Medica, medizinische Laboratorien Dr. F. Kaeppeli, Wolfbachstrasse 17, CH-8024 Zurich, Switzerland.
We report a case of a 37-year-old woman with persistent parvovirus B19 infection and arthralgia mistakenly treated for Lyme disease.
This case indicates that poor standardization of both screening and confirmatory assays for Lyme disease can lead to an incorrect diagnosis of Lyme disease.
Before making a final diagnosis of Lyme arthritis in an endemic region, other causative agents of arthritis, such as parvovirus B19, should be excluded to avoid unnecessary treatment or to add appropriate therapy in the case of co-infections.
Since parvovirus B19 is often associated with arthralgia and can mimic rheumatoid arthritis and autoimmune diseases, it should be included in the differential diagnosis of arthralgia.
PMID: 18653379 [PubMed - in process]
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AliG
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Kaufmann J, Buccola JM, Stead W, Rowley C, Wong M, Bates CK.
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, E/CC-6, 330 Brookline Avenue, Boston, MA 02215, USA.
Parvovirus B19 is a common infection in adults and children. There are reports of secondary parvovirus infection in immunocompromised persons, but no reports of symptomatic secondary infection in healthy persons.
We describe a healthy 39-year-old woman who presented with fever, rash, and arthralgia. Her symptoms were thought most compatible with parvovirus B19 infection, but she reported prior positive parvovirus antibody 2 years earlier during prenatal care.
Tests were therefore also sent for HIV, streptococcal infection, hepatitis C, and Lyme disease.
Testing revealed both elevated IgG and IgM antibodies for parvovirus B19; previously, the patient was positive only for IgG.
On a subsequent visit she related that a community outbreak of parvovirus developed in her town and church group.
We believe this case demonstrates that a symptomatic secondary infection with parvovirus can occur in healthy persons, and that prior positive antibody test does not preclude the development of acute infection.
PMID: 17384979 [PubMed - indexed for MEDLINE]
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AliG
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posted
Dermatology. 2008;216(4):341-6. Epub 2008 Feb 15.
Department of Dermatology, Ogaki Municipal Hospital, Ogaki City, Japan. [email protected]
BACKGROUND: It is unclear how often chronic fatigue syndrome (CFS) appears after human parvovirus B19 (B19) infection and whether prolonged B19 viremia or some other factors cause CFS.
OBJECTIVES: To determine how often CFS appears after B19 infection and whether prolonged B19 DNA presence, antibody production and persistently reduced complement levels occur in CFS patients after B19 infection.
METHODS: Clinical findings were examined in 210 patients after B19 infection, and CH50, C3 and C4 levels were determined. B19 DNA and antibodies to B19 were also tested in 38 patients' sera including 3 with CFS.
RESULTS: Serum B19 DNA disappeared after 4-5 months in all 18 patients tested.
There are no differences in B19 DNA-positive period between patients with and without persistent symptoms.
IgM antibody titers to B19 became reduced after 2 months in all 38 patients.
Complement levels persistently decreased in a greater proportion of patients with persistent symptoms.
CONCLUSIONS: The present study suggests that we should consider the possibility of CFS after B19 infection and that CFS may be derived from several aspects other than prolonged B19 DNA presence in sera.
Copyright 2008 S. Karger AG, Basel.
PMID: 18277075 [PubMed - indexed for MEDLINE]
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AliG
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* In children: a mild disease with slapped face syndrome * Rash on face * Fever. In adults: joint pain and inflammation * Rash * Fever. In sickle cell anaemia patients: failure of blood cells * Tiredness * Fatigue
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lymielauren28
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posted
Weird! I had a lady here in Mississippi that I was corresponding with via e-mail. She'd contacted me regarding finding a lyme doc.
She had seventeen "Lyme symptoms" and she sure sounded like a Lymie to me. She had been tested by a regular doc for Lyme which was negative - I of course told her that didn't mean a hill of beans.
She actually made an appt. with an LLMD I'd recommended and when she told her regular doc about it, as a last ditch effort, he tested her for parvovirus - and that's what she had!!
Scary how similar the symptoms are! Soo, after this experience, yes I agree - people should be tested for Parvovirus B19!!
