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World J Clin Pediatr. Nov 8, 2015; 4(4): 126-134
Published online Nov 8, 2015. doi: 10.5409/wjcp.v4.i4.126
Acute encephalitis and encephalopathy associated with human parvovirus B19 infection in children
Toru Watanabe, Hideshi Kawashima
Toru Watanabe, Hideshi Kawashima, Department of Pediatrics, Niigata City General Hospital, Niigata 950-1197, Japan
Author contributions: Watanabe T designed the aim of this mini-review and performed the majority of the writing; Kawashima H coordinated the writing of the manuscript.
Conflict-of-interest statement: We declare that we have no conflicts of interest in the manuscript, including financial, consultant, institutional or other relationships.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CCBY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Toru Watanabe, PhD, Department of Pediatrics, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata 950-1197, Japan. twata@hosp.niigata.niigata.jp
Telephone: +81-25-2815151 Fax: +81-25-2815169
Received: June 24, 2015
Peer-review started: June 26, 2015
First decision: August 10, 2015
Revised: August 11, 2015
Accepted: September 10, 2015
Article in press: September 16, 2015
Published online: November 8, 2015
Abstract

Reports of neurologic manifestations of human parvovirus B19 (B19) infection have been on the rise. Acute encephalitis and encephalopathy is the most common, accounting for 38.8% of total B19-associated neurological manifestations. To date, 34 children with B19 encephalitis and encephalopathy have been reported, which includes 21 encephalitis and 13 encephalopathy cases. Ten (29%) were immunocompromised and 17 (39%) had underlying diseases. Fever at the onset of disease and rash presented in 44.1% and 20.6% of patients, respectively. Neurological manifestations include alteration of consciousness occurred in all patients, seizures in 15 (44.1%) patients, and focal neurologic signs in 12 (35.3%) patients. Anemia and pleocytosis in cerebrospinal fluid (CSF) occurred in 56.3% and 48.1% of patients, respectively. Serum Anti-B19 IgM (82.6%) and CSF B19 DNA (90%) were positive in the majority of cases. Some patients were treated with intravenous immunoglobulins and/or steroids, although an accurate evaluation of the efficacy of these treatment modalities cannot be determined. Nineteen (57.6%) patients recovered completely, 11 (33.3%) patients had some neurological sequelae and 3 (8.8%) patients died. Although the precise pathogenesis underlying the development of B19 encephalitis and encephalopathy is unclear, direct B19 infection or NS1protein of B19 toxicity in the brain, and immune-mediated brain injuries have been proposed.

Keywords: Encephalitis, Neurological manifestation, Human parvovirus B19, Encephalopathy, Pathogenesis, Complication

Core tip: Reports of acute encephalitis and encephalopathy associated with human parvovirus B19 (B19) infection have recently increased. B19 DNA has been detected in cerebrospinal fluid samples in approximately 4% patients with etiologically undiagnosed encephalitis. Some patients were treated with intravenous immunoglobulins and/or steroids. More than half of the patients with B19 encephalitis and encephalopathy recovered completely, but some patients developed severe neurological sequelae or died. Although the precise pathogenesis underlying the development of B19 encephalitis and encephalopathy is unclear, direct B19 infection or NS1 protein of B19 toxicity in the brain, and immune-mediated brain injuries have been proposed.