Parvovirus B19 Diagnosis (anti-parvovirus IgM, IgG)

Reporting Name


Useful For

Determining susceptibility to- and diagnosis of parvovirus infection in a pregnant woman exposed to a confirmed/suspected parvovirus infected individual, or presenting with signs or symptoms of parvovirus infection.

 

Indications for Testing

  • Pregnant woman exposed to a confirmed/suspected parvovirus infected individual to determine if they are susceptible to infection (nonimmune).
  • Pregnant woman who develops signs and symptoms of parvovirus infection.
  • Parvovirus screening should not be ordered as part of routine prenatal serology.

 

Method Name

IgM, IgG Enzyme-Linked Immunosorbent Assay (ELISA)

 

Reporting Name

Parvovirus IgG

Parvovirus IgM

 

Aliases

B19

B19 Antibodies

Erythrovirus B19

Fifth Disease

Human Parvovirus B19

Parvovirus

Specimen Required

Human sera or EDTA/heparinized/lithium/citrated plasma

 

Container/Tube: Plain, red-top tube(s) or serum gel tube(s)/ Serum separator tubes

 

Specimen Volume: 0.5 mL of serum

 

Specimen Minimum Volume

0.4 mL

 

Transport Temperature

Specimen Room temperature Refrigerated Frozen
Serum NO YES* YES**
Plasma NO YES* YES**

*The samples should be stored for not more than 3 days at 2-8°C.

**For longer delays freeze at ≤ -20°C and transport on dry ice.

 

Reject Due To

Specimens other than Serum (EDTA, Heparin, Citrate) or plasma
Anticoagulants OK
Hemolysis REJECT
Lipemia REJECT
Icteric REJECT

 

Useful For

Determining susceptibility to- and diagnosis of parvovirus infection in a pregnant woman exposed to a confirmed/suspected parvovirus infected individual, or presenting with signs or symptoms of parvovirus infection.

 

Clinical Information

Parvovirus B19 is the causative agent of fifth disease (erythema infectiosum, slapped cheek syndrome), which usually produces a mild illness characterized by an intensive erythematous maculopapular facial rash in children. Parvovirus B19  has been shown to be the causative agent of a number of clinical conditions such as rash, arthralgia and fetal damage. Parvovirus infection in adults, especially woman, may cause acute arthritis which can persist for some time.  Infection can lead to life threatening anemia in immunocompromised patients and individuals with underlying haemolytic disorders such as sickle cell disease.

 

Seronegative woman are susceptible to parvovirus B19  infection. The majority of pregnancies during which parvovirus B19 infection occurs result in delivery of a healthy fetus at term. However, infection during pregnancy presents the risk of transmission to the fetus which may result in hydrops fetalis or intraurterine death due to infection of red blood cell precursors leading to fetal anemia whereby the hemoglobin levels fall to < 2g/dl. The rate of fetal death following maternal infection ranges between 1% and 9%.

 

Most outbreaks of parvovirus infection are acquired by direct contact with respiratory secretions and occur in the spring of the year. Close contact between individuals is responsible for infection in schools, daycare centers, and hospitals. Of note, symptoms associated with parvovirus B19 infection only become apparent after the viremic (contagious) phase.

 

Both IgG and IgM may be present at or soon after onset of illness and reach peak titers within 30 days. Because IgG antibody may persist for years, diagnosis of acute infection is made by the detection of IgM antibodies.

 

The prevalence of parvovirus B19 IgG antibodies increases with age. The age-specific prevalence of antibodies to parvovirus is 2-9% of children under 5 years, 15-35% in children 5 to 18 years of age, and 30-60% in adults (19 years or older). Parvovirus B19 infection is common in childhood, and by age 15 approximately 50% of children have detectable immunoglobulin G (IgG) against Parvovirus B19. Infection also occurs in adult life, and more than 80% of elderly people have detectable antibody. Women of child-bearing age in the United States and Europe have an annual seroconversion rate of approximately 1%. Studies in different countries (France, Germany, Japan, the United Kingdom, and the United States) show similar patterns, with a slightly higher prevalence in children from countries such as Africa and Brazil. Some isolated tribal populations have a much lower prevalence: 2% on Rodriquez Island, Africa, and 4% to 10% among the tribes around Belem, Brazil.

 

At least four different parvoviruses are known to infect humans. Parvovirus B19 (B19V) is the best characterized, and is classified as a member of the Erythrovirus genus, of which it is the type species. The other human viruses are the human adeno-associated viruses (AAVs, or dependoviruses), human bocavirus (HboV), and human parvovirus 3. The last two viruses have not officially been classified yet, but HboV is clearly a member of the Bocavirus genus, whereas human parvovirus 4 is markedly different from all other known viruses, and will probably become part of a new genus.

