Investigation of Parvovirus B19 seropositivity levels in patients with joint pain

Abstract

Objective: Parvovirus B19 is a DNA virus belonging to the genus Erythrovirus of the Parvoviridae family, which is widespread worldwide and associated with different clinical pictures. Parvovirus B19 can cause arthritis and arthralgia. In this study, we aimed to compare seropositivity rates in patients with and without joint symptoms. Methods: In the study, Parvovirus B19 IgG, IgM and PCR results of patients who were studied in the microbiology laboratory between 2020 and 2024 were retrospectively analyzed. Blood samples were evaluated with ELISA-based serologic tests and the presence of viral genome was investigated in PCR tests. In statistical analyses, p<0.05 was considered significant. Results: Parvovirus B19 IgG seropositivity rate was 33.37% in the group without joint pain, while this rate increased to 50.4% in individuals with joint pain (p=0.00017). In addition, while the IgG positivity rate was 36.18% in women in the group without joint pain, this rate was 58.2% in the group with joint pain (p=0.00058). Parvovirus B19 IgM rates increased from 2.90% in the group without joint pain to 3.20% in the group with joint pain. No positivity was detected in individuals with joint pain in PCR tests. Conclusion: The seropositivity rate of parvovirus B19 increases with age and is higher in women. The high seropositivity rate in individuals with joint complaints suggests that this infection should be considered in the differential diagnosis of diseases with joint pain, especially rheumatologic diseases. These findings on the epidemiology and clinical presentation of parvovirus B19 are consistent with the literature.

Keywords

• Parvovirus B19
• Arthralgia
• Serology

Eklem ağrısı olan hastalarda Parvovirus B19 seropozitiflik düzeylerinin araştırılması

Abstract

Amaç: Parvovirus B19, Parvoviridae ailesinin Erythrovirus cinsine ait, dünya genelinde yaygın görülen ve farklı klinik tablolarla ilişkili bir DNA virüsüdür. Parvovirus B19 artrit, artraljiyi neden olabilmektedir. Çalışmada, eklem semptomları olan ve olmayan hastalarda seropozitiflik oranlarının karşılaştırması amaçlandı. Yöntem: Çalışmada, 2020-2024 yılları arasında mikrobiyoloji laboratuvarında çalışılmış, hastalara ait Parvovirus B19 IgG, IgM ve PCR sonuçları retrospektif olarak analiz edilmiştir. Kan örnekleri ELISA tabanlı serolojik testlerle değerlendirilmiş, PCR testlerinde viral genom varlığı araştırılmıştır. İstatistiksel analizlerde p<0.05 anlamlı kabul edilmiştir. Bulgular: Eklem ağrısı olmayan grupta Parvovirus B19 IgG seropozitiflik oranı %33.37 iken, eklem ağrısı olan bireylerde bu oran %50.4'e yükselmiştir (p=0.00017). Ayrıca eklem ağrısı olmayan gruptaki kadınlarda IgG pozitiflik oranı, %36.18 iken eklem ağrısı olan grupta bu oran %58.2 bulunmuştur (p=0.00058). Parvovirus B19 IgM oranları eklem ağrısı olmayan grupta %2.90 iken, eklem ağrısı olanlarda %3.20’ye yükselmiştir. PCR testlerinde eklem ağrısı olan bireylerde pozitiflik tespit edilmemiştir. Sonuç: Parvovirus B19 seropozitiflik oranı yaşla birlikte artmakta ve kadınlarda daha yüksek görülmektedir. Eklem yakınmaları olan bireylerde seropozitiflik oranının yüksek bulunması, bu enfeksiyonun romatolojik hastalıklar başta olmak üzere eklem ağrısı görülen hastalıkların ayırıcı tanısında akılda tutulması gerektiğini düşündürmektedir. Parvovirus B19’un epidemiyolojisi ve klinik prezentasyonu hakkındaki bu bulgular, literatürle uyumludur.

