Fatal parvovirus B19 infections: a report of two autopsy cases
Parvovirus B19 (PVB19) commonly infects children and is usually asymptomatic. Lethal outcomes of PVB19 infection are unusual; nevertheless, the two cases reported here are rare examples of PVB19-induced hemophagocytic syndrome and myocarditis in infants and children. The two cases show the indisputable usefulness of immunohistochemistry and in situ hybridization in the detection of PVB19. In the death investigations, histopathological examinations provided stronger evidence than did serology or molecular biology. The cases also highlight the importance of forensic autopsy in vaccine-related death. As vaccine-related deaths are what people fear and may cause declines in vaccination rates, it is important to clarify deaths temporally or causally associated with vaccine administration.
KeywordsParvovirus b19 Vaccine-related death Hemophagocytic syndrome Fulminant lymphocytic myocarditis
The authors extend particular appreciation to Dr. Jung-Jung Mu and Dr. Sung-Hsi Wei for their experimental help and clinical data. For this type of study, formal consent was not required.
This study was supported by grants (103-1301-05-05-03, 104-1301-05-05-06, 105-1301-05-05-01, and 106-1301-05-04-02) from the Ministry of Justice, Taiwan. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with animals performed by any of the authors.
The article does not include participants from whom informed consent was required.
- 5.Centers for Disease Control (CDC) (1989) Risks associated with human parvovirus B19 infection. MMWR Morb Mortal Wkly Rep 38:81–88 93–7Google Scholar
- 6.Kaya Z, Ozturk G, Gursel T, Bozdayi G (2005) Spontaneous resolution of hemophagocytic syndrome and disseminated intravascular coagulation associated with parvovirus b19 infection in a previously healthy child. Jpn J Infect Dis 58:149–151Google Scholar
- 13.Saint-Martin J, Bonnaud E, Morinet F, Choulot JJ, Mensire A (1991) Acute parvovirus myocarditis with fatal outcome. Pediatrie 46:597–599Google Scholar
- 23.Dettmeyer R, Kandolf R, Baasner A, Banaschak S, Eis-Hubinger AM, Madea B (2003) Fatal parvovirus B19 myocarditis in an 8-year-old boy. J Forensic Sci 48:183–186Google Scholar
- 24.Respondek M, Bratosiewicz J, Pertynski T, Liberski PP (1997) Parvovirus particles in a fetal-heart with myocarditis: ultrastructural and immunohistochemical study. Arch Immunol Ther Exp 45:465–470Google Scholar
- 28.Wang YC, Liu DJ, Ma LN, Liu MJ, Sheng GY, Zhao XM (2015) Clinical features of childhood hemophagocytic syndrome and its association with human parvovirus B19 infection. Zhongguo Dang Dai Er Ke Za Zhi 17:26–30. https://doi.org/10.7499/j.issn.1008-8830.2015.01.006 [pii]
- 30.Tavera M, Petroni J, Leon L, Minue E, Casadei D (2012) Reactive haemophagocytic syndrome associated with parvovirus B19 in a kidney-pancreas transplant patient. Nefrologia 32:125–126. https://doi.org/10.3265/Nefrologia.pre2011.Oct.11179 Google Scholar
- 31.Matsubara K, Uchida Y, Wada T, Iwata A, Yura K, Kamimura K, Nigami H, Fukaya T (2011) Parvovirus B19-associated hemophagocytic lymphohistiocytosis in a child with precursor B-cell acute lymphoblastic leukemia under maintenance chemotherapy. J Pediatr Hematol Oncol 33:565–569. https://doi.org/10.1097/MPH.0b013e3182099a54 CrossRefGoogle Scholar
- 36.Imashuku S, Hibi S, Ohara T, Iwai A, Sako M, Kato M, Arakawa H, Sotomatsu M, Kataoka S, Asami K, Hasegawa D, Kosaka Y, Sano K, Igarashi N, Maruhashi K, Ichimi R, Kawasaki H, Maeda N, Tanizawa A, Arai K, Abe T, Hisakawa H, Miyashita H, Henter JI (1999) Effective control of Epstein-Barr virus-related hemophagocytic lymphohistiocytosis with immunochemotherapy. Histiocyte Society Blood 93:1869–1874Google Scholar
- 38.Lapphra K, Scheifele D (2011) Can children with minor illnesses be safely immunized? Paediatr Child Health 16:463Google Scholar
- 39.Grohskopf LA, Sokolow LZ, Broder KR et al (2017) Prevention and control of seasonal influenza with vaccines: recommendations of the advisory committee on immunization practices - United States, 2017-18 influenza season. MMWR Recomm Rep 66:1–20Google Scholar