Skin nontumor
Infectious disorders
Parvovirus B19
Last author update: 1 May 2016
Last staff update: 16 November 2020
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PubMed Search: Parvovirus B19 [title]
Table of Contents
Definition / general | Terminology | Etiology | Clinical features | Case reports | Treatment | Clinical images | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Molecular / cytogenetics description | Additional referencesCite this page: Soni A, Hamodat M. Parvovirus B19. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/skinnontumorparvovirus.html. Accessed April 26th, 2024.
Definition / general
- Viral infection that typically causes mild rash in children
Terminology
- Clinical syndrome is called "Fifth disease" or erythema infectiosum
Etiology
- Parvovirus B19 is spread by respiratory droplets, and has an incubation period of 5 - 14 days
- Viral receptor is the erythrocyte P antigen, which is expressed on endothelial cells
- Parvovirus attacks erythroblasts; may cause acute anemic crisis in patients with accelerated erythropoiesis, immunocompromised or minimal reserve (chronic anemia, hemolytic anemia, sickle cell, fetuses), although usually recipients have no symptoms (Transfusion 2005;45:1811)
- Pregnant women may pass virus to fetus, where it may cause marked fetal anemia and hydrops
- Rash may be due to delayed type hypersensitivity, antibody dependent cellular immunity against microbial antigens in epidermis or endothelium, or circulating immune complexes
Clinical features
- Causes "Fifth disease" in children, a mild illness with a "slapped cheek" facial rash
- Characteristic skin manifestations are petechial eruption in a glove and stocking distribution, reticular truncal erythema and "slapped cheek" sign (Hum Pathol 2000;31:488)
- May produce influenza-like illness, miscarriage, fetal hydrops and neonatal angioedema
- Atypical presentations include generalized petechial rash (Pediatrics 2010;125:e787), asymptomatic papular eruption or lower extremity palpable purpura, red baby syndrome (Indian J Pediatr 2009;76:309), papular purpuric gloves and socks syndrome (Med Oral Patol Oral Cir Bucal 2007;12:E4); may resemble Sweet syndrome, myopathic dermatomyosis or lupus erythematosus (Intern Med 1998;37:708)
- Immune responses usually clear infection and provide lifelong protection but virus may persist in blood or tissue (Transfus Med 2007;17:263)
- Parvovirus B19 has been associated with some cases of Rosai-Dorfman disease (J Clin Pathol 2006;59:1320)
Case reports
- Parvovirus and acute hepatic failure in two children (Am J Transplant 2014;14:2645)
- Parvovirus B19 induced transient anemia in an immunocompetent child (Turk Patoloji Derg 2015;31:158)
- Parvovirus B19 in children with sickle cell anemia (Exp Biol Med (Maywood) 2016;241:749)
- Sudden cardiac death from parvovirus in a young man with Brugada syndrome (J Forensic Leg Med 2014;25:8)
Treatment
- Usually self resolving
- Can treat symptoms of fever, joint pain, swelling and itching
- Children and healthy adults have complete recovery
Clinical images
Images hosted on other servers:
Lace-like rash on extremities
Microscopic (histologic) description
- Interstitial histiocytic infiltrate with piecemeal fragmentation of collagen and mononuclear cell-predominant vascular injury pattern
- Extravasated red blood cells
- Erythrocyte precursors may have intranuclear inclusions
- Eosinophils and occasional neutrophils may be present
- Perineuritis may also be present
- Also interface dermatitis, eczematous alterations, papillary dermal edema; occasionally mesenchymal mucinosis, leukocytoclastic vasculitis
Microscopic (histologic) images
Images hosted on other servers:
Bone marrow
Fetal spleen
Parvovirus B19 infection in formalin - fixed and paraffin - embedded placenta and fetal tissues
B19 positive immunostain
Positive stains
- B19 immunostain
Molecular / cytogenetics description
- Virus identified in endothelial cells of lesional skin by several methods, including PCR
- Also identified in keratinocytes
