Case report
Anaemia and fever in kidney transplant. The role of human parvovirus B19
Anemia y fiebre en el postrasplante renal: su relación con el parvovirus humano B19
Yanet Parodis Lópeza, Raquel Santana Estupiñána, Silvia Marrero Robaynaa, Roberto Gallego Sampera, Fernando Henríquez Palopa, José Carlos Rivero Verab, Rafael Camacho Galánb, María José Pena Lópezc, Nery Sablón Gonzáleza, Fayna González Cabreraa, Elena Oliva Dámasoa, Nicanor Vega Díaza, José Carlos Rodríguez Péreza,
Corresponding author
a Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
b Servicio de Anatomía Patológica, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
c Servicio de Microbiología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
Read
12196
Timeswas read the article
2703
Total PDF
9493
Total HTML
Share statistics
array:25 [ "pii" => "S2013251417300767" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2017.04.004" "estado" => "S300" "fechaPublicacion" => "2017-03-01" "aid" => "261" "copyright" => "Sociedad Española de Nefrología" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Nefrologia (English Version). 2017;37:206-12" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5596 "formatos" => array:3 [ "EPUB" => 356 "HTML" => 4531 "PDF" => 709 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0211699516301394" "issn" => "02116995" "doi" => "10.1016/j.nefro.2016.08.005" "estado" => "S300" "fechaPublicacion" => "2017-03-01" "aid" => "261" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Nefrologia. 2017;37:206-12" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6271 "formatos" => array:3 [ "EPUB" => 411 "HTML" => 4927 "PDF" => 933 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso clínico</span>" "titulo" => "Anemia y fiebre en el postrasplante renal: su relación con el parvovirus humano B19" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "206" "paginaFinal" => "212" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Anaemia and fever in Kidney transplant. The role of human parvovirus B19" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figura 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 146023 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Imagen de médula ósea que muestra células inmaduras eritroides con signos de infección por el parvovirus B19 (hematoxilina eosina; x100).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Yanet Parodis López, Raquel Santana Estupiñán, Silvia Marrero Robayna, Roberto Gallego Samper, Fernando Henríquez Palop, José Carlos Rivero Vera, Rafael Camacho Galán, María José Pena López, Nery Sablón González, Fayna González Cabrera, Elena Oliva Dámaso, Nicanor Vega Díaz, José Carlos Rodríguez Pérez" "autores" => array:13 [ 0 => array:2 [ "nombre" => "Yanet" "apellidos" => "Parodis López" ] 1 => array:2 [ "nombre" => "Raquel" "apellidos" => "Santana Estupiñán" ] 2 => array:2 [ "nombre" => "Silvia" "apellidos" => "Marrero Robayna" ] 3 => array:2 [ "nombre" => "Roberto" "apellidos" => "Gallego Samper" ] 4 => array:2 [ "nombre" => "Fernando" "apellidos" => "Henríquez Palop" ] 5 => array:2 [ "nombre" => "José Carlos" "apellidos" => "Rivero Vera" ] 6 => array:2 [ "nombre" => "Rafael" "apellidos" => "Camacho Galán" ] 7 => array:2 [ "nombre" => "María José" "apellidos" => "Pena López" ] 8 => array:2 [ "nombre" => "Nery" "apellidos" => "Sablón González" ] 9 => array:2 [ "nombre" => "Fayna" "apellidos" => "González Cabrera" ] 10 => array:2 [ "nombre" => "Elena" "apellidos" => "Oliva Dámaso" ] 11 => array:2 [ "nombre" => "Nicanor" "apellidos" => "Vega Díaz" ] 12 => array:2 [ "nombre" => "José Carlos" "apellidos" => "Rodríguez Pérez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2013251417300767" "doi" => "10.1016/j.nefroe.2017.04.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417300767?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699516301394?idApp=UINPBA000064" "url" => "/02116995/0000003700000002/v1_201704211146/S0211699516301394/v1_201704211146/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2013251417300676" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2017.03.002" "estado" => "S300" "fechaPublicacion" => "2017-03-01" "aid" => "253" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2017;37:213-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3313 "formatos" => array:3 [ "EPUB" => 364 "HTML" => 2382 "PDF" => 567 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "<span class="elsevierStyleItalic">Enterococcus gallinarum</span> and Chilaiditi syndrome in peritoneal dialysis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "213" "paginaFinal" => "214" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Enterococcus gallinarum</span> y síndrome de Chilaiditi en diálisis peritoneal" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1125 "Ancho" => 1649 "Tamanyo" => 142609 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Thoracic X-ray with Chilaiditi syndrome.