Abstract & Commentary
Synopsis: Following use of fibrin sealant in thoracic surgical procedures, 21% of previously seronegative patients developed evidence of acute parvovirus B19 infection. Viral DNA was detectable in blood for up to 48 weeks after infection.
Source: Kawamura M, et al. Frequency of transmission of human parvovirus B19 infection by fibrin sealant used during thoracic surgery. Ann Thorac Surg. 2002;73:1098-1100.
Fibrin sealant, produced from pooled donor serum, is used to control bleeding in a variety of surgical procedures. The processing method includes pasteurization at 60°C for 10 hours. This is adequate to inactivate most bloodborne pathogens, but does not inactivate human parvovirus (HPV) B19. Kawamura and colleagues performed a prospective study to investigate potential transmission of HPV B19 by fibrin sealant in thoracic surgery patients. They entered 85 adult patients into the study; patients were excluded if they had received blood transfusion other than autologous transfusion. All patients had determination of anti-HPV B19 antibody. Twenty-three seronegative patients were followed at weeks 12, 24, and 48 with antibody titre and determination of HPV B19 in blood by PCR. Six of 23 (21%) patients developed evidence of HPV B19 infection based on seroconversion and detection of viral DNA in blood. Clinical illness was mild. Five of 6 developed marked depression in reticulocyte counts between 12 and 20 days postoperatively. Two patients developed low-grade fevers. None developed rash or arthralgia. Viral DNA was detectable in blood at 48 weeks in 3 patients.
Comment by Robert Muder, MD
Parvovirus B19 is a common infectious agent that causes one of the classic childhood exanthems, erythema infectiosum (Fifth disease). Infected adults may suffer an acute symmetrical arthritis of the small joints that may on occasion become chronic. The virus specifically infects erythrocyte precursors in the marrow, leading to transient suppression of red cell production. This is of little consequence in healthy patients. Those with hemolytic anemias, for example, sickle cell anemia, may suffer aplastic crises with dramatic drops in peripheral red cell counts. Primary infection of a pregnant woman may result in fetal infection and hydrops fetalis due to lack of red cell production. Immunosuppressed patients may have prolonged periods of red cell aplasia that respond variably well to intravenous immunoglobulin infusion.1
HPV B19 is typically transmitted by close contact with respiratory secretions; school and family-based outbreaks are common. However, pooled blood products may contain HPV B19; one survey detected HPV B19 DNA in 18 of 27 samples of factor VIII and IX concentrate.2 HPV B19 is particularly resistant to a variety of disinfection methods, including the pasteurization process used in preparing fibrin sealant.
While the clinical consequences of HPV B19 infection reported by Kawamura et al were of little clinical consequence, infection in certain groups of patients could have serious sequelae. Use of fibrin sealant should, therefore, be avoided during surgical procedures performed on immunosuppressed patients, pregnant women, or those with chronic hemolytic anemias.
Dr. Muder, Hospital Epidemiologist, Pittsburgh VA Medical Center, Pittsburgh, is Associate Editor of Infectious Disease Alert.
References
1. Lui SL, et al. Nosocomial outbreak of parvovirus B19 infection in a renal transplant unit. Transplantation. 2001;71:59-64.
2. McOmish F, et al. Detection of parvovirus B19 in donated blood; a model system for screening by polymerase chain reaction. J Clin Microbiol. 1993;31: 323-328.
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