The Scientific World Journal
Volume 2012, Article ID 102829, 3 pages
Parvovirus B19 InfectionandSevereAnemiainRenal Transplant
1Clinical Pathology Laboratory, Santa Maria Goretti Hospital, AUSL Latina, 04100 Latina, Italy
2CEREM, Experimental Zooprophylactic Institute of Umbria and Marche (IZSUM), 60126 Ancona, Italy
3Kidney Transplant Unit, Santa Maria Goretti Hospital, AUSL Latina, 04100 Latina, Italy
Correspondence should be addressed to Antonio Carraturo, firstname.lastname@example.org
Received 27 October 2011; Accepted 22 December 2011
Academic Editor: Chitra Hosing
Copyright © 2012 Antonio Carraturo et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
Kidney transplant (KT) recipients can develop symptomatic Parvovirus (PV) B19 infections, frequently associated with persistent
anemia. The aim of this study was to evaluate the prevalence and clinical significance of PV B19 infection in anemic and non-
anemic KT patients. Overall, out of 64 patients monitored for the presence of PV B19 by real-time PCR, 2 (3.12%) had an active
4%), while none of the anemic transplant patients (0/14) was found to suffer from this infection. Moreover, patients affected by
active PV B19 infection showed viral loads not exceeding 1 × 105genome copies/reaction. In conclusion, in this study, PV B19
infection was not common in renal transplant population and wasn’t associated with severe anemia.
Anemia is a frequent problem after renal transplantation:
up to 39% of kidney transplant (KT) recipients suffer from
chronic anemia and, of these patients, 9% suffer from a
severe form, characterized by hemoglobin levels ≤11g/dL
for males and ≤10g/dL for females [1, 2]. Many evidence
suggests that the anemic state in transplant recipients can
also be caused by Parvovirus (PV) B19 infection [3, 4].
Discovered in 1975, PV B19 is a small, nonenveloped, single-
This is a common pathogen in humans, and the expression
of the infection depends on the host’s hematological and
immunologic status. In immunocompetent children, PV
B19 is the etiologic agent of erythema infectiosum (fifth
In immunosuppressed patients, including organ transplant
recipients, B19 virus can persist for years due to impair-
ment of the neutralizing antibody response and/or cellular
immunity and it may be associated with chronic clinical
manifestations, such as anemia and other cytopenias [3, 4].
In particular, KT recipients may acquire symptomatic
PV B19 infection from the donor, from the community,
or from reactivation of endogenous latent or persistent
virus . Although numerous cases of PV B19 infection
in renal transplant patients have been reported [2, 7], the
clinical burden of PV B19 infection is not well characterized.
Moreover, the association between PV B19 infection and
anemia in KT recipients remains to be clarified .
To address these issues, we evaluated the prevalence and
clinical significance of Parvovirus B19 infection in anemic
and nonanemic patients who had received a renal transplant
for at least 6 months. We chose these patients because most
published studies have assessed the occurrence of PV B19
infection in KT recipients within a 6-month period after
only few studies have been performed in patients belonging
to the population that we selected.
2The Scientific World Journal
From January to July 2008, 128 blood samples from 64
informed KT patients attending to Santa Maria Goretti
Hospital in Latina, Italy, were collected. Of these patients
(39 males, 25 females, aged 25–67), who had received
a kidney transplant for at least 6 months, 14 suffered
from unexplained severe anemia, with hemoglobin levels
≤11g/dL in males and ≤10g/dL in females. Two blood
samples for each patient were taken (the second 3 months
after the first). All the samples were analyzed for the
presence of PV B19 DNA by quantitative real-time PCR.