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Cristina Pérez Melón, Beatriz Ferreiro Álvarez, Elena Iglesias Lamas, María Jesús Camba Caride, María Paz Borrajo Prol, Enrique Novoa Fernández" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Cristina" "apellidos" => "Pérez Melón" ] 1 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Ferreiro Álvarez" ] 2 => array:2 [ "nombre" => "Elena" "apellidos" => "Iglesias Lamas" ] 3 => array:2 [ "nombre" => "María Jesús" "apellidos" => "Camba Caride" ] 4 => array:2 [ "nombre" => "María Paz" "apellidos" => "Borrajo Prol" ] 5 => array:2 [ "nombre" => "Enrique" "apellidos" => "Novoa Fernández" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0211699516301187" "doi" => "10.1016/j.nefro.2016.09.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699516301187?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417300676?idApp=UINPBA000064" "url" => "/20132514/0000003700000002/v1_201705250045/S2013251417300676/v1_201705250045/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2013251417300846" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2017.04.012" "estado" => "S300" "fechaPublicacion" => "2017-03-01" "aid" => "315" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2017;37:199-205" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3154 "formatos" => array:3 [ "EPUB" => 334 "HTML" => 2093 "PDF" => 727 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short Original</span>" "titulo" => "Establishing the buttonhole technique as a puncture alternative for arteriovenous fistulas. Experience of a centre over 3 years" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "199" "paginaFinal" => "205" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Instauración de la técnica de <span class="elsevierStyleItalic">buttonhole</span> como alternativa de punción para las fístulas arteriovenosas. Experiencia de un centro en 3 años" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 844 "Ancho" => 1402 "Tamanyo" => 30182 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Haemostasis times prior to and following the buttonhole technique. The median time (interquartile range) until onset of haemostasis using the technique prior to BH (pre-BH) was 15 (15–20) min, and after a month of the BH technique (post-BH) the median was 10 (10–15) min (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.005).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Laura Baena, José L. Merino, Blanca Bueno, Beatriz Martín, Verónica Sánchez, Luca Caserta, Beatriz Espejo, Patricia Domínguez, Alicia Gómez, Vicente Paraíso" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Laura" "apellidos" => "Baena" ] 1 => array:2 [ "nombre" => "José L." "apellidos" => "Merino" ] 2 => array:2 [ "nombre" => "Blanca" "apellidos" => "Bueno" ] 3 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Martín" ] 4 => array:2 [ "nombre" => "Verónica" "apellidos" => "Sánchez" ] 5 => array:2 [ "nombre" => "Luca" "apellidos" => "Caserta" ] 6 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Espejo" ] 7 => array:2 [ "nombre" => "Patricia" "apellidos" => "Domínguez" ] 8 => array:2 [ "nombre" => "Alicia" "apellidos" => "Gómez" ] 9 => array:2 [ "nombre" => "Vicente" "apellidos" => "Paraíso" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0211699516302090" "doi" => "10.1016/j.nefro.2016.11.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699516302090?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417300846?idApp=UINPBA000064" "url" => "/20132514/0000003700000002/v1_201705250045/S2013251417300846/v1_201705250045/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Anaemia and fever in kidney transplant. The role of human parvovirus B19" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "206" "paginaFinal" => "212" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Yanet Parodis López, Raquel Santana Estupiñán, Silvia Marrero Robayna, Roberto Gallego Samper, Fernando Henríquez Palop, José Carlos Rivero Vera, Rafael Camacho Galán, María José Pena López, Nery Sablón González, Fayna González Cabrera, Elena Oliva Dámaso, Nicanor Vega Díaz, José Carlos Rodríguez Pérez" "autores" => array:13 [ 0 => array:3 [ "nombre" => "Yanet" "apellidos" => "Parodis López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Raquel" "apellidos" => "Santana Estupiñán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Silvia" "apellidos" => "Marrero Robayna" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Roberto" "apellidos" => "Gallego Samper" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Fernando" "apellidos" => "Henríquez Palop" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "José Carlos" "apellidos" => "Rivero Vera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "Rafael" "apellidos" => "Camacho Galán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 7 => array:3 [ "nombre" => "María José" "apellidos" => "Pena López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 8 => array:3 [ "nombre" => "Nery" "apellidos" => "Sablón González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 9 => array:3 [ "nombre" => "Fayna" "apellidos" => "González Cabrera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 10 => array:3 [ "nombre" => "Elena" "apellidos" => "Oliva Dámaso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 11 => array:3 [ "nombre" => "Nicanor" "apellidos" => "Vega Díaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 12 => array:4 [ "nombre" => "José Carlos" "apellidos" => "Rodríguez Pérez" "email" => array:1 [ 0 => "jrodperd@gobiernodecanarias.