Keywords

• Parvovirus B19
• Artralji
• Seroloji

References

1. Qiu J, Söderlund-Venermo M, Young NS. Human parvoviruses. Clin Microbiol Rev. 2017;30(1):43-113. https://doi.org/10.1128/cmr.00040-16
2. Cossart YE, Field AM, Cant B, Widdows D. Parvovirus-like particles in human sera. Lancet. 1975;1:72-73. https://doi.org/10.1016/S0140-6736(75)91074-0
3. Cossart YE. Parvovirus B19 finds a disease. Lancet. 1981;2:988-989. http://dx.doi.org/10.1016/S0140-6736(81)91185-5
4. Cohen BJ, Buckley MM. The prevalence of antibody to human parvovirus B19 in England and Wales. J Med Microbiol. 1988;25:151-153. doi:10.1099/00222615-25-2-151.
5. De Jong EP, Walther FJ, Kroes AC, Oepkes D. Parvovirus B19 infection in pregnancy: new insights and management. Prenat Diagn. 2011;31:419-425. doi:10.1002/pd.2714.
6. Kelly HA, Siebert D, Hammond R, Leydon J, Kiely P, Maskill W. The age-specific prevalence of human parvovirus immunity in Victoria, Australia, compared with other parts of the world. Epidemiol Infect. 2000;124:449-457. doi:10.1017/S0950268899003817.
7. Anderson MJ, Higgins PG, Davis LR, et al. Experimental parvoviral infection in humans. J Infect Dis. 1985;152:257-265. https://doi.org/10.1093/infdis/152.2.257
8. Jordan JA. Identification of human parvovirus B19 infection in idiopathic nonimmune hydrops fetalis. Am J Obstet Gynecol. 1996;174:37-42. doi:10.1016/S0002-9378(96)70370-8.