Lauren
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posted
If a person is positive on Band 31 of the Igenex WB, they can do a Band confirmation test to make sure it isn't cross-reacting with a virus.
Is there a treatment for Parvovirus?
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TerryK
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posted
Thanks for posting. I've seen this mentioned in a differential diagnosis for lyme but I've never been tested.
Makes sense that anyone who hasn't had the normal response to treatment should be tested for this.
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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emla999/Lyme
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posted
Another scary thing about the Parvovirus B19 infection is that it can cross react with the Western blot test.
And according to the researchers of the study on the link bellow this could lead to a miss diagnoses of Lyme Disease.
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AliG
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Dean D. Erdman 1 *, Barbara C. Anderson 1, Thomas J. T�r�k 1, Terri H. Finkel 2, Larry J. Anderson 1
Abstract To look for genetic changes in human parvovirus B19 that might be associated with chronic infection, we sequenced B19 DNA obtained from serum specimens collected over an approximately 1-year period from a patient with systemic vasculitis.
A comparison of the nucleotide sequences of the VP1/VP2 gene from four specimens revealed an abrupt change in the B19 genotype that coincided with initiation of intravenous immune globulin (IVIG) therapy.
We suspect that one or more of the lots of IVIG administered to the patient were contaminated with B19.
If true, this finding suggests that investigators must be careful in linking B19 infection to disease based on detection of B19 DNA in persons who have received multiple unit blood products.
J. Med. Virol. 53:233-236, 1997. Published 1997 Wiley-Liss, Inc.[Note ][This article was prepared by a group consisting of both United States government employees and non-United States government employees, and as such is subject to 17 U.S.C. Sec. 105.]
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AliG
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Could this be tick-transmitted?
Could it be a co-infection?
Could it be re-activated by Lyme?
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Unfortunately, it looks like that discussion group has been invaded by the spammers for the past several weeks. So, you have to weed through the spammers posts.
There seems to be some good info on that discussion group though.
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posted
Interesting, thanks for this thread on Parvovirus B19. My test was through Quest.
The reference range for both IgG and IgM is greater than 1.1
My IgM is less than 0.1 My IgG is 5.2 (5x the level to be positive)
With a lot of the viral factors (and I am assuming this would be applicable to any viral), the research work of Dr. Martin Lerner and Dr. Jose Montoya is showing that high titers on IgG is far more important than most doctors realize. When the IgG titer continues to rise, it shows there has beeen ongoing reactivation periods.
For example, based on what I have read, IgM titers may only show active for 2 months or so (depends on the type of infection).
So, if you didn't happen to test during that 2 month period of IgM activation, then you would have no way of knowing (other than symptoms) that you had a reactivation.
Yet, monitoring your IgG panel to see if IgG titers are climbing can tell you a lot. The only cause of rising IgG can be a reactivated infection. With each reactivation period, it signals the body to make increased antibodies in the IgG panel to protect you against future infection.
I couldn't get the link to work in one of the above posts where it said Parvovirus B19 can interfere with western blot results. Thank you to whomever mentioned it though so I can ask my LLMD about it at my next appt.
Posts: 495 | From SF Bay area, CA | Registered: Dec 2007
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Dean D. Erdman 1 *, Barbara C. Anderson 1, Thomas J. T�r�k 1, Terri H. Finkel 2, Larry J. Anderson 1
Abstract To look for genetic changes in human parvovirus B19 that might be associated with chronic infection, we sequenced B19 DNA obtained from serum specimens collected over an approximately 1-year period from a patient with systemic vasculitis.
A comparison of the nucleotide sequences of the VP1/VP2 gene from four specimens revealed an abrupt change in the B19 genotype that coincided with initiation of intravenous immune globulin (IVIG) therapy.
We suspect that one or more of the lots of IVIG administered to the patient were contaminated with B19.
If true, this finding suggests that investigators must be careful in linking B19 infection to disease based on detection of B19 DNA in persons who have received multiple unit blood products.