Viral DNA was extracted from 200µL EDTA-anticoagulated
whole blood with the COBAS AmpliPrep instrument using
the TNAI (Total Nucleic Acids Isolation) Kit (both Roche
Diagnostics GmbH, Mannheim, Germany). The amount of
Internal Control (IC) was 3.1µL per 50µL of quantitation
standard (QS) diluent . The eluates (5µL) containing
viral nucleic acids were analyzed by real-time PCR on the
Quantification Kit (Roche Diagnostics), according to the
manufacturer’s instructions. Samples positive for PV B19
DNA were also tested to detect the possible presence of
concomitant active viral infections. Detection and quantifi-
cation by real-time PCR method of hepatitis C virus (HCV),
hepatitis B virus (HBV), and human immunodeficiency
virus (HIV), were performed using the fully automated
system COBAS Ampliprep/COBAS TaqMan (Roche Diag-
nostics). For Cytomegalovirus (CMV) detection, the COBAS
Amplicor CMV Monitor Test was used (Roche Diagnostics),
with nucleic acid extraction performed on the Ampliprep
instrument using the TNAI kit (Roche Diagnostics). For
Polyomavirus JC/BK, Epstein-Barr virus (EBV), and Herpes
simplex virus type 1 and type 2 (HSV) detection and
quantification, viral DNA was extracted by the automated
MagNA Pure LC system (Roche Diagnostics) according
to the manufacturer’s instructions and the real-time PCR
reactions were performed on the LightCycler instrument
using LightMix Kit Polyomaviruses JC and BK (TIB MOL-
(Roche Diagnostics), and LightCycler HSV 1/2 Detection
Kit (Roche Diagnostics), respectively. Statistical analysis was
performed using Fisher exact test, with P ≤ 0.05 required for
The results are summarized in Table 1. Overall, out of 64 KT
recipients, 2 (3.12%) were affected by active Parvovirus B19
infection, both belonged to the nonanemic patients group.
In particular, the prevalence of PV B19 infection was 4%
(2/50) in nonanemic patients compared to 0% (0/14) in
anemic patients. This result is not supported by statistical
significance (Fisher exact test P = 0.6), probably because of
the small sample size.
The first patient affected by active PV B19 infection
was a 60-years-old man on dialysis treatment since 1992
who received a deceased donor kidney in 1998. He was
Table 1: Prevalence of Parvovirus B19 in kidney transplant
recipients, from January to July 2008, Latina, Italy.
No. of patients
No. of PV B19
using cyclosporine and mycophenolate-mofetil as immuno-
suppressive drugs and his value of serum creatinine was
1.3mg/dL. During PV infection his hematocrit was 37%
from a baseline of 44% with an hemoglobin value decreased
from 14 to 12.4g/dL and PV B19 viremia of 1 × 105genome
tion, he suffered from myalgia, abdominal pains, arthralgias,
and recurrent fevers. After treatment with Immunoglobulin
(IVIG), viremia fell below detection limit and his hematocrit
and hemoglobin levels returned to normal.
The second patient was a 62-years-old man who received
a deceased donor kidney in 2001, after 4 years of dialysis.
He was receiving sirolimus and mycophenolate-mofetil as
immunosuppressive treatment and his serum creatinine
was 2.30mg/dL. This patient showed no clinical signs or
hematological disorders having hemoglobin and hematocrit
values of 14g/dL and 41%, respectively. His PV B19 viremic
titer was 1 × 104genome copies/reaction. After reduction of
immunosuppressive medication, viremia fell to undetectable
levels and the patient recovered.
In these two patients affected by active PV B19 infection,
Polyomavirus JC/BK, CMV, EBV, HSV, HCV, HBV, and HIV,
were not detected.
Previous studies have shown that the prevalence of PV
B19 infection in KT patients ranged from 0 to 6.3% [9–
11], while reached 23% in anemic KT patients . In
agreement with these findings, we found 2 positive cases
out of 50 nonanemic KT patients (4%). It is to be noted
that nonanemic patients positive for PV B19 investigated
here showed viral loads not exceeding 1 × 105genome
copies/reaction. Our results are consistent with a previous
study that correlated only the viremic titers higher than 1 ×
106copies/reaction with severe anemia . Surprisingly, in
an active infection by Parvovirus B19, although one PV B19
concentration and in hematocrit. However, it is to underline
that it is difficult to compare the results of different studies
because of the heterogeneity in definition of posttransplant
In conclusion, we can support that results of the
present study are partially consistent with data reported
in the literature, although Parvovirus B19 infection was
not common in the renal transplant population and wasn’t
associated with severe anemia. We believe that could be
important routinely performing a differential diagnosis for
Parvovirus B19 in all cases of posttransplant anemia and/or
heavy immunosuppression regimen.
The Scientific World Journal3
The authors thank Francesca Leoni (IZSUM) for scientific
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