PARVOVIRUS - THE EXPANDING SPECTRUM OF DISEASE

Treatment of parvovirus infections among immunocompromised hosts using immunoglobulin has provided the clinician with a useful therapeutic t ool but has also highlighted the problems concerning chronic disease s tates. The discovery of the human parvovirus B19 in 1975 and subsequen t studies of its effects in humans have identified this virus as the c ausative agent of a broad spectrum of diseases. Recent improvements re garding the development of sensitive PCR techniques and methods for cu ltivation have provided new insight into its pathogenic role, its viro logy and immunology, and the varied clinical manifestations. The curre nt state of knowledge concerning parvovirus enabled us to divide the l ong list of diseases caused by this virus into three main categories : (1) diseases found among normal hosts (asymptomatic disease, erythema infectiosum, arthropathy, hydrops fetalis), (2) hematologic diseases (aplastic crisis, chronic anemia, idiopathic thrombocytopenic purpura, transient erythroblastopenia of childhood, Diamond-Blackfan anemia) a nd, finally, (3) a heterogeneous group of diseases, in which the etiol ogic role of parvovirus is less clear and sometimes putative (neurolog ic disease, rheumatologic disease, vasculitic and myocarditic syndrome s). In particular, arthropathy, hydrops fetalis and the hematologic di sorders may be of pediatric concern. Consequently, it is of paramount importance that in all of these cases the clinician includes parvoviru s as a differential diagnosis.