PLACENTAL CYTOPATHIC DAMAGE FACTOR DUE TO PARVOVIRUS B19 – AS A HALLMARK OF INTRAUTERINE SYMPTOMATHY OF INFECTED FETUS

Natalia Bondarenko, Anastasiia Aksonova

Abstract


Aim of the work. The focus of this study was to analyze the frequency of fetal intrauterine symptomatic realization as a result of B19 parvovirus infection of pregnant women during I and II gestation periods, with the combination of determination the levels of alpha-fetoprotein in maternal serum blood and histopathological investigation of placenta in cases of negative effects for infected fetuses.

Materials and methods. A total of 478 pregnant women were at risk of infection and screened for parvovirus B19. The study was based on serological, morphological and virological testing of fetuses from mothers with confirmed parvovirus B19 infection. Infection of pregnant women was detected by serological diagnosis of specific antibodies IgM and IgG to parvovirus B19. Intrauterine fetal infection was confirmed by polymerase chain reaction method. Levels of alpha-fetoprotein in meternal venous blood were detected using an immunochemical test method. An antenatal diagnosis of hydrops fetalis was confirmed by ultrasound scanning. Placenta from the 8 infected fetuses was studied histologically with hematoxylin and eosin staining using electron microscope during gestational periods of 12-22 weeks. Statistical analysis of the obtained data was carried out using nonparametric statistics with the definition of Fisher's criterion.

Results and discussion. The average gestational period of symptomatic manifestations of intrauterine fetal infection was 19.9±0.5 weeks of gestation. It was established that in 33 of cases were confirmed the intrauterine infection due to parvovirus B19 by using the morphological placenta tissue analysis. The research found that the levels of maternal serum alpha-fetoprotein was significantly higher (in 2.17 times) in group of fetuses who suffered from fetal hydrops and in cases of intrauterine fetal death before detecting the general echographic sings of fetal failure (p˂0.05). It will be very important to compare this indicator with the Doppler ultrasound measurements of the human fetal middle cerebral artery peak systolic velocity (MCA PSV) and blood flow parameters in the fetal ductus venosus and to predict the possibility of poor perinatal outcomes. It was identified a cytopathic effect in placental cells viral origin and detected in cells of the cytotrophoblast, syncytiotrophoblast, endothelial cells, and blood cells.

Conclusions. Parvovirus B19 fractions were visualized in 100 % of cases of miscarriages with fetal hydrops and placental edema during 12-22 weeks of gestation, while acute maternal parvovirus infection (with the detection of IgM against to parvovirus B19) was diagnosed by immunoassay only in 62.5 % of cases.

Detection of B19 particles in placental tissue from fetuses with non-immune origin hydrops is an auxiliary method in the diagnosis of vertical transmission of parvovirus during pregnancy.

 It is more preferable to estimate the levels of alpha-fetoprotein in maternal serum blood in case of parvovirus B19 affected pregnancies as raising rates of this marker may be an early prediction hallmark for adverse fetal outcome.


Keywords


histopathology; parvovirus B19 infection; B19 virions; non-immune fetal hydrops; fetal death; spontaneous miscarriage; cytotrophoblast; syncytiotrophoblast; pregnancy; intrauterine symptomathy

Full Text:

PDF

References


Ornoy, A., Ergaz, Z. (2017). Parvovirus B19 infection during pregnancy and risks to the fetus. Birth Defects Research, 109 (5), 311–323. doi: http://doi.org/10.1002/bdra.23588

Bonvicini, F., Bua, G., Gallinella, G. (2017). Parvovirus B19 infection in pregnancy – awareness and opportunities. Current Opinion in Virology, 27, 8–14. doi: http://doi.org/10.1016/j.coviro.2017.10.003

Chen, C.-C., Chen, C.-S., Wang, W.-Y., Ma, J.-S., Shu, H.-F., Fan, F. S. (2015). Parvovirus B19 infection presenting with severe erythroid aplastic crisis during pregnancy in a woman with autoimmune hemolytic anemia and alpha-thalassemia trait: a case report. Journal of Medical Case Reports, 9 (1). doi: http://doi.org/10.1186/s13256-015-0542-7

Waring, G. J. (2018). Parvovirus B19 infection: Timely diagnosis in pregnancy essential. Case Reports in Women’s Health, 18, e00057. doi: http://doi.org/10.1016/j.crwh.2018.e00057

León-Juárez, M., Martínez-Castillo, M., González-García, L. D., Helguera-Repetto, A. C., Zaga-Clavellina, V., García-Cordero, J. et. al. (2017). Cellular and molecular mechanisms of viral infection in the human placenta. Pathogens and Disease, 75 (7). doi: http://doi.org/10.1093/femspd/ftx093

Faucette, A. N., Pawlitz, M. D., Pei, B., Yao, F., Chen, K. (2015). Immunization of pregnant women: Future of early infant protection. Human Vaccines & Immunotherapeutics, 11 (11), 2549–2555. doi: http://doi.org/10.1080/21645515.2015.1070984

Gallinella, G. (2017). Parvovirus B19: recent insights and implications for pathogenesis, diagnosis and therapy. Microbiologia Medica, 32 (3). doi: http://doi.org/10.4081/mm.2017.7109

Shabani, Z., Esghaei, M., Keyvani, H., Shabani, F., Sarmadi, F., Mollaie, H., Monavari, S. H. (2015). Relation between parvovirus B19 infection and fetal mortality and spontaneous abortion. Medical journal of the Islamic Republic of Iran, 29, 197.

Gao, Y.-L., Gao, Z., He, M., Liao, P. (2018). Infection status of human parvovirus B19, cytomegalovirus and herpes simplex Virus-1/2 in women with first-trimester spontaneous abortions in Chongqing, China. Virology Journal, 15 (1). doi: http://doi.org/10.1186/s12985-018-0988-5

Habibzadeh, S., Peeri-Doghaheh, H., Mohammad-Shahi, J., Mobini, E., Shahbazzadegan, S. (2016). The prevalence of parvovirus B19 infection among pregnant women of Ardabil in 2013. Iranian journal of microbiology, 8 (3), 214–218.

Delwart, E. (2012). Human parvovirus 4 in the blood supply and transmission by pooled plasma-derived clotting factors: does it matter? Transfusion, 52 (7), 1398–1403. doi: http://doi.org/10.1111/j.1537-2995.2012.03721.x

Lamont, R., Sobel, J., Vaisbuch, E., Kusanovic, J., Mazaki-Tovi, S., Kim, S. et. al. (2010). Parvovirus B19 infection in human pregnancy. BJOG: An International Journal of Obstetrics & Gynaecology, 118 (2), 175–186. doi: http://doi.org/10.1111/j.1471-0528.2010.02749.x

Ling, Y., Yu, Y.-H., Jin, S., Hu, C.-X., Peng, W., Zhang, H.-Y. et. al. (2017). Study of concentration of amniotic fluid alpha-fetal protein in thalassemia fetus. Asian Pacific Journal of Tropical Medicine, 10 (2), 201–203. doi: http://doi.org/10.1016/j.apjtm.2017.01.001




DOI: http://dx.doi.org/10.21303/2585-663.2018.00782

Refbacks

  • There are currently no refbacks.


Copyright (c) 2018 Natalia Bondarenko, Anastasiia Aksonova

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

ISSN 2585-6634 (Online), ISSN 2585-6626 (Print)