J. Med. Virol. 53:233-236, 1997. Published 1997 Wiley-Liss, Inc.[Note ][This article was prepared by a group consisting of both United States government employees and non-United States government employees, and as such is subject to 17 U.S.C. Sec. 105.] [/qb]
Highlighted for "Raymond"...
hey Raymond... your PM box is full
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96239 | From Texas | Registered: Feb 2001
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emla999/Lyme
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kelmo
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posted
I got parvovirus back in the mid-90s. I went to see my PCP because I was extremely fatigued (I had just come off a long EBV illness that lasted three years), my joints and bones ached, and I had a weird rash under my skin.
When he mentioned parvo, I that that was rediculous. When it came up positive, I was contacted by a lab in CA that wanted to pay me $500 for a pint of my blood for research and control.
When I went to have it drawn, they said I was too anemic. Parvovirus attacks the bone marrow and stops blood production.
I can see how someone can die from it. I was pretty sick.
The next week, my daughter came down with Fifths Disease, which is the childhood version of parvo.
It did resolve on it's own, and it re-ignited my EBV.
The next year, I came down with a SERIOUS double pneumonia.
My LLMD now thinks I've been infected for a very long time with the soup we now know as the Lyme family.
AliG
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posted
Sheeesh Kelmo!
I'm guessing this would be another one of the darn viruses, that our immune system is expected to keep under control, that start acting up again when Lyme & the tick-borne co-infections take down our immune systems.
I would guess that, whether you've gotten it from a tick-bite or contracted it previously, it could still be a complication when we're trying to overcome this mess.
Have you had any antiviral treatments at all?
Was that double-pneumonia from Mycoplasma?
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gemofnj
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How do they treat Parovirus?
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AliG
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posted
I just realized something....
Are they relying on SEROLOGY to determine that neither of those two cases also had Lyme Disease?
I would imagine that there was a reason that it was suspected in both cases. I wish they would have stated whether a tick-bite was involved.
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ByronSBell 2007
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posted
My LLMD has been testing all of her patients for parvo virus for quite a while and most patients here at the lyme clinic have it, including myself.
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Keebler
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kelmo
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posted
I don't think my LLMD is very active in treating the viruses. He did recommend Transfer Factor to me.
I think this is something I'll just have to figure out how to live with.
I'm hoping that taking care of the bacteria will give my body the opportunity to build the immune system so that my body can kick the viruses.
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AliG
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quote:In chronic infection, Human Parvovirus B19 can infect the brain. Because of its ability to induce autoimmunity, this virus is suspected of triggering co-morbid bipolar and autoimmune thyroid disorders in females and schizophrenia and autoimmune thyroid disorders in males.
I've been looking for Tx & it seems mostly just symptomatic Tx has been used.
I have come across IVIg used for chronic Parvovirus B19 infection.
[ 14. October 2008, 10:57 PM: Message edited by: AliG ]
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AliG
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Corcioli F, Zakrzewska K, Rinieri A, Fanci R, Innocenti M, Civinini R, De Giorgi V, Di Lollo S, Azzi A.
Department of Public Health, University of Firenze, Italy.
Parvovirus B19 (B19V) can persist in immunocompetent symptomatic and non-symptomatic individuals, as demonstrated by the finding of viral DNA in different tissues, in absence of viremia and of anti-B19V IgM.
The spread and the nature of this phenomenon have not been clearly determined.
In order to investigate the frequency of persistence and the tissue distribution of the three genotypes of B19V, the viral load of the persistent virus and its expression in the affected tissues, 139 tissue samples and 102 sera from 139 asymptomatic individuals have been analyzed by consensus PCRs and genotype specific PCRs for B19V detection and genotyping.
Viral load was measured by real time PCR and viral mRNAs were detected by RT-PCR.
Altogether, 51% individuals carried B19V DNA, more frequently in solid tissues (65%) than in bone marrow (20%).
Genotype 1 was found in 28% tissue samples, genotype 2 in 68% and genotype 3 in 3% only.
Viral load ranged from less then 10 copies to 7 x 10(4) copies per 10(6) cells, with the exception of two samples of myocardium with about 10(6) copies per 10(6) cells.
mRNA of capsid proteins was present in two bone marrow samples only.
