone marrow is the major site where virus replication occurs due to great tropism of B19 virus to erythroid progenitor cells causing destruction of colony forming and blast forming units of red cells resulting in anaemia and reticulocytopenia [16] . Bowel tissues had lower virus copies/ml since tissue distribution of B19 remains to be determined. However B19 may remain at cryptic sites and infect vascular endothelial cells. The possible mechanisms of these three clinical associations of B19 remain unexplained till date. Further studies on larger number of cases need to be done to substantiate these novel clinical associations of B19 virus.

 
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Rahav G. Parvovirus B19infection--an emerging infectious disease? Isr Med Assoc J 2002; 4 : 810-1.  Back to cited text no. 1
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2.
Bock CT. Parvovirus B19:a new emerging pathogenic agent of inflammatory cardiomyopathy. Ernst Schering Res Found Workshop 2006; 55 : 83-97.  Back to cited text no. 2
    
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Kishore J, Kapoor A. Erythrovirus B19 infection in humans. Indian J Med Res 2000; 112 : 49- 64.  Back to cited text no. 3
    
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Heegaard ED, Brown KE. Human parvovirus B19. Clin Microbiol Rev 2002; 15 : 485-505.  Back to cited text no. 4
    
5.
Kishore J, Das NR, Saxena R, Krishnani N. Novel detection of parvovirus B19 DNA and IgM antibodies in patients with non-occlusive gangrene of stomach & bowel. Indian J Med Res 2010; 131 : 702-10.   Back to cited text no. 5
    
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Bhattacharyya J, Kumar R, Tyagi S, Kishore J, Mahapatra M, Choudhary VP. Human parvovirus B19-induced acquired pure amegakaryocytic thrombocytopenia. Br J h0 ematol 2005; 128 : 128-9.  Back to cited text no. 6
    
7.
Kishore J, Singh J.Detection of parvovirus B19 in a case of erythema infectiosum with myositis. Indian Pediatr 2006; 43 : 814-7.  Back to cited text no. 7
    
8.
Finkel TH, Török TJ, Ferguson PJ, Durigon EL, Zaki SR, Leung DY, et al. Chronic parvovirus B19 infection and systemic necrotising vasculitis: opportunistic infection or aetiological agent? Lancet 1994; 343 : 1255-8.  Back to cited text no. 8
    
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Murer L, Zacchello G, Bianchi D, Dall'Amico R, Montini G, Andreetta B, et al. Thrombotic microangiopathy associated with parvovirus B 19 infection after renal transplantation. J Am Soc Nephrol 2000; 11 : 1132-7.  Back to cited text no. 9
    
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Ammaturo C, De Rosa A, Morra C, Bassi U, Cerrato C, D'Eliso E, et al. Intestinal infarction: report of 98 cases. Chir Ital 2001; 53 : 45-56.  Back to cited text no. 10
    
11.
Perri S, Lotti R, Procacciante F, Gabbrielli F, Nardi M, Amendolara M, et al. Intestinal infarction. Retrospective clinical study. Chir Ital 2001; 53 : 57-64.  Back to cited text no. 11
    
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Crum-Cianflone NF.Bacterial, fungal, parasitic, and viral myositis.Clin Microbiol Rev 2008; 21 : 473-94.  Back to cited text no. 12
    
13.
Koliou M, Karaoli E, Soteriades ES, Pavlides S, Bashiardes S, Christodoulou C. Acute hepatitis and myositis associated with erythema infectiosum by Parvovirus B19 in an adolescent. BMC Pediatr 2014; 14 : 6.  Back to cited text no. 13
    
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Oliver ND, Millar A, Pendleton A. A case report on parvovirus b19 associated myositis. Case Rep Rheumatol 2012; 2012 : 250537.  Back to cited text no. 14
    
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Kishore J. Standardization of parvovirus B19 DNA extraction from serum and quantitative PCR. Indian J Pathol Microbiol 2005; 48 : 522-5.  Back to cited text no. 15
    
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Brown KE, Young NS. Parvovirus B19 infection and hematopoiesis. Blood Rev 1995; 9 : 176-82.  Back to cited text no. 16
    



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