The use of monoclonal antibody R92F6 and polymerase chain reaction to confirm the presence of parvovirus B19 in bone marrow specimens of patients with acquired immunodeficiency syndrome

Background,Parvovirus B19 infection is a cause of chronic anemia and red ce ll aplasia in patients with acquired immunodeficiency syndrome (AIDS) and i n other immunocompromised hosts. Anemia in AIDS patients has a multifactori al etiology, with parvovirus B19 infection being an infrequent but neverthe less treatable cause. Therapy with intravenous immune globulin can result i n rapid improvement of parvovirus-induced anemia. This treatment is expensi ve, therefore accurate and rapid confirmation of parvovirus infection is im portant in providing appropriate and cost-effective therapy. Methods,Bone marrow samples from 2 AIDS patients with severe anemia and ret iculocytopenia were studied. Bone marrow morphology and serologic studies w ere evaluated for parvovirus B19 infection. An immunohistochemical method u sing a monoclonal antibody, R92F6, to B19 capsid proteins was utilized on d ecalcified, B5-fixed, paraffin-embedded bone marrow biopsies. Bone marrow a spirate cells were examined by electron microscopy for evidence of viral pa rticles. In addition, polymerase chain reaction (PCR) studies using a neste d PCR assay to the parvovirus B19 viral genome were performed in a case for which fresh cells were available. Results,Bone marrow findings included marked erythroid hypoplasia with char acteristic giant pronormoblasts and intranuclear inclusions. Serologic stud ies were negative in one case, while the second case showed positive parvov irus B19 immunoglobulin M antibody, Immunohistochemical studies for parvovi rus B19 were positive in both eases. The presence of Intranuclear virions w as demonstrated by electron microscopy and was confirmed by PCR analysis. B oth patients were treated with intravenous immune globulin(in, and subseque nt improvement was noted, Conclusions.-Both immunohistochemistry and PCR studies on bone marrow speci mens from AIDS patients with anemia are rapid and sensitive methods for the confirmation of parvovirus B19 infection. They are valuable tools, particu larly when serologic studies are negative. When PCR is not available, immun ohistochemical methods can be useful. The rapid confirmation of parvovirus B19 infection will allow for early and cost-effective therapy.