In conclusion, in asymptomatic individuals B19V persistence is more common in solid tissues than in bone marrow, and genotype 2 persists more frequently than genotype 1.
The results suggest that the virus persists without replicating, at sub-immunogenic levels.
2008 Wiley-Liss, Inc.
PMID: 18814251 [PubMed - in process]
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Angelica
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Byron how are you doing and how is your treatment going?
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just don
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posted
VERY interesting topic. Can one who does NOT respond to any teatment be suspect for this??
I KNOW animals carry parvovirus,,,but not sure it is this P-19 version,,how many versions are there?
Maybe merry girl would have valuable info on this,,,as to whether animals have SAME type??
any idea how expensive the test is for this?? Is it something fry labs can or will do??
I was tested for burcellosis once and it said negative,,,didnt know at the time it had to be tested immediately and not 'shelved' for awhile
,,,most small labs here dont even know that I think
Guesing fry labs would be beter at it,,but IF it cant wait,how does one ship??
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AliG
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posted
B19 is the human strain. I don't believe the animal strain can jump species.
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emla999/Lyme
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posted
Just Don,
I believe that it would be wise to get tested for Parvovirus B19 if you have been diagnosed with Chronic Lyme Disease, particularly if you are not improving on antibiotics. Actually, it would probably be helpful to be tested for other viral infection at the same time, such as EBV, HHV-6,CMV etc..
Thus far the only strain of parvovirus that has been identified to infect humans is the Parvovirus B19 strain. So,you can't catch parvo from your pet.
And to my knowledge the Parvovirus B19 strain only infects humans and doesn't infect other animals. Although, I read somewhere that monkeys may be carriers of the Parvovirus B19 strain. But animals such as dogs,cats,cows,deer etc. do not carry the Parvovirus B19 strain.
Also, I don't believe that the Fry lab tests for Parvovirus B19. Focus Diagnostics is a lab that does test for Parvovirus B19.
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AliG
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posted
I'm guessing that a tick could not carry Parvovirus B19 if there would be no animal reservoir.
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emla999/Lyme
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posted
According to the link bellow humans are the only known host of the Parvovirus B19 strain.
Tincup
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posted
Many many moons ago I had myself tested for Parvo B-19 for some reason. Something caught my eye about it in something I read somewhere. Anyhow...
I was positive. I've since encouraged others to be tested and LLMD's to test for it... to be sure the patients were ok and to see if I was the only "unlucky one" who got it along with multiple other co-infections.
I would be VERY cautious about the "misdiagnosis" the author of the abstract mentions. I've seen a number of other pieces of literature on it and in MY opinion...
Docs are missing the Lyme (more often than not due to bad Lyme tests and stupidity)... and catching the Parvo in some folks. These folks are also not tested for other tick borne coinfections.. making me very concerned about any "results" reported in studies like this one.
Some of the studies also reported the people were exposed to ticks, then got Parvo... but they played down that theory.
In some studies I've noted in the past people were treated for Parvo and Lyme (the standard 3 weeks antibiotics for Lyme) and went on to have lifelong problems with arthritis, fatigue, etc. (Lyme symptoms)... with a number of them becoming totally disabled from the infections.
The Parvo was being blamed for their misery ... but no one treated the Lyme any further. I think they still had Lyme and or unknown coinfections. Some patients also had positive Lyme tests years later and they were written off as being "false positive" due to prior exposure.
It is also my opinion that it is passed by ticks and other vectors.
This theory that it can't be sustained in other hosts, in MY opinion, is hooey. Especially since the IDSA ducks (some of ours) are involved in a lot of the "theories" out there. And others simply feed off those basic bad "facts" to do their studies and make their conclusions.
They said Lyme couldn't be in any other hosts for the longest time.. and Babesiosis, etc.. and that these diseases couldn't be transmitted from vectors to humans... and certain species couldn't be carried, transmitted or couldn't infect other animals or humans other than the ones THEY said.... which denied many people the proper diagnosis and treatment.
just don
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posted
I read alot of the links and info supplied here. I am SOOO releived,,,most of them said easy to treat or NO treatment neededd cause it goes away on its own,,,take something for the headache,like tylenol or something.
OH goodie,,sounds easy to ME!!!
