Unfortunately, infectious diseases can hardly be considered a rarity. Similar problems are extremely often encountered in pediatric practice. According to statistical studies, today parvovirus infection in children is often recorded.
Most often, the disease is easy. However, this condition can be very dangerous. That is why many parents are interested in additional information about this disease. What is its cause? What are the first signs of parvovirus infection? What difficulties can be encountered during treatment? Are there effective preventative measures? Answers to these questions will be useful to many readers.
Parvovirus infection: what is it?
A similar term in modern medicine is used to describe an acute infectious disease, which is accompanied by a lesion of the erythroid sprout of the bone marrow and, accordingly, temporary disorders of the blood formation process.
Parvovirus infection in children is most often diagnosed. Symptoms of it can be different, ranging from fever and general malaise to erythema, arthralgia and even aplastic crises. But in adults, such a disease is observed much less frequently.
The main causes of the development of the disease
The causative agent of parvovirus infection is parvovirus B19, which belongs to the parvovirus family. It is worth noting that only this strain of the virus is dangerous to humans. By the way, the pathogen was discovered in England in 1975, during studies of donated blood. He got the name “B19” from a serum sample, from which he was first isolated.
This is a small virus whose diameter does not exceed 20-25 nm. It has no outer shell, and its capsid is characterized by an icosahedral form. Structural proteins surround one "+" and one "-" DNA strand. It is worth noting that this strain of the virus is quite resistant to environmental influences - it can withstand temperatures of 60 degrees for 16 hours.
B19 virus is not active against animals. In laboratory conditions, it can be cultured only using red blood cell precursor cells that are derived from human bone marrow, liver or fetal umbilical cord.
Similar diseases are found at any time of the year, but the most common outbreaks of infection in winter and spring. During the epidemic, about 20-60% of children get sick in schools and other public institutions. However, in many infected, the disease proceeds without any noticeable symptoms.
The transmission of the virus has not yet been fully studied. It is believed that you can become infected during contact with the carrier of the infection, but only if his disease is at the stage of viremia (the virus actively multiplies in the tissues). Viral particles are secreted into the external environment along with secretions and mucus from the upper respiratory tract. In addition, it is possible to transmit the infection along with blood from mother to baby during pregnancy.
Due to the wide spread of this virus, many parents today are interested in the question of what symptoms are associated with parvovirus infection. Treatment, complications, prevention - all this is extremely important information, which you should definitely familiarize yourself with.
Pathogenesis of infection
Parvovirus infection in children develops in two stages. In the first phase, active proliferation of viruses, intoxication of the body, as well as the release of viral particles into the environment are observed (infected patients at this time are extremely contagious).
About the third day after infection of the body, general symptoms of intoxication appear that resemble a common malaise or a cold. In particular, patients complain of chills, a slight increase in body temperature, muscle weakness and pain, aches, slight skin itching, and headache. Around the same period, there is a slight decrease in hemoglobin, which persists for 7-10 days. In blood tests, you can notice mild neutro, lymph and thrombocytopenia.
About 17-18 days after infection, the second phase of the development of the disease begins. Reproduction and isolation of viruses cease. On the 20-22nd day, the child may have a characteristic skin rash, and even after a few days - joint pain. On the other hand, these symptoms do not appear in every case - some children suffer the disease as a normal malaise.
Parvovirus infection in children and adults in the second phase is accompanied by the production of specific antibodies - immunoglobulins M and G, the titers of which are extremely important for proper diagnosis. By the way, immunoglobulins G remain in the blood for a rather long time, sometimes even until the end of life. Laboratory studies indicate that more than half of the world's population has these antibodies, although for many of them the disease went completely unnoticed.
Patients suffering from severe forms of anemia or immunodeficiency (including HIV infection) tolerate this disease much more difficult. Often, against the background of parvovirus activity, there is a significant destruction of the bone marrow and, accordingly, a violation of normal hematopoiesis up to life-threatening conditions. Moreover, in patients with a deficiency of the immune system, viremia processes do not stop, the reproduction of viruses continues, which is accompanied by more pronounced lesions of the body.