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Microbiología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Anemia y fiebre en el postrasplante renal: su relación con el parvovirus humano B19" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 146023 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Image of bone marrow showing immature erythroid cells with signs of parvovirus B19 infection (haematoxylin and eosin; 100x).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Factors involved in the development of post-transplant anaemia are: blood loss, iron and folate deficiency, low erythropoietin, and also hyperparathyroidism, neoplasms, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers, immunosuppressive drugs, valganciclovir, co-trimoxazole, and chronic graft dysfunction<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> infections caused by cytomegalovirus (CMV), Epstein–Barr virus (EBV) and parvovirus B19, which can produce bone marrow aplasia.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Parvovirus B19 infection affects 40–60% of the general population, and its highest incidence is in school age children (“fifth disease”).</p><p id="par0015" class="elsevierStylePara elsevierViewall">In kidney transplants, parvovirus B19 infection is a rare complication. Molecular biology techniques have shown viral DNA in the blood of 20–30% of transplant patients.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a> Several authors have reported that the incidence of this virus in solid organ transplants is 2%.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a> However, the exact incidence of infection in kidney transplants is not known, although it has been reported up to 12%.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In healthy subjects with no transplant, parvovirus B19 is transmitted through respiratory secretions, blood and urine,<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a> and across the placenta to the foetus.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">5</span></a> In kidney transplant patients, other possibilities are secondary viral reactivation due to severe immunosuppression, transmission through blood transfusions, or even donor-derived pathways.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">5,7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The symptoms of parvovirus B19 infection include fever, arthralgia and rash. Other clinical changes include arthropathy, transient aplastic crisis, hydrops fetalis, abortion and foetal death; it has also been associated with vasculitis, peripheral neuropathy, myocarditis, fulminant liver failure and Nezelof syndrome.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">8</span></a> In kidney transplant patients, the main sign is the presence of acute or chronic aplastic anaemia.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Here we present a short review accompanied by a case report of a kidney transplant patient who had anaemia refractory to erythropoiesis-stimulating agents given during the first few months after transplantation. Fever and general malaise subsequently appeared, and both the serological and polymerase chain reaction (PCR) tests for parvovirus B19 were negative.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0035" class="elsevierStylePara elsevierViewall">We present the case of a 65-year-old man with a history of hypertension due to primary hyperaldosteronism and chronic kidney disease since 1999, with nephrotic-range proteinuria due to chronic glomerulonephritis (no kidney biopsy). He was on haemodialysis since May 2012 until 30/09/2014, when a cadaveric kidney transplant with 6 incompatibilities was performed. The donor biopsy, with 41 glomeruli, showed that 7.3% were sclerotic glomeruli, slight hyaline thickening, less than 25% tubular atrophy and less than 5% interstitial fibrosis. Induction immunosuppressive treatment was given with basiliximab, tacrolimus, mycophenolate mofetil (MMF) and steroids.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In the immediate post-transplant period, the patient had effective diuresis with no need for dialysis. In terms of complications, he developed post-transplant diabetes mellitus and haematoma from the surgical bed with development of anaemia requiring transfusion of 5 packed red blood cells. At discharge, the following values were observed: plasma creatinine (pCr): 1.56<span class="elsevierStyleHsp" style=""></span>mg/dl; haemoglobin (Hb): 8.2<span class="elsevierStyleHsp" style=""></span>g/dl; haematocrit: 25.5%; leukocytes: 11,300/μl; platelets: 291,000/μl. His immunosuppressive treatment consisted of prednisone 25<span class="elsevierStyleHsp" style=""></span>mg/day, tacrolimus 5.5<span class="elsevierStyleHsp" style=""></span>mg/day and MMF 2<span class="elsevierStyleHsp" style=""></span>g/day. He was also prescribed valganciclovir and trimethoprim-sulfamethoxazole as prophylaxis. The patient progressed without symptoms, with a reduction in pCr to 1.2<span class="elsevierStyleHsp" style=""></span>mg/dl in the first 15 days after the transplant. His Hb was around 8–9<span class="elsevierStyleHsp" style=""></span>g/dl, with a progressive increase in erythropoietin requirements and fluctuating lymphopenia, but with no other haematological abnormalities.