Human Parvovirus B19 In Solid Organ Transplantation

Publication Date: April 1, 2019
Last Updated: March 14, 2022

Recommendations

DIAGNOSTIC STRATEGIES

Parvovirus B19 infection should be suspected in SOT recipients with:
  • Anemia with inappropriate reticulocyte response or erythro‐ poietin‐resistant anemia with or without:
  • Fever, arthralgia, or rash
  • Organ‐invasive diseases such as hepatitis, myocarditis, pneu‐ monitis, neurological disease, or vasculitis
  • Pancytopenia
(Moderate, Strong)
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The initial work‐up for suspected parvovirus B19 infection should include IgG and IgM serology (Low, Strong)
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  • and serum/whole blood quantitative PCR for parvovirus B19.
(Moderate, Strong)
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Bone marrow examination should be performed when parvovirus B19 infection is strongly suspected, and the serology and serum PCR are negative. In addition, in situ hybridization or immunohistochemical staining should be performed. (Moderate, Strong)
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TREATMENT

Patients with parvovirus B19 infection may be treated with 400 mg/kg/day of IVIG for five consecutive days. (Moderate, Strong)
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Reduction of immunosuppression should be attempted if possible at the time of diagnosis. (Low, Strong)
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In case of non‐response to the first IVIG course or in case of symptomatic relapse additional course(s) of IVIG may be given. (Low, Strong)
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Shorter course (2‐4 days) of higher daily doses of IVIG may be given as long as the total dose is 2 g/kg. However, a daily dose of ≥1 g/kg seems to be associated with higher incidence of nephrotoxicity and other side effects. (Low, Weak)
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Despite the high rate of recurrence of parvovirus B19 infection manifestations, there are no data to support the systematic, preemptive use of additional courses of IVIG to prevent recurrences. (Low, Weak)
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PREVENTION

Application of good infection control practices including use of standard and droplet isolation precautions should be implemented when a patient has active parvovirus B19 disease. (Moderate, Strong)
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Recommendation Grading

Overview

Title

Human Parvovirus B19 In Solid Organ Transplantation

Authoring Organization

American Society of Transplantation

Publication Month/Year

April 1, 2019

Last Updated Month/Year

December 2, 2022

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

The overview of etiology, epidemiology and risk factors, clinical manifastations, diagnostic strategies, treatment and prevention of Human parvovirus B19 in solid organ transplantation patients

Target Patient Population

Solid organ transplant patients

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Operating and recovery room, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Prevention, Management

Diseases/Conditions (MeSH)

D014180 - Transplantation, D019737 - Transplants, D016377 - Organ Transplantation, D017992 - Parvovirus, D016732 - Parvovirus B19, Human, D016756 - Immunoglobulins, Intravenous

Keywords

infection prevention, infection, solid organ transplant, parvovirus, immunoglobulin

Source Citation

Eid, AJ, Ardura, MI; the AST Infectious Diseases Community of Practice. Human parvovirus B19 in solid organ transplantation: Guidelines from the American society of transplantation infectious diseases community of practice. Clin Transplant. 2019; 33:e13535.