Infectious erythema
Parvovirus infection in children (photo) is often accompanied by the appearance of erythema. This condition is considered the most common manifestation of this infection. Moreover, it is often called the "fifth disease." This name appeared around the end of the 19th century, since a similar ailment was one of the six most common infectious diseases that were accompanied by skin manifestations.
Most often, this is what parvovirus infection looks like in children - the rash has the form of large spots of bright color and appears mainly on the cheeks (this symptom is known as “stained cheeks”). Most often, the rash is spotty-papular, but sometimes it can be vesicular or even hemorrhagic. Some children easily tolerate the infection, while others complain of severe itching. The rash quickly spreads to the limbs, but in most cases disappears on its own after a few days.
Nevertheless, repeated rashes may occur over the next few weeks. Most often this happens against the background of physical activity, overheating, hypothermia, bathing, a sharp change in climatic conditions or under stressful conditions.
Acute arthritis and arthralgia due to infection
Immediately it should be said that the parvovirus infection in a child is rarely accompanied by joint damage. Nevertheless, such a complication is still possible, and more often it occurs in adolescence (girls are more prone to a similar phenomenon).
Joint lesions can occur both against the general background of a viral disease, and be its only manifestation. Most often, joints of the wrists, hands, ankles and knees are affected, although theoretically, the disease can cause inflammation of any joint. Sometimes patients have arthralgia, which is accompanied by morning stiffness. Nevertheless, the development of high-grade arthritis is not excluded.
This is what parvovirus infection in children looks like in some cases. These complications, however, do not entail destruction of the articular cartilage and, as a rule, pass after a few weeks on their own. Occasionally, soreness and stiffness of the joints remains for months, sometimes even years - in such cases, additional diagnostic and therapeutic measures are necessary.
Aplastic crisis
Parvovirus infection quite often causes the so-called aplastic crisis. This is a rather dangerous condition, which is accompanied by a violation of normal blood formation. There are some risk groups, among which the likelihood of a crisis is much higher. In particular, a similar condition is often observed in patients with chronic hemolytic anemia, autoimmune anemia, thalassemia, and fermentopathy. Risk factors also include sickle cell anemia, paroxysmal nocturnal hemoglobinuria, and hereditary microspherocytosis.
Violation of hematopoiesis is what parvovirus infection of children can lead to. Symptoms of aplastic crisis are severe anemia, which is accompanied by severe weakness, drowsiness, and severe pallor of the skin. In the study, you may find that the cells of the erythroid germ in the bone marrow are absent. Often there is a sharp drop in hemoglobin to low, life-threatening indicators. In such cases, it is impossible to do without a blood transfusion.
It is also worth noting that, against the background of an aplastic crisis, active viremia is observed - viruses multiply rapidly, enter the bloodstream and affect other tissues. Patients with this diagnosis are carriers of infection.
Intrauterine infection and its consequences
In gynecological and obstetric practice, an intrauterine parvovirus infection is sometimes registered, the symptoms of which are much more difficult to notice. It is immediately worth noting that in most cases, infection of the mother's body during pregnancy does not lead to infection of the fetus and does not have any harmful effect on the fetus.
Nevertheless, the risk still exists. According to statistics and reviews of practitioners, the virus most often leads to complications in the first or second trimester of pregnancy. Infection of fetal tissues (in particular normoblasts and erythroblasts) in approximately 13% of cases leads to spontaneous abortion.
There are some other complications. Against the background of infection, a growing child develops non-immune dropsy. Severe anemia and heart failure may also occur, leading to fetal death.
On the other hand, if the presence of the disease can be detected at an early stage (using ultrasound) and the appropriate therapy is carried out, then the child is born healthy, without any complications (occasionally there is a lag in physical development, delayed weight gain). In some cases, the baby is diagnosed with congenital anemia and hypogammaglobulinemia immediately after birth, which, however, are compatible with life and can be treated.
In the event that a pregnant woman comes into contact with infected people, she is recommended to regularly conduct ultrasound examinations, as well as donate blood to determine the level of alpha-fetoprotein and the titer of immunoglobulins - this helps to detect the problem at an early stage and increases the chances of a successful and complete recovery.
Modern diagnostic methods
Parvovirus infection in children and adults requires a thorough diagnosis. First of all, the doctor collects an anamnesis and conducts an examination. The clinical picture in this case is similar to some other diseases, therefore, additional laboratory tests must be performed.
