Parvovirus B19 is a small, single-stranded, species-specific DNA virus that replicates in dividing cells and has a remarkable tropism for human erythroid progenitor cells.
It is a pathogen responsible for several diseases, including erythema infectiosum, transient aplastic crisis, anemia in HIV disease; fetal hydrops in infected mothers; and polyarthritis/rash syndrome in adults. Rarely, patients can develop a mild myocarditis, peripheral neuropathy, and/or hepatitis.
It is presumed that parvovirus B19 is transmitted via respiratory secretions. Some individuals develop a flu-like syndrome, whereas most (70%) remain asymptomatic. In children, rash is common and appears as bright red “slapped cheeks.”. In rare cases adults can develop “socks and gloves” acral erythema. Joint symptoms are rare in children but common in adults.
Arthritic symptoms in Parvovirus B19 infection
The arthropathy associated with HPV infection is similar to that seen after natural rubella or vaccine-associated infection. There is rapid onset of symmetrical polyarthritis in peripheral small joints, primarily of the hands and wrists. Joint symptoms are more common in adults (60%) than in children (5% to 10%) and in women than in men.
The symptoms are in generalself-limited. No long-term joint damage or significant functional disability has been reported after HPV infection. The pathogenesis of acute joint symptoms appears to be secondary to immune-complex deposition and a nonspecific inflammatory response. Patients with chronic joint symptoms have B19 DNA in their synovium and bone marrow.
Treatment is symptomatic with antiinflammatory medications. Hydroxychloroquine has been used successfully in some patients.