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Due to proteinuria of up to 1.2<span class="elsevierStyleHsp" style=""></span>g/day, with no impairment in renal function, a graft biopsy was performed, this was fifty six days after the transplant (Nov/2014),. The findings were compatible with mild tubular toxicity caused by anticalcineurinics, segmental sclerosis of one glomerulus, interstitial fibrosis with mild tubular atrophy without inflammation, as well as the presence of isolated lymphocytes in the arterial intima. Immunofluorescence revealed mild-moderate IgM and C3 positivity and the C4d staining was negative. The patient was asymptomatic without impairment of renal function (pCr: 1–1.2<span class="elsevierStyleHsp" style=""></span>mg/dl), with optimal immunosuppression levels, 0% anti-HLA class I and II antibodies, with no changes on the ultrasound and negative virological tests (CMV/BK). It was decided to maintain close monitoring, and a progressive reduction in urine protein was observed.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Sixty four days after the transplant (December 2014), the patient had hyperthermia, no focal deficit and a poor general condition, with asthenia, hyporexia,weight loss, with a reduction of haemoglobin to 7.1<span class="elsevierStyleHsp" style=""></span>g/dl and a haematocrit of 20.6%, for which he was hospitalised. The additional tests showed no leukopenia or thrombocytopenia; normal procalcitonin levels (0.15<span class="elsevierStyleHsp" style=""></span>ng/ml) and elevated LDH (321–397<span class="elsevierStyleHsp" style=""></span>U/l) and C-reactive protein (7.17<span class="elsevierStyleHsp" style=""></span>mg/l); total proteins: 5.7<span class="elsevierStyleHsp" style=""></span>g/dl; elevated total bilirubin (1.62<span class="elsevierStyleHsp" style=""></span>mg/dl) with indirect bilirubin of 0.98<span class="elsevierStyleHsp" style=""></span>mg/dl; elevated ferritin (1528.60<span class="elsevierStyleHsp" style=""></span>ng/ml); Na 130<span class="elsevierStyleHsp" style=""></span>mEq/l, Mg 1.02<span class="elsevierStyleHsp" style=""></span>mg/dl and K 3.4<span class="elsevierStyleHsp" style=""></span>mEq/l, in the context of his primary hyperaldosteronism. As far as renal function, plasma creatinine did not exceed 1.05<span class="elsevierStyleHsp" style=""></span>mg/dl.</p><p id="par0055" class="elsevierStylePara elsevierViewall">During this first admission, the complete serology of the following pathogens was negative: EBV, CMV, herpesvirus, hepatotropic virus, rubella, varicella-zoster, parvovirus B19, <span class="elsevierStyleItalic">Mycoplasma pneumoniae, Coxiella burnetii, Rickettsia typhi, Bartonella henselae, Toxoplasma gondii</span>, leishmania, mycobacteria and fungi; as well as the blood PCR for parvovirus B19 and CMV. He had fever only the first day of admission, and thereafter the patient remained afebrile. He was treated with quinolones and third-generation cephalosporins, which were discontinued at discharge.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Normocytic, normochromic and hyporegenerative anaemia with iron overload was attributed to the blood transfusions and drug toxicity (valganciclovir and trimethoprim-sulfamethoxazole), which was decided to be discontinued.</p><p id="par0065" class="elsevierStylePara elsevierViewall">At discharge, a serology suggested acute Q fever with positive IgM antibodies on the indirect immunofluorescence (IIF) test for <span class="elsevierStyleItalic">Coxiella burnetii</span>, for which treatment with doxycycline was started for 10 days. As the fever and anaemia lasted 4 months after the transplant, it was decided to admit him to hospital in order to rule out chronic Q fever.</p><p id="par0070" class="elsevierStylePara elsevierViewall">During this second admission, chest X-ray, abdominal ultrasound, abdominal CT, PET-CT, echocardiogram, gastroscopy and colonoscopy were normal. The tumoural markers and serology tests (including new antibody assay [IIF] for parvovirus B19 and <span class="elsevierStyleItalic">Coxiella burnetii</span>), as well as cultures for tuberculosis and viruses (HSV-1, HSV-2, VZV, CMV, EBV, VHH-6, VHH-7, VHH-8 and enterovirus RNA), were negative in all cases. Therefore, the diagnosis of Q fever as the origin of the clinical symptoms was ruled out. It was considered a false positive, as there was no seroconversion in the second sample and the fever persisted despite treatment.