In particular, blood and tissue samples are taken from a child to measure titers of specific immunoglobulins M and G. As a rule, the amount of IgM increases on the third day after infection is activated. But an increased amount of immunoglobulins G is observed even a year after the infection. In aplastic crisis, not only a high amount of proteins is determined in the samples, but also the virus itself and its DNA. In addition, in studies of the bone marrow, hypoplasia of the erythroid germ and the presence of characteristic giant erythroblasts can be detected.
In diagnosing the disease in patients with immunodeficiency, antibodies cannot be detected, but a large number of viral particles can be isolated.
If we are talking about the diagnosis of intrauterine infection, then thorough ultrasound examinations are needed here (they help to detect fetal dropsy). A laboratory study of the blood of the mother and amniotic fluid for the presence of viral DNA and specific antibodies is also carried out.
Parvovirus infection in children: treatment
If even the slightest suspicion of having such a disease appears, you should consult a doctor. Only a specialist knows how to treat a parvovirus infection.
It is worth noting that in mild cases, the child does not even need hospitalization. Nevertheless, it is worth limiting his communication with healthy people, since in the first phase the disease is quite contagious. How is parvovirus infection in children treated at home? Komarovsky, a well-known children's doctor, recommends bed rest. The child needs to rest, drink more fluid (to eliminate the symptoms of intoxication). But active games and physical activity are contraindicated. Parents must adhere to the rules of hygiene, wash their hands after contact with the baby, regularly do wet cleaning, change bedding, etc.
An equally important part of therapy is diet. With parvovirus infection, a child needs a nourishing balanced diet of high-calorie and easily digestible foods. It is also worth making sure that the dishes contain a sufficient amount of vitamins and minerals, which are necessary to strengthen immunity (you must include fruits and vegetables in the menu). Also, food should be rich in iron and animal proteins, as the disease is accompanied by anemia and a decrease in hemoglobin levels.
As a rule, the symptoms of the disease go away on their own after 1-2 weeks. However, in some cases, more specific treatment is required. For example, with severe fever, the use of antipyretic drugs (Aspirin, Paracetamol, Analgin, etc.) is required. If the patient has developed arthritis, the symptoms of which do not go away for several weeks, then it is advisable to take non-steroidal anti-inflammatory drugs (Ibuprofen, Diclofenac, Nurofen, etc.).
If we are talking about the treatment of patients with immunodeficiency, then intravenous administration of immunoglobulin, which contains specific antibodies to the B19 virus, is possible. This method does not provide a complete cure, but helps to suppress the activity of infection. Severe aplastic crisis is an indication for transfusion of red blood cells.
Chronic form of parvovirus infection
In some cases, if untreated or improperly treated, the acute form of the disease becomes chronic. This condition is extremely dangerous, since its symptoms are less pronounced. It is difficult to diagnose and treat. Chronic parvovirus infection is accompanied by anemia, which occurs in waves. Often a similar form of the disease becomes the cause of idiopathic aplasia of the erythroid process of the bone marrow. It is extremely difficult to get rid of such a disease. Blood transfusions and the introduction of immunoglobulins help maintain normal body function.
The main methods of prevention
It can be noted that parvovirus infection in a child can be really dangerous. Therefore, many parents are interested in questions about whether effective remedies exist.
Unfortunately, the vaccine against this virus does not exist today. Nevertheless, the possibility of obtaining a drug that would not cause the development of the disease, but have immunogenic properties, is being actively investigated. It is possible that in the near future such a medicine will still appear.
In some cases, people who are exposed to the infection are advised to administer therapy with an intravenous immunoglobulin. In particular, such procedures are indicated for pregnant women, patients with chronic hemolytic anemia or immunodeficiency. Nevertheless, to date it has not been precisely established whether such prevention is really effective.
The only means of protection against the virus is the lack of contact with carriers of the infection, which, unfortunately, is not so simple. In addition, it is recommended to follow the rules of personal hygiene, in particular, wash hands after contact with patients, before eating, etc.
Patients with a chronic form of the disease, as well as those who have an aplastic crisis, are active agents of infection. That is why they need immediate hospitalization in the infectious ward and the absence of direct contacts with healthy people until the completion of therapy.