Symptomatic Parvovirus B19 Infection of One Fetus in a Twin Pregnancy
Institute of Microbiology, University of Bologna, Italy. Clinical Infectious Diseases
(Impact Factor: 8.89).
09/1993; 17(2):262-3. DOI: 10.1093/clinids/17.2.262
Twin pregnancies complicated by infection due to parvovirus B19 are uncommon. We report a case in which only one fetus developed
a symptomatic infection, which presented at first as ascites and pleural effusion; later, meconium peritonitis developed.
Hydrops spontaneously resolved, and at birth meconium peritonitis was successfully treated with surgery. However, even with
the positive outcome of this pregnancy, a long-term follow-up is needed to exclude damage other than injury to the erythropoietic
Available from: Birgit Arabin
- "The virus may replicate in fetal erythroid progenitor cells and infect fetal tissues  . Both anemia and myocarditis can cause nonimmune hydrops fetalis and perinatal death  . "
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ABSTRACT: Monochorionic (MC) twins are characterized by prenatal intertwin placental anastomoses, which can lead to twin oligo-polyhydramnios sequence (TOPS) or twin anemia-polycytemia sequence (TAPS). Symptoms of both TOPS and TAPS may interfere with symptoms of parvovirus B19 (B19V) infection. We describe here the course of an MC twin pregnancy with prenatal B19V infection and intrauterine death of one twin. Both the antenatal and postnatal diagnoses of B19V infection require a detailed approach including serology, DNA analysis, and specific fetopathologic investigation.
Available from: Consolato Sergi
- "Pustilnik and Cohen (1994) described a dichorionic, diamniotic twin pregnancy with differential infection and immunological diagnosis in a 35-year-old white woman at 20 weeks gestation with IUFD of the affected twin. Zerbini et al. (1993) reported a twin pregnancy in which only one fetus developed a symptomatic infection with ascites and pleural effusion that spontaneously resolved. A case of differential fetal infection in a dichorionic twin pregnancy culminating in a dual live-birth has been reported recently (Dickinson et al., 2006). "
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ABSTRACT: Maternal infection with parvovirus B19 during pregnancy can cause aplastic anemia in the fetus and may lead to nonimmune fetal hydrops and fetal demise. Twin pregnancies complicated by infection due to parvovirus B19 are very rare clinical events. We present a dichorionic, diamniotic, dizygotic twin pregnancy after in vitro fertilization with parvovirus B19 infection and viral transmission to both twins, but different outcomes. At 19 weeks gestation, hydrops fetalis was diagnosed for male twin A, female twin B did not show any abnormalities. At 22 weeks gestation an acute parvovirus B19 infection was detected and twin A was diagnosed with intrauterine fetal death (IUFD) by ultrasound at 23 weeks gestation. Viral DNA was detected in maternal blood as well as in placenta and liver tissue of this twin. Twin B was born at 35 weeks gestation asymptomatically and no signs of hydrops or other congenital anomalies but viral DNA was detected by PCR in serum. At the age of 2 years, both IgG titres against B19 and parvovirus DNA amplification copies were still positive in plasma of the surviving twin, but no clinical signs were detectable. It is remarkable that both twins were infected with parvovirus B19 early in pregnancy but showed a discordant clinical outcome. Our case report describes the rare occurrence of an intrauterine fetal death (IUFD) of one twin and the asymptomatic infection of the other in a twin pregnancy.
Available from: Jan E Dickinson
- "Differential twin pregnancy parvovirus infection with dual term survivors has been rarely reported. A solitary case in 1993 of fetal hydrops secondary to parvovirus infection in a dichorionic twin pregnancy at 25 weeks' gestation has been reported (Zerbini et al., 1993). A single intrauterine transfusion was required with resolution of the hydrops, although in the third trimester meconium peritonitis occurred necessitating surgical resection of necrotic bowel in the neonatal period. "
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ABSTRACT: There are only a few reports of fetal parvovirus infection in the circumstance of a twin pregnancy. We report a case of differential fetal infection following maternal parvovirus B19 infection in a dichorionic twin pregnancy culminating in a dual live-birth. A 32-year-old woman was diagnosed with parvovirus infection following exposure to her infected child at 19 weeks' gestation in a dichorionic twin gestation. Maternal IgG seroconversion was documented and maternal blood parvovirus B19 DNA was detected by PCR testing. Fetal monitoring with serial ultrasound assessment was instituted. At 25 weeks' gestation Twin I (male) displayed minor ascites, small pericardial effusion, placentomegaly and oligohydramnios. Middle cerebral artery peak systolic velocity (MCA PSV) studies were abnormal. Twin II (female) was sonographically unremarkable. A single fetal intravascular transfusion for Twin I was performed (pretransfusion Hb 80 g/L). Twin I fetal blood parvovirus B19 DNA was detected by polymerase chain reaction (PCR) and serum demonstrated both B19 IgG and IgM. Following fetal transfusion the hydrops resolved, although the placentomegaly persisted. Two live infants were delivered at 37 weeks' gestation. Individual neonatal venepuncture detected B19 DNA by PCR in Twin I but not in Twin II. B19 IgM was present in Twin I but not Twin II. Both neonates had B19 IgG antibodies. Placental histopathology demonstrated mild edema for Twin I but no inclusion cells. The placenta of Twin II was unremarkable. This case demonstrates the ability for differential transplacental infection of this virus and the assistance of fetal MCA flow studies to guide therapy in a multiple pregnancy at risk of parvovirus infection.
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