The clinical manifestations of Parvovirus B19 infection have been investigated in liver, kidney, heart and bone marrow transplant patients (1,2,3,4). Parvovirus B19 can cause acute or chronic aplastic anemia in solid-organ transplant recipients and can contribute to some cases of rejection(5,6).

There are a number of reasons why patients who have undergone a solid organ or bone marrow transplant are at risk of developing a Parvovirus B19 infection:

• There are different paths of infection including airway transmission, blood transfusion, viral reactivation or infection through the transplanted organ(5). Therefore infection may be acquired from the transplanted organ or blood transfusions or it may represent activation of latent infection.
• Immunosuppressive medications are often used with transplant patients and are a major factor in allowing chronic Parvovirus B19 infection to become established in organ transplant patients(2).
• The cellular receptor for Parvovirus B19, the P antigen, can be found on myocardial cells which might explain why in some patients Parvovirus B19 directly infects and damages the heart(2).
• There are reported cases where diseases such as pneumonia or liver disease have been caused by Parvovirus B19 infection following cardiac transplantation(5).
  

One study reports three groups of patients who were tested for Parvovirus B19 DNA(6). These included a group of myocarditis patients, a group of transplant rejection patients and a control group. Parvovirus B19 DNA was found in:

• 0.8% of the myocarditis patients.
• 3% of the transplant rejection patients.
• 0% of the control group.

This is a statistically significant number of transplant rejection patients with evidence of B19 DNA in comparison to the control group. Two of these transplant rejection patients suffered persistent rejection despite aggressive antirejection therapy. These findings show that Parvovirus infection following transplantation may contribute to some cases of rejection. It also appears that Parvoviral myocarditis, although rare, may be more common than previously identified and reported.

It is important that Parvovirus B19 infection is considered in cases where patients present with myocarditis or transplant rejection due to unknown etiological agents. In solid-organ transplant recipients, a Parvovirus B19 infection should be suspected in the presence of aplastic anemia following aspecific symptoms of viral infection (fever, fatigue, cutaneous rash), or even if no such symptoms are detected. The onset of anemia after transplantation varies from 2 to 34 months(5). Intravenous immunoglobulin (IVIG) therapy is effective in treating chronic Parvovirus B19 infection in transplant patients(2,5,8).

References:

1. Nour B, Green M, Michaels M et al.: Parvovirus B19 Infection in Pediatric Transplant Patients. Transplantation 56: 835-838, 1993.
   
2. Moudgil A, Shidban H, Nast CC et al.: Parvovirus B19 Infection-Related Complications In Renal Transplant Recipients. Transplantation 64: 1847-1850, 1997.
   
3. Enders G, Dötsch J, Bauer J et al.: Life-Threatening Parvovirus B19-Associated Myocarditis and Cardia Transplantation as Possible  Therapy: Two Case Reports. Clinical Infectious Diseases 26: 355-358, 1998.
   
4. Cohen BJ, Beard S, Knowles WA et al.: Chronic Anemia Due to Parvovirus B19 Infection in a Bone Marrow Transplant Patient After Platelet Transfusion. Transfusion 37: 947-951.
   
5. Murer L, Zacchello G, Bianchi D et al.: Thrombotic Microangiopathy associated with Parvovirus B19 Infection after Renal Transplantation. J Am Soc Nephrol 11:1132-1137, 2000.
   
6. Schowengerdt K, Ni J, Denfield S et al.: Association of Parvovirus B19 Genome in Children with Myocarditis and Cardiac Allograft Rejection. Circulation 96: 3549-3554, 1997.
   
7. Heegaard ED, Eiskjaer H, Baandrup U et al: Parvovirus B19 Infection Associated with Myocarditis following Adult Cardiac Transplantation. Scand J Infect 30: 607-610, 1998.
   
8. Wicki J, Samii K, Cassinotti P et al.: Parvovirus B19-induced red cell aplasia in solid-organ transplant recipients. Two case reports and review of the literature. Hematology Cell Therapy 39: 199-204.