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JRWagner
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posted
Ali...up late doing research again I see!!!THANK YOU!!!!
Wow...interesting stuff for sure, as I have auto-immune indicators in my CSF, as you might know.
Now to get tested...but what is the best treatment?
Timaca, could you ask Dr. Montoya what he thinks?
Peace, love and Wellness, JRW
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emla999/Lyme
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posted
Regarding Parvovirus B19.
"In conclusion, a syndrome characterized by fatigue, arthralgia, sore throat, unrefreshing sleep, new headache, pos-texertional malaise, increased tendency to sweat, dizzy spells, and blurred vision may occur following B19 infection and may persist for several years."
Symptoms may persist for several years!!!!
Posts: 1223 | From U.S.A | Registered: Jul 2007
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AliG
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posted
It would seem to me that. if your immune system is taxed by Lyme Disease Complex (aka-AIDS-Lite)This could be something that WOULD reqiure some form of Tx.
I think it's really messed up that the Tx they recommend is IVIg and there was a study showing that someone actually contracted it FROM IVIg.
If it would take IVIg to fight it off, are you OK if you have positive Ig for it?
* Acetaminophen or ibuprofen is effective for treating fever. Fever does not always require treatment with antipyretics; however, consider antipyretics if a patient appears clinically uncomfortable.
* Resolution of infection depends on the presence of immunoglobulins against B19V.
No definitive evidence that cell-mediated immunity is a necessary part of the immune response has been reported.
IVIG may have a role in treating chronic parvovirus infection.
* Patients in aplastic crisis require packed RBC transfusions.
* In patients receiving immunosuppressive agents, temporarily decreasing the dose of immunosuppressive agents usually enables the immune system to produce sufficient IgG to eradicate the infection and confer lifelong protection.
In some individuals with human immunodeficiency virus (HIV) infection, highly active antiretroviral therapy restores immune function, enabling resolution of chronic parvovirus B19 (B19V) infection.
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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emla999/Lyme
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posted
I just realized that Parvovirus B19 is also known as Erythrovirus B19.
Department of Clinical Microbiology, University State Hospital, Rigshospitalet, Denmark. [email protected]
Diagnosis of erythrovirus B19 (B19) relies on serology and the detection of viral DNA.
Recently, a distinct erythrovirus isolate termed V9, markedly different from erythrovirus B19 (> 11% nucleotide disparity), was isolated.
Standard B19 PCR assays were inconclusive and serologic tests failed to categorize V9 as an acute B19-like infection.
Sequencing, combined with PCR studies, have since demonstrated the need for specific and differentiated techniques when examining samples for possible B19 or V9 viremia.
The antigenic properties of the V9 capsid proteins have not been characterized previously. To address this question, V9 VP1 and VP2 open reading frames were cloned and expressed in insect cells using a baculovirus vector.
Large quantities of purified recombinant V9 capsid protein were produced and electron micrographs revealed self-assembly of V9 VP1/VP2 and VP2 capsids into empty icosahedral erythrovirus-like particles with a diameter of approximately 23 nm.
Screening of a panel of 270 clinical samples for the presence of V9 IgM and IgG antibodies in ELISA showed 100% serologic cross-reactivity between B19 and V9 when comparing V9 VP2 capsids to a commercial B19 VP2 assay.
This suggests that both a V9 and a B19 antibody response may be diagnosed equally well by ELISA using either V9 or B19 recombinant capsids as antigen source.
Retrospectively, translation of the V9 sequence indicates that despite a significant genetic variation on the DNA level, the majority of the discrepant DNA sequence represents silent mutations leading to an amino acid sequence very similar to the known B19 strains (96-97% homology).
Copyright 2002 Wiley-Liss, Inc.
PMID: 11782935 [PubMed - indexed for MEDLINE]
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AliG
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Baculovirus can infect the human liver and is being used for commercial insect control?!!!
THAT does NOT sound good!
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emla999/Lyme
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Penn State University College of Medicine, Rheumatology and Pediatric Rheumatology, Hershey, PA 17033, USA.