 

Parvoviridae are among the smallest known DNA-containing viruses that infect mammalian cells. The virions are nonenveloped particles about 22nm in diameter with icosahedral symmetry. The Parvoviridae are divided into two subfamilies Parvovirinae and Densovirinae, on the basis of their ability to infect vertebrate or invertebrate cells, respectively. The Parvovirinae are futher subdivided into five genera on the basis of their transcription map, their ability to replicate efficiently either autonomously or with helper virus, and their sequence homology. The five genera are: Parvovirus, Dependovirus, Erythrovirus, Bocavirus, and Amdovirus.

 

Reference Values

Non-reactive

 

 

Interpretation Guidelines for Parvovirus IgG/IgM Serology in Conjunction with Parvovirus PCR

 

Interpret all results in conjunction with clinical presentation and patient history

Parvovirus Serology Parvovirus PCR Interpretation
IgG IgM
+ + + Indicative of current infection
+ +

Indicative of recent exposure.

If previously stored serum is available at the PHL, Parvovirus serology may be performed, upon request, to aid in further diagnosis

+ + Indicative of current infection
+

Likely non-specific false positive IgM reactivity.

Suggest repeat serology in 2-4 weeks to demonstrate seroconversion

+ Samples with these sero-profiles not routinely tested by PCR*. Indicative of immunity
No evidence of exposure or immunity

* PCR is limited to only those who are immunocompromised. If this is required, contact the PHL at 777-6583.

If PCR is performed on special request as indicated above, please see below for interpretation.

Interpretation of Parvovirus Serology/PCR for Immunocompromised Patients

Parvovirus Serology Parvovirus PCR Interpretation
IgG IgM
+ +

Indicative of current infection.

Likely False Negative IgM.

+ Indicative of Immunity
+

Indicative of current infection.

Suggest repeat serology in 2-4 weeks

No evidence of exposure or immunity

 

Note:  Occasionally serology results may be indeterminate. In such instances, serology should be repeated in 2-4 weeks.  If the sero-profile remains the same, it likely represents non-specific reactivity, and recent exposure is unlikely.

 

Clinical Reference

Society of Obstetricians and Gynecologists of Canada. 2002. Parvovirus B19 infection in pregnancy. JOGC. 119:1-8.

 

Brown, K. E. 2010. Human Parvoviruses, Including Parvovirus B19 and Human Bocavirus, p. 2087-2095. In Mandell, D., Bennett, J. E., and Dolin, R. Principles and practice of infectious diseases, 7th ed., vol. 2. Churchill Livingstone, Elsevier, Philadelphia, PA.

 

Jordan, J. A. 2007. Human Parvoviruses, p. 1622-1623. In Murray, P. R., Baron, E. J., Jorgensen, J. H., Landry, M. L., and Pfaller, M. A. Manual of Clinical Microbiology, 9th ed., vol. 2. ASM Press, American Society for Microbiology, Washington, DC.

 

Biotrin. 2008. Parvovirus B19 IgG Enzyme Immunoassay Package Insert. Biotrin International Ltd. Dublin, Ireland.           

 

 

Status Days Analytic Time Maximum Laboratory Time Specimen Retention
Routine Monday, Thursday 24h 5 days 1 month

 

Method Description

Biotrin IgG sandwich Enzyme-linked immunosorbent assay (ELISA) detects IgG class antibodies to Parvovirus B19. Specific IgG if present will bind to the wells coated with Parvovirus B19 recombinant VP2 protein. Following a wash step peroxidase-labelled rabbit anti-human IgG is added which binds to the human parvovirus B19 IgG present. The whole complex is then detected by addition of Tetramethylbenzidine substrate (TMB) which turns blue in the presence of peroxidase. A stable yellow end product is achieved by the addition of a stopping reagent.

 

Biotrin IgM sandwich Enzyme-linked immunosorbent assay (ELISA) detects IgM class antibodies to Parvovirus B19. Specific IgM if present will bind to the rabit anti-human IgM coated wells. Following a wash step biotinylated Parvovirus B19 recombinant VP2 protein is added which binds to any human anti-Parvovirus B19 IgM present. After another wash step, strepavidin-peroxidase is added which binds to the biotinylated VP2 present. The whole complex is then detected by addition of Tetramethylbenzidine substrate (TMB) which turns blue in the presence of peroxidase. A stable yellow end product is achieved by the addition of a stopping reagent.

 

Performing Laboratory Location

Newfoundland & Labrador Public Health Laboratory

St. John’s

 

 

 

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