Parvovirusinfection in women

Abstract

Parvovirus B19 is the causative agent of the childhood exanthem erythema infectiosum. Erythema infectiosum can occur sporadically, or as part of community outbreaks. Outbreaks typically occur in elementary schools during the late winter and early spring. Increasing age is associated with an increasing prevalence of prior B19 infection. The primary mode of transmission is through respiratory secretions and hand-to-mouth contact. A susceptible pregnant woman’s risk of parvovirus B19 infection is closely associated with her level of contact with children and the environment in which the exposure takes place. The greatest risk factor for seroconversion is having a child aged 6 to 7 years. The most common clinical presentation in adults is symmetrical peripheral polyarthropathy. Diagnosis of maternal infection is usually established by maternal serology. If a patient contracts parvovirus B19 infection during pregnancy, the risk of fetal infection can be as high as 33%. The mechanism for fetal infection is maternal viremia with transplacental passage of parvovirus B19. The infected fetus is at risk for developing aplastic anemia, heart failure, and hydrops. Fetal death occurs most frequently when maternal infection takes place between 10–20 weeks’ gestation, and may be as high as 10%. Pregnant women with serologic evidence of recent parvovirus B19 infection should be followed with weekly ultrasound examinations, looking for signs of hydrops. If hydrops develops, consideration should be given to cordocentesis. Circumstantial evidence supports performing intrauterine transfusion in selected cases with severe fetal anemia and hydrops. Long-term sequelae of congenital parvovirus infection are rare.