Infectious diseases commonly cause illnesses that mimic rheumatic diseases. Both Lyme disease and Parvovirus B19 infections produce arthritis, rashes, and a systemic illness that may be thought to represent a chronic rheumatic disease. In the case presented, a child with both infections simultaneously exhibited arthralgias, aseptic meningitis, and a facial rash.
The features of Lyme disease and Parvovirus B19 infection that may mimic systemic lupus erythematosus include a facial rash, often in a malar distribution, hematologic abnormalities, arthritis, neurologic disorders, and autoantibody positivity.
Given the proper season and geographical location, one must consider the possibility of co-infection with these two organisms, especially in those with atypical rheumatic complaints.
AliG
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posted
WOW - great find emla999!
That was from 2001. I wonder how that poor child is doing now.
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emla999/Lyme
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posted
I don't know how that child is doing now. I sure wish I knew though.
I wonder how many other people are co-infected with both Lyme Disease and parvovirus B19?
Personally, I am beginning to believe that there may be several people that are concurrently infected with both parvovirus B19 and Lyme Disease.
Posts: 1223 | From U.S.A | Registered: Jul 2007
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AliG
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posted
It looks like they may be able to get some serious research done on this now.
J Virol. 2008 March; 82(5): 2470-2476. Published online 2007 December 26. doi: 10.1128/JVI.02247-07.
PMCID: PMC2258946 Copyright � 2008, American Society for Microbiology
Susan Wong, Ning Zhi,* Claudia Filippone,� Keyvan Keyvanfar, Sachiko Kajigaya, Kevin E. Brown,�� and Neal S. Young� Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
Abstract
The pathogenic parvovirus B19 (B19V) has an extreme tropism for human erythroid progenitor cells.
In vitro, only a few erythroid leukemic cell lines (JK-1 and KU812Ep6) or megakaryoblastoid cell lines (UT7/Epo and UT7/Epo-S1) with erythroid characteristics support B19V replication, but these cells are only semipermissive.
By using recent advances in generating large numbers of human erythroid progenitor cells (EPCs) ex vivo from hematopoietic stem cells (HSCs), we produced a pure population of CD36+ EPCs expanded and differentiated from CD34+ HSCs and assessed the CD36+ EPCs for their permissiveness to B19V infection.
Over more than 3 weeks, cells grown in serum-free medium expanded more than 800,000-fold, and 87 to 96% of the CD36+ EPCs were positive for globoside, the cellular receptor for B19V.
Immunofluorescence (IF) staining showed that about 77% of the CD36+ EPCs were positive for B19V infection, while about 9% of UT7/Epo-S1 cells were B19V positive.
Viral DNA detected by real-time PCR increased by more than 3 logs in CD36+ EPCs; the increase was 1 log in UT7/Epo-S1 cells.
Due to the extensive permissivity of CD36+ EPCs, we significantly improved the sensitivity of detection of infectious B19V by real-time reverse transcription-PCR and IF staining 100- and 1,000-fold, respectively, which is greater than the sensitivity of UT7/Epo-S1 cell-based methods.
This is the first description of an ex vivo method to produce large numbers of EPCs that are highly permissive to B19V infection and replication, offering a cellular system that mimics in vivo infection with this pathogenic human virus.
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
I didn't notice this in any of the articles but did you all know that Parvovirus B19 is more commonly called Fith Disease?
We've all probably had it at some point. It is an extremely common childhood illness, most characteristic symptom is the "slapped- face" rash.
So it makes me wonder, do people who test pos. for it get reinfected later in life (after becoming immune compromised by lyme and co)? Or does the virus reactivate kinda like chronic EBV or shingles?
Interesting.
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johnnyb
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Member # 7645
posted
This is actually one virus the ducks DID test me for!
Thanks for the post, Ali.
- J
Posts: 1197 | From New Jersey | Registered: Jul 2005
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AliG
Frequent Contributor (1K+ posts)
Member # 9734
posted
It's also contagious, through bodily fluids, before it's symptomatic.
children can pass it too each other before anyone seems sick.
Parents can then catch it, while caring for those children before they even appear ill.
I was tested for it too & nothing showed up.
Do I remember anything about subclinical levels of virus or latency in here? I'll have to re-read because my memory is not being nice to me rightt now.
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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