Asian Journal of Research in Infectious Diseases

Parvovirus B19 infection occurs only in humans. The infection is self-limiting in immunocompetent healthy individuals who are able to mount an adequate humoral response. The antibodies IgM and IgG are produced in response to the infection help in clearing away the virus. The infection is transmitted through respiratory droplets, blood products, and from mother to child (vertical transmission). It causes diseases including erythema infectiosum or fifth disease (usually in children), polyarthropathy (in adults), aplastic crisis in patients who either have reduced erythrocyte production (example iron deficiency) or increased RBC destruction (example sickle cell disease). In immunosuppressed or immunocompromised patients, it can cause pure red cell aplasia or chronic anemia. Anemia in kidney transplant patients is common and could be multifactorial. Iron deficiency, effect of immunosuppressive medications, inadequate erythropoietin, and viral infections including (but not limited to) parvovirus B19, cytomegalovirus, and BK polyoma virus can result in chronic anemia. Parvovirus B19 is not a common cause of anemia in kidney transplant patients making it necessary to be vigilant of this infection as a cause of anemia. If a kidney transplant recipient has unexplained anemia, testing of the viruses including parvovirus B19 infection that could cause anemia in these patients could help in early diagnosis and early treatment. Due to immunosuppressive medications used by the kidney transplant patients, they are in immunosuppressed state and are unable to mount an adequate humoral response. So, tests to detect IgM or IgG antibodies (serological tests) against parvovirus B19 may not be helpful in detecting the virus. Antigen detection methods are preferable, PCR (polymerase chain reaction) being the test of choice to detect parvovirus B19 infection. The treatment of parvovirus related anemia in kidney transplant recipients involves reduction of immunosuppression and/or immunoglobulin therapy (IVIg). The published studies show that a sequential reduction of immunosuppression is followed in clinical practice, with careful monitoring. The commonly used IVIg treatment involves IVIg 400mg/kg/day for 5-10 days or 1 gram/kg/day for 2-3 days. The authors have described the pathogenesis, diagnostic methods, and treatment of parvovirus related anemia in kidney transplant patients in this review.