Original Articles

Pediatric and Developmental Pathology

, Volume 6, Issue 5, pp 414-420

First online:

Parvovirus Infects Cardiac Myocytes in Hydrops Fetalis

  • Aiveen O’MalleyAffiliated withDepartment of Pathology, Rotunda Hospital, Dublin 1 Email author 
  • , Carole Barry-KinsellaAffiliated withDepartment of Obstetrics and Gynaecology, Rotunda Hospital, Dublin 1
  • , Caroline HughesAffiliated withDepartment of Pathology, Rotunda Hospital, Dublin 1
  • , Peter KelehanAffiliated withDepartment of Pathology, National Maternity Hospital, Holles Street, Dublin 2
  • , Deirdre DevaneyAffiliated withDepartment of Pathology, Rotunda Hospital, Dublin 1
  • , Eoghan MooneyAffiliated withDepartment of Pathology, National Maternity Hospital, Holles Street, Dublin 2
  • , John GillanAffiliated withDepartment of Pathology, Rotunda Hospital, Dublin 1

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Abstract

Parvovirus infection during pregnancy is an important cause of hydrops fetalis. It is attributed to anemia caused by viral-induced destruction of red blood cells. Infection of other organs has been reported including the heart, liver, and lungs. Few of these reports, however, convincingly demonstrate virions within the functional parenchyma of the tissue. This is of particular concern regarding myocardium in the context of hydrops fetalis which is, in part, due to cardiac failure. The problem in routine pathology practice is that most fetuses with the infection are macerated. This, in part, probably explains the paucity of published information on cardiac involvement. This study examined five cases of fatal hydrops fetalis with variable maceration with serologically proven parvovirus B19 infection. Transmission electron microscopy of cardiac tissue demonstrated intranuclear virions in both erythroid precursor cells and in cardiac myocytes in three of these cases. In each of these, immunogold electron microscopy provided confirmatory evidence of parvovirus infection. Virions were not identifiable where maceration had caused disintegration of nuclei in the myocytes. In addition, virions were absent in the three negative control cases where retroplacental hemorrhage was confirmed as the cause of death.This study suggests that parvovirus infection of cardiac myocytes may play a more important role in causing hydrops fetalis than previously realized. It also demonstrates that maceration should not discourage the use of electron microscopy.

Keywords

cardiac myocyte electron microscopy hydrops fetalis immunohistochemistry macerated tissue parvovirus