9. Azzi A, Morfini M, Mannucci PM. The transfusion-associated transmission of parvovirus B19. Transfus Med Rev. 1999;13:194-204. doi:10.1016/S0887-7963(99)80033-9.
10. Heegaard ED, Laub PB. Parvovirus B19 transmitted by bone marrow. Br J Haematol. 2000;111:659-661. doi:10.1046/j.1365-2141.2000.02407.x.
11. Broliden K. Parvovirus B19 infection in pediatric solid-organ and bone marrow transplantation. Pediatr Transplant. 2001;5:320-330. doi:10.1034/j.1399-3046.2001.00035.x,
12. Egbuna O, Zand MS, Arbini A, Menegus M, Taylor J. A cluster of parvovirus B19 infections in renal transplant recipients: A prospective case series and review of the literature. Am J Transplant. 2006;6:225-231. doi:10.1111/j.1600-6143.2005.01139.x.
13. Lindblom A, Isa A, Norbeck O, at al. clearance of human parvovirus B19 viremia following acute infection. Clin Infect Dis. 2005;41:1201-1203. https://doi.org/10.1086/444503
14. Lefrére JJ, Servant-Delmas A, Candotti D. Persistent B19 infection in immunocompetent individuals: Implications for transfusion safety. Blood. 2005;106:2890-2895. doi:10.1182/blood-2005-03-1053.
15. Anderson LJ. Role of parvovirus B19 in human disease. Pediatr Infect Dis J. 1987;6:711-718. doi:10.1097/00006454-198708000-00003.
16. White DG, Woolf AD, Mortimer PP, Cohen BJ, Blake DR, Bacon PA. Human parvovirus arthropathy. Lancet. 1985;1:419-421. https://doi.org/10.1016/S0140-6736(85)91145-6
17. Woolf AD, Campion GV, Chishick A, et al. Clinical manifestations of human parvovirus B19 in adults. Arch Intern Med. 1989;149:1153-1156. doi:10.1001/archinte.1989.00390050111022
18. Arend WP, Dayer JM. Cytokines and cytokine inhibitors or antagonists in rheumatoid arthritis. Arthritis Rheum. 1990;33:305-315. https://doi.org/10.1002/art.1780330302
19. Pinto NC, Newman C, Gomez CA. Parvovirus B19-induced severe anemia in heart transplant recipients: Case report and review of the literature. Clin Transplant. 2019;33(4):e13498. https://doi.org/10.1111/ctr.13498
20. Dittmer FP, Guimarães CdM, Peixoto AB, et al. E. Parvovirus B19 Infection and Pregnancy: Review of the Current Knowledge. J Pers Med. 2024;14:139. doi:10.3390/jpm14020139
21. CDC. About Parvovirus B19. https://www.cdc.gov/parvovirus-b19/about/index.html#:~:text=Overview,sometimes%20lead%20to%20additional%20complications, Erişim tarihi: 06.01.2025
22. Farahmand M, Tavakoli A, Ghorbani S, Monavari SH, Kiani SJ, Minaeian S. Molecular and serological markers of human parvovirus B19 infection in blood donors: A systematic review and meta-analysis. Asian J Transfus Sci. 2021;15:212-222. doi: 10.4103/ajts.ajts_185_20
23. Dağı HT, Özdemir M, Baykan M, Baysal B. Investigation of parvovirus B19 seroprevalence in various age groups in Central Anatolia Region, Turkey. Mikrobiyol Bul. 2010;44:467-472.
24. Erden S, Keskin F, Çiftçi S, Çınar S, Deniz G. The relationship between parvovirus B19 and Hashimoto’s thyroiditis. Turkiye Klinikleri J Med Sci. 2013;33:98-102.
25. Motor VK, Üstün N, Evirgen Ö, İnci M, Yula E, Önlen Y. The seropositivity of parvovirus B19 in patients with ankylosing spondylitis. Turk J Phys Med Rehab. 2014;60:37-40. doi: 10.5152/tftrd.2014.28000
26. Motor VK, Arıca S, Motor S, et al. Investigation of parvovirus B19 seroprevalence, endothelin-1 synthesis, and nitric oxide levels in the etiology of essential hypertension. Clin Exp Hypertens. 2012;34:217-221. https://doi.org/10.3109/10641963.2011.628731
27. Hasbek M, Çubuk F. Eklem yakınmaları olan hastalarda Parvovirus B19 IgG ve IgM seropozitiflik düzeylerinin araştırılması. Turk Hijyen ve Deneysel Biyoloji Derg. 2023;80(3):309-316. https://dx.doi.org/10.5505/TurkHijyen.2023.58908
28. Röhrer C, Gärtner B, Sauerbrei A. Seroprevalence of parvovirus B19 in the German population. Epidemiol Infect. 2008;136(11):1564-1575. https://doi.org/10.1017/S0950268807009958
29. Aktaş O, Aydin H, Uslu H. Serological prevalence of human parvovirus B19 in diseases or disorders related to different human body systems. Turk J Med Sci. 2016;46(2):368-373. doi: 10.3906/sag-1409-79
30. Göral Ş, Yenicesu İ, Bozdayı G, Duyan Çamurdan A, Altay Koçak A. Parvovirus B19 seroprevalence in Turkish blood donors. Turk J Med Sci. 2018;48(5):956-960. doi:10.3906/sag-1802-150. doi: 10.3906/sag-1802-150
31. Blümel J, Burger R, Drosten C, et al. Parvovirus B19 - Revised. Transfus Med Hemother. 2010;37(6):339-350. doi:10.1159/000322190.
32. Varache S, Narbonne V, Jousse-Joulin S. Is routine viral screening useful in patients with recent-onset polyarthritis of a duration of at least 6 weeks? Arthritis Care Res (Hoboken). 2011;63(11):1565-1570. doi: 10.1002/acr.20576
33. Dağı HT. Parvovirus B19. Genel Tıp Derg. 2013;23(3):96-102
34. Kerr JR. The role of parvovirus B19 in the pathogenesis of autoimmunity and autoimmune disease. J Clin Pathol. 2016;69(4):279-291. https://doi.org/10.1136/jclinpath-2015-203455
35. Solak, Ö, Altındiş, M, Toktaş H, ve ark. Serologic and Molecular Diagnosis of Human Parvovirus B19 in Rheumatoid Arthritis Patients. Turk J Rheumatol. 2008;24:17-20.
36. Mauermann M, Hochauf-Stange K, Kleymann A, Conrad K, Aringer M. Parvovirus infection in early arthritis. Clin Exp Rheumatol. 2016;34(2):207-213.
37. Gran JT, Johnsen V, Myklebust G, Nordbo SA. The variable clinical picture of arthritis induced by human parvovirus B19. Scand J Rheumatol. 1995;24:174-179. https://doi.org/10.3109/03009749509099309
38. Heegaard ED, Brown KE. Human Parvovirus B19. Clin Microbiol Rev. 2002;15(3):485-505. doi:10.1128/CMR.15.3.485-505.2002
39. Kerr JR. Pathogenesis of human parvovirus B19 in rheumatic disease. Ann Rheum Dis. 2000;59(9):672-683. doi:10.1136/ard.59.9.672
40. Caliskan R, Masatlioglu S, Aslane M, ve ark. The relationship between arthritis and human parvovirus B19 infection. Rheumatol Int. 2005;26:7-11. https://doi.org/10.1007/s00296-004-0494-5
41. Güner ŞN, Göktürk B, Gökdemir M, ve ark. "Poliartrit ile Seyreden Parvovirus B 19 Enfeksiyonu: Olgu Sunumu." Fırat Tıp Dergisi 11.2 (2006): 147-149.