Parvovirus b19 as an etiologic agent of fulminant non-a, non-b, non-c, non-e hepatms (hna-e): evidence for productive viral infection

We previously found B19 DNA in liver tissue of HNA-E patients with or without red cell aplasia. In this study, we used immune adherence polymerase chain reaction (IA-PCR) to demonstrate productive infection by showing whole B19 viral particles in livers from the patients with fulminant hepatitis of unknown etiology. B19 virions were captured by monoclonal anti-B19 antibody bound to solid phase and standard PCR amplification was performed. IA-PCR had specificity and sensitivity comparable to standard PCR. Using IAPCR, B19 was detected in 5 of 6 (83%) livers from patients with fulminant HNA-E and aplastic anemia; in 3 of 4 (75%) with fulminant HNA-E only; 1 of 4 (25%) with liver transplant complications, and 6 of 34 (18%) patients with chronic liver diseases. Detection by IA-PCR of "full" B19 virions in the liver from the patients with fulminant HNA-E with or without aplastic anemia confirmed the presence of productive B19 infection, suggesting the direct involvement of B19 in the etiology and pathogenesis of fulminant hepatitis of unknown etiology.