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The patient remained with fever with a marked deterioration in his general condition, anaemia and lymphopenia (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–3</a>); it was therefore decided to perform a bone marrow biopsy on February/2015, in which hypocellular bone marrow was observed with a marked decrease of the erythroid series and with giant erythroblasts, with scarce eosinophilic nuclear inclusions that determined an increase in cell size. All of this was suggestive of parvovirus B19 infection (<a class="elsevierStyleCrossRefs" href="#fig0020">Figs. 4 and 5</a>), which was confirmed by PCR with a positive result in the tissue specimen of the biopsy. Simultaneously, it was decided to perform a new blood PCR test for parvovirus B19, which this time was positive.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">After the confirmation of parvovirus B19 infection, the MMF was discontinued, and treatment with a daily IV immunoglobulin 0.5<span class="elsevierStyleHsp" style=""></span>g/kg/dose (10 doses) was started, with adequate tolerance, disappearance of fever, and normalisation of Hb and WBC series, after which he was discharged in March 2015.</p><p id="par0085" class="elsevierStylePara elsevierViewall">At the end of the treatment, with stable Hb and afebrile, it was decided to resume the MMF at low doses. However, 6 months after discharge, there was a slight impairment of renal function: pCr up to 1.55<span class="elsevierStyleHsp" style=""></span>mg/dl and urine protein of 2.1<span class="elsevierStyleHsp" style=""></span>g/24<span class="elsevierStyleHsp" style=""></span>h (previous 0.6–0.8<span class="elsevierStyleHsp" style=""></span>g/24<span class="elsevierStyleHsp" style=""></span>h). In considering that it could be due to the reduced immunosuppression a second kidney biopsy was performed in November 2015, which revealed mild renal tubulitis indicative of borderline acute rejection, interstitial fibrosis, moderate tubular atrophy, and areas of isometric vacuolation. There were inflammatory cells in the artery wall there were, most of which were intraparietal and a few, subendothelial. C4d staining and immunofluorescence were negative.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The parvovirus viral load was stabilised, so the immunosuppression was optimised by increasing the MMF dose from 500 to 750<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h and with a tacrolimus dose able to maintain levels around 7–8<span class="elsevierStyleHsp" style=""></span>ng/dl, after which there was a reduction in urine protein and a stabilisation of renal function, with plasma Cr of 1.48–1.55<span class="elsevierStyleHsp" style=""></span>mg/dl. The possibility of administering anti-rejection therapy was not considered since it could lead to an increase in the replication of parvovirus B19.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">9</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">A year after the end of treatment, the patient remained afebrile, with increased appetite and weight gain. With regard to the lab results, the patient had Hb levels of 15.2<span class="elsevierStyleHsp" style=""></span>g/dl, with no need for erythropoietin, stable renal function, and with urine protein of less than 1<span class="elsevierStyleHsp" style=""></span>g/day (controlled with dual RAAS blockade). Anti-HLA class I and II antibodies remained negative.</p><p id="par0100" class="elsevierStylePara elsevierViewall">As for plasma PCR for parvovirus B19, our hospital's laboratory validated the quantitative method for parvovirus B19. We did not have the viral load available at the time of diagnosis, and the first quantitative measurement was done in September 2015 (approximately 7 months after the end of treatment), with <50<span class="elsevierStyleHsp" style=""></span>copies/ml. We inferred that, although we were not able to completely eliminate the virus, the pre-treatment viral load was probably much larger, given the clinical and lab-value improvement observed. The current viral load remains below 100<span class="elsevierStyleHsp" style=""></span>copies/ml, and clinical and lab parameters are being monitored, including periodic PCR measurements so a relapse can be detected.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">Viral infections predominate in the first year after transplant, when immunosuppression is at maximum.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a> Parvovirus infection in the transplanted population is rare, and the symptoms may be subtle: anaemia is the main manifestation.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Our patient was diagnosed with parvovirus B19 infection 142 days after transplantation. Anaemia was the initial finding, which subsequently worsened; there was also hyperthermia, with a progressive deterioration in his general state, asthenia, hyporexia and weight loss.