Parvovirus B19 testing is generally not used to test those with mild and uncomplicated infections. It is typically used to detect a current infection or determine immunity in those who are at an increased risk of complications, such as those with sickle cell anemia. There are several methods of detecting a parvovirus B19 infection:
Antibody testing Two types of parvovirus B19 antibodies may be produced in response to an infection: IgM and IgG. IgM antibodies are the first to be produced by the body in response to a parvovirus infection. They are present in most individuals within a week or two after the initial exposure. IgM antibody production rises for a short time period and then declines. Eventually, the level of parvovirus IgM antibody usually falls below detectable levels. IgG antibodies are produced by the body a few weeks after the initial infection to provide long-term protection. Levels of IgG rise during the active infection, then stabilize as the parvovirus B19 infection resolves. Once a person has been exposed to parvovirus B19, that person will have some measurable amount of IgG antibody in their blood for the rest of their lifetime.
Parvovirus B19 antibody testing may be performed to determine immunity to parvovirus in pregnant women who have been exposed to someone with parvovirus B19 or who have symptoms suggestive of parvovirus infection. It may also be ordered for people who have acute or chronicanemia or persistent joint pain that may be due to a parvovirus B19 infection. By comparing the absence or presence of both IgG and IgM in the same sample, the health practitioner can distinguish between current, recent, and previous infections. Antibody testing is usually not performed on children who have the characteristic fifth disease rashes and, since parvovirus B19 infection is widespread and causes few problems to those with healthy immune systems, general population screening is rarely done.
Viral detection Viral detection involves finding parvovirus B19 genetic material (DNA) in a blood sample or, less commonly, in a sample of bone marrow, fetal cord blood, or amniotic fluid. Parvovirus B19 DNA testing is performed primarily to detect active parvovirus infection in immune-compromised people who have acute or persistent anemia. These people will frequently not produce a sufficient amount of antibodies to detect or to resolve the infection. It may also be performed to detect the presence of the virus in babies when a mother is infected or was exposed during the pregnancy.
Parvovirus B19 testing is usually not required when a child has the characteristic "slapped cheek" and lacy rashes. The distinctive rashes are sufficient evidence for the health practitioner to be able to diagnose the infection. In general, most people who have or have had parvovirus B19 do not require laboratory testing because illness does not typically last more than 5-7 days and symptoms are usually mild.
Parvovirus B19 IgG and IgM antibody tests may be ordered when a pregnant female has flu-like symptoms and/or has been exposed to someone with a parvovirus B19 infection to determine if she has an active infection, had a recent infection, or has been exposed in the past. DNA testing may be performed on fetal samples in some cases.
Antibody testing and/or DNA testing may be ordered when someone has acute or persistent anemia or joint pain that the health practitioner suspects may be due to a parvovirus B19 infection. Parvovirus B19 DNA testing is usually ordered when the affected person is immune-compromised.
One or more parvovirus B19 tests may be repeated if they are initially negative but the health practitioner still suspects that a parvovirus infection is present, or to evaluate changes in concentrations of antibody over time.
Antibody testing If both parvovirus B19 IgG and IgM are present, then it is likely that the person tested has an active, or had a recent, parvovirus infection. This can be confirmed by measuring IgG levels again 2 or 3 weeks later. A high level of IgG is not as important as an increasing concentration of antibody. If there is a 4-fold increase in IgG between the first and second sample, then the person has an active, or had a recent, infection.
If only IgM is present, then the person may have very recently been infected, within the previous 2-4 months. If only parvovirus B19 IgG is present, then the person had a parvovirus infection at some time in the past and has protection against the virus.
If antibody tests are negative, then the person tested has not had the infection and is not immune. If a pregnant woman is not immune and has been exposed to someone with the disease, she will typically be closely monitored by her doctor.
If someone is symptomatic but has low or undetectable levels of IgG and/or IgM, it may mean that the person either has a condition other than parvovirus B19 or that their immune system is not responding normally. i.e., not producing an adequate amount of antibody even if parvovirus is present. This may be true for immunocompromised people and DNA testing may need to be done.
Viral detection If a parvovirus B19 DNA test is positive, then the person is currently infected with parvovirus B19. A negative result does not rule out the infection. The virus may not be present in sufficient amount in the sample to be detected.
Fetal infection of parvovirus B19 is often detected through testing of viral DNA in maternal samples as well as samples from the baby.
The PCR assay is used to detect viral DNA and is the optimal method for detecting chronic infection in immunocompromised patients as the antibody levels are variable.
Sometimes a reticulocyte test may be performed along with parvovirus B19 testing to evaluate red blood cell (RBC) production. This test measures new immature RBCs, called reticulocytes, in the blood that still contain genetic material. Since parvovirus B19 disrupts RBC production, the number of reticulocytes will decrease during an active infection.
Parvovirus B19 infections are usually self-limiting (limited in duration) in otherwise healthy people. Treatment may be given to relieve symptoms and, when necessary, to address anemia.
A pregnant woman who passes parvovirus B19 infection to her fetus will be closely monitored for several weeks with periodic ultrasounds. In most cases, the fetus will be healthy. When hydrops fetalis or severe anemia develops, it can sometimes be addressed by giving the fetus a blood transfusion. The parvovirus B19 infection is not known to cause birth defects.
This article was last reviewed on July 26, 2013. | This article was last modified on May 13, 2014.
The review date indicates when the article was last reviewed from beginning to end to ensure that it reflects the most current science. A review may not require any modifications to the article, so the two dates may not always agree.
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