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Multicenter Study
. 2017 Oct;48(10):2875-2877.
doi: 10.1161/STROKEAHA.117.018272. Epub 2017 Sep 1.

Parvovirus B19 Infection in Children With Arterial Ischemic Stroke

Heather J Fullerton  1 , Jorge M Luna  1 , Max Wintermark  1 , Nancy K Hills  1 , Rafal Tokarz  1 , Ying Li  1 , Carol Glaser  1 , Gabrielle A DeVeber  1 , W Ian Lipkin  1 , Mitchell S V Elkind  2 ; VIPS Investigators*
Affiliations
Multicenter Study

Parvovirus B19 Infection in Children With Arterial Ischemic Stroke

Heather J Fullerton et al. Stroke. 2017 Oct.

Abstract

Background and purpose: Case-control studies suggest that acute infection transiently increases the risk of childhood arterial ischemic stroke. We hypothesized that an unbiased pathogen discovery approach utilizing MassTag-polymerase chain reaction would identify pathogens in the blood of childhood arterial ischemic stroke cases.

Methods: The multicenter international VIPS study (Vascular Effects of Infection in Pediatric Stroke) enrolled arterial ischemic stroke cases, and stroke-free controls, aged 29 days through 18 years. Parental interview included questions on recent infections. In this pilot study, we used MassTag-polymerase chain reaction to test the plasma of the first 161 cases and 34 controls enrolled for a panel of 28 common bacterial and viral pathogens.

Results: Pathogen DNA was detected in no controls and 14 cases (8.7%): parvovirus B19 (n=10), herpesvirus 6 (n=2), adenovirus (n=1), and rhinovirus 6C (n=1). Parvovirus B19 infection was confirmed by serologies in all 10; infection was subclinical in 8. Four cases with parvovirus B19 had underlying congenital heart disease, whereas another 5 had a distinct arteriopathy involving a long-segment stenosis of the distal internal carotid and proximal middle cerebral arteries.

Conclusions: Using MassTag-polymerase chain reaction, we detected parvovirus B19-a virus known to infect erythrocytes and endothelial cells-in some cases of childhood arterial ischemic stroke. This approach can generate new, testable hypotheses about childhood stroke pathogenesis.

Keywords: carotid artery, internal; case–control studies; heart diseases; middle cerebral artery; parvovirus B19, human; polymerase chain reaction; stroke.

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Conflict of interest statement

DISCLOSURES: The authors have no commercial interests related to this project.

Figures

Figure
Figure
Brain MRA (A) in a case with parvovirus B19 and the characteristic long-segment distal left ICA stenosis (arrowheads) and proximal left MCA irregularity (arrow). Brain diffusion weighted imaging (DWI) (B) in the same case demonstrates a small acute left lenticulostriate infarction.
See this image and copyright information in PMC

References

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