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The parvovirus infection could have been transmitted from the donor, but there was no serology or viral load available; therefore we cannot confirm transmission by this route. Another possible source of infection might have been blood transfusions during the immediate post-transplant period. It could be a reactivation of the virus in the receptor caused by immunosuppression, since we did not have the recipient's pre-transplant serology. Considering that at the time of diagnosis there was an epidemic of parvovirus B19 in the population, we suspect that our patient may have acquired the infection during this epidemiological outbreak.</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">The reason for anaemia</span><p id="par0120" class="elsevierStylePara elsevierViewall">Parvovirus B19 produces lysis of proerythroblast (erythroid progenitor cell).<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">8,9</span></a> The infection of this cell occurs through the P antigen (globoside Gb4), a receptor present in erythroid cells and in others, including endothelial cells, platelets, synoviocytes, smooth muscle cells and foetal myocytes. The virus need the P antigen to bind to the cell but it is also required the presence of a co-receptor (α5β1) for the infection to be successful and to act as an integrin. Erythroid cells contain large amount of both molecules on their surface.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">9</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Anaemia may be normocytic, severe normochromic, or with poor reticulocyte response which does not respond to blood transfusions or erythropoiesis-stimulating agents.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a> Leukopenia, thrombocytopenia, and reactive haemophagocytic syndrome have also been associated to parvovirus B19 infection.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">In our patient, normocytic and normochromic anaemia was the main manifestation during the clinical course, with Hb values as low as to 6.7<span class="elsevierStyleHsp" style=""></span>g/dl, with no response to erythropoiesis-stimulating agents, so he had to receive several transfusions.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Diagnosis</span><p id="par0135" class="elsevierStylePara elsevierViewall">The diagnosis of parvovirus B19 infection is made based on the presence of persistent anaemia, usually reticulocytopenia, with giant proerythroblasts with prominent eosinophilic viral inclusions in the bone marrow, anti-parvovirus serum IgM/IgG and anti-DNA positive parvovirus PCR.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In kidney transplant patients, the main sign is the presence of acute or chronic aplastic anaemia.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> In a study of 98 patients, the main clinical manifestations associated with parvovirus B19 infection were anaemia with associated dyspnoea and asthenia in 98% of cases, and fever in 54.9%.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a> The literature on the relationship between chronic graft dysfunction and active parvovirus B19 infection is not consistent. Some authors<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">7,15</span></a> confirm this relationship, whereas others do not.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">5</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">The serological testing needed to make the diagnosis of acute parvovirus B19 infection (IgM) has a sensitivity and specificity of 89% and 99%, respectively, in immunocompetent patients. This fact has not been confirmed in transplant patients because of their immunosuppression; in these patients the most reliable method is peripheral blood or bone marrow PCR.</p><p id="par0150" class="elsevierStylePara elsevierViewall">The choice of diagnostic test of PCR for parvovirus B19 is important so false negatives are avoided. Some methods are sensitive for genotype 1, but not suitable for detecting genotypes 2 or 3. Therefore it is necessary to have methods able to detect the 3 genotypes.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Inhibitors in blood samples may also cause false negatives. Testing for internal inhibitors should be included when analysing the samples, to be certain that the negative result is not due to inhibitors in the sample.</p><p id="par0160" class="elsevierStylePara elsevierViewall">In our patient, blood PCR for parvovirus B19 was first positive for 4 months and 19 days after the transplant, with a previous negative result at 73 days. The PCR method used in our hospital is the LightMix<span class="elsevierStyleSup">®</span> parvovirus B19 kit, which is able to detect all 3 types of parvovirus. The fact that the first result was negative could be justified by the possibility of intermittent viraemia or a low level of viraemia at the time of the measurement.</p><p id="par0165" class="elsevierStylePara elsevierViewall">In patients whose blood PCR is negative but in whom clinical suspicion persists, as in our case here, the definitive diagnosis of parvovirus B19 infection is performed by bone marrow aspiration.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a> It shows not only a pure red cell aplasia with the characteristic medullary “