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Persistence of Parvovirus B19, genotype 2 in transplant patients Susanne Modrow Institut für Medizinische Mikrobiologie Universität Regensburg.

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Presentation on theme: "Persistence of Parvovirus B19, genotype 2 in transplant patients Susanne Modrow Institut für Medizinische Mikrobiologie Universität Regensburg."— Presentation transcript:

1 Persistence of Parvovirus B19, genotype 2 in transplant patients Susanne Modrow Institut für Medizinische Mikrobiologie Universität Regensburg

2 Frequent unspecific illness Erythema infectiosum, fifth disease, slapped cheek disease (Ringelröteln) transient anemia transient mono-, oligo-, polyarthritis/arthropathy Rare Mono-, oligo-, polyarthritis Henoch-Schönlein purpura/Papular-purpuric gloves-and-socks-syndrome (PPGSS) Idiopathic thrombocytopenic purpura Thrombocytopenia/granulocytopenia/pancytopenia Virus-associated hemophagocytic syndrome (VAHS) Acute liver failure/hepatitis Vasculitis/giant cell arteritis/polyarteritis nodosa/myositis Myocarditis Glomerulonephitis Chronic fatigue syndrome/meningitis/encephalitis Gullian-Barré-syndrome Cerebellar ataxia Disease Manifestation in immunocompetent individuals

3 Patients with special problems Patients with increased red blood cell turnover severe anemia aplastic crisis Pregnant women spontaneous abortion Hydrops fetalis intrauterine death Immuodeficient patients chronic anemia pure red cell aplasia chronic thrombocytopenia chronic granulocytopenia chronic pancytopenia chronic arthritis myocarditis/pericarditis/acute heart failure acute liver failure/hepatitis meningitis/encephalitis

4 IVIG-treatment of a kidney transplant recipient Parvovirus B19-infection (genotype 2) was diagnosed in association with severe anemia 2 months after transplantation Source of infection is unknown, the patient obtained several erythrocyte concentrates During a period of 26 months three periods of severe anemia were observed in combination with high viremia (> 4x10 11 geq/ml) Repeated IVIG-treatment was associated with the reduction of virus load to geq/ml and with resolvement of anemia Virus elimination from peripheral blood could not be achieved Today, > 50 months after transplantation, the patient displays low level viremia without symptoms Recurrent high viremia may occur in persistenly infected patients Virus load has to be monitored in order to avoid severe symptoms by early IVIG treatment

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6 month post Tx IVIG 2d á 20g5d á 40g IgM IgG ELISA IgM / IgG: PCR/qualitatve: PCR Transfusion of red cells

7 Phylogenetic analysis of parvovirus B19 genotypes 1-3

8 Parvovirus B19 – Genotypes 1 to 3: Amino Acid Differences in the VP1-unique region 1 50 gt 1:MSKKSGKWWESDDKFAKAVYQQFVEFYEKVTGTDLELIQILKDHYNISLD gt 2:MSKESGKWWESDDKFAKDVYKQFVEFYKKVTGTDLELIQILKDHYNISLD gt 3:MSKTTNKWWESSDKFAQDVYKQFVQFYEKATGTDLELIQILKDHYNISLD gt 1:HPLENPSSLFDLVARIKNNLKNSPDLYSHHFQSHGQLSDHPHALSSSSSH gt 2:NPLENPSSLFDLVARIKSNLKDSPDLYSHHFQSHGQLSDHPHALSPSSSH gt 3:NPLENPSSLFDLVARIKSNLKNSPDLYSHHFQSHGQLSDHPHALSSSNSS PLA gt 1:AEPRGENAVLSSEDLHKPGQVSVQLPGTNYVGPGNELQAGPPQSAVDSAA gt 2:TEPRGENAVLSSEDLHKPGQVSIQLPGTNYVGPGNELQAGPPQSAVDSAA gt 3:AEPRGENAVLSSEDLHKPGQVSIQLPGTNYVGPGNELQAGPPQNAVDSAA 151--*---*----*-----* gt 1:RIHDFRYSQLAKLGINPYTHWTVADEELLKNIKNETGFQAQVVKDYFTLK gt 2:RIHDFRYSQLAKLGINPYTHWTVADEELLKNIKNETGFQAQAVKDYFTLK gt 3:RIHDFRYSQLAKLGINPYTHWTVADEELLKNIKNETGFQAQAVKDYFTLK gt 1:GAAAPVAHFQGSLPEVPAYNASEKYPS gt 2:GAAAPVAHFQGSLPEVPAYNASEKYPS gt 3:GAAAPVAHFQGSLPEVPAYNASEKYPS

9 Comparison of IgG reactivity using VP1-unique region of genotypes as antigens in ELISA

10 Comparison of IgG avidity using VP1-unique region of genotypes as antigens in ELISA

11 Co-workers Today in Regensburg:Yesterday in Regensburg: Dr. Antje Knöll Dr. Ulla Raab Dr. Annelie Plentz Dr. Andrea Hemauer Dipl.-Biol. Juha Lindner Dr. Andreas Gigler Dipl.-Biol. Claudia Müller Dr. Simone Dorsch Dipl.Biol. Markus Möbs Dipl.-Bio. Regina Rabl And outside in the rest of the world... PD Dr. Hartwig Lehmann, Pädiatrie, Universität Gießen Prof. Dr. Philipp von Landenberg, Universität Mainz Prof. Dr. Klaus Hedman, Institut für Virologie, Universität Helsinki Dr. Bärbel Kaufmann, Purdue University, West Lafayette Dr. Sean Doyle, National University of Ireland, Dublin

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