Unusual bone marrow manifestations of parvovirus B19 infection in immunocompromised patients

Terri W. Crook, Beverly Barton Rogers, Richard D. McFarland, Steven H. Kroft, Pietro Muretto, Jose A. Hernandez, M. Jane Latimer, Robert W. McKenna

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Parvovirus B19 is responsible for a spectrum of disease in humans. The usual bone marrow findings in acute parvovirus infections are marked erythroid hypoplasia and occasional giant erythroblasts. Intranuclear inclusions in developing erythroid precursors are rarely described in children or adults with parvovirus infection, although abundant intranuclear inclusions are commonly observed in the placenta and other tissues in infected fetuses. In this study, 8 patients are reported in whom the first evidence of parvovirus infection was the recognition of numerous intranuclear inclusions in erythroid precursors on bone marrow biopsy sections. Six of the 8 patients had documented immunodeficiencies; 4 had acquired immune deficiency syndrome (AIDS), and 2 were on chemotherapy. Five of 7 patients were negative for immunoglobulin G (IgG) anti-parvovirus antibodies, including all 4 with AIDS. Unlike the typical pattern in parvovirus infection, the bone marrow was hypercellular in most of the patients, and erythroid precursors were usually increased with the entire spectrum of normoblast maturation represented; abundant intranuclear inclusions were observed similar to the finding in fetuses. The inclusions were variably eosinophilic and compressed the chromatin against the nuclear membrane. In situ hybridization showed parvovirus B19 DNA in numerous erythroid precursors in all cases. The findings of erythroid maturation and abundant viral inclusions in these immunocompromised patients is consistent with the hypothesis that failure to produce effective IgG parvovirus neutralizing antibodies may lead to persistent infection through viral tolerance that allows erythroid development of infected cells past the pronormoblast stage. Identification of parvovirus inclusions in marrow biopsies and subsequent confirmation of infection by in situ hybridization can be important in the assessment of anemia in immunodeficient patients because serological studies for parvovirus B19 are frequently negative. (C) 2000 W.B. Saunders Company.

Original languageEnglish (US)
Pages (from-to)161-168
Number of pages8
JournalHuman Pathology
Volume31
Issue number2
StatePublished - 2000

Fingerprint

Parvoviridae Infections
Parvovirus
Immunocompromised Host
Intranuclear Inclusion Bodies
Bone Marrow
Erythroblasts
In Situ Hybridization
Acquired Immunodeficiency Syndrome
Fetus
Immunoglobulin G
Biopsy
Nuclear Envelope
Virus Diseases
Neutralizing Antibodies
Placenta
Chromatin
Anemia
Anti-Idiotypic Antibodies
Drug Therapy
DNA

Keywords

  • AIDS
  • Bone marrow
  • Immunodeficient
  • Nuclear inclusions
  • Parvovirus B19

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Crook, T. W., Rogers, B. B., McFarland, R. D., Kroft, S. H., Muretto, P., Hernandez, J. A., ... McKenna, R. W. (2000). Unusual bone marrow manifestations of parvovirus B19 infection in immunocompromised patients. Human Pathology, 31(2), 161-168.

Unusual bone marrow manifestations of parvovirus B19 infection in immunocompromised patients. / Crook, Terri W.; Rogers, Beverly Barton; McFarland, Richard D.; Kroft, Steven H.; Muretto, Pietro; Hernandez, Jose A.; Jane Latimer, M.; McKenna, Robert W.

In: Human Pathology, Vol. 31, No. 2, 2000, p. 161-168.

Research output: Contribution to journalArticle

Crook, TW, Rogers, BB, McFarland, RD, Kroft, SH, Muretto, P, Hernandez, JA, Jane Latimer, M & McKenna, RW 2000, 'Unusual bone marrow manifestations of parvovirus B19 infection in immunocompromised patients', Human Pathology, vol. 31, no. 2, pp. 161-168.
Crook TW, Rogers BB, McFarland RD, Kroft SH, Muretto P, Hernandez JA et al. Unusual bone marrow manifestations of parvovirus B19 infection in immunocompromised patients. Human Pathology. 2000;31(2):161-168.
Crook, Terri W. ; Rogers, Beverly Barton ; McFarland, Richard D. ; Kroft, Steven H. ; Muretto, Pietro ; Hernandez, Jose A. ; Jane Latimer, M. ; McKenna, Robert W. / Unusual bone marrow manifestations of parvovirus B19 infection in immunocompromised patients. In: Human Pathology. 2000 ; Vol. 31, No. 2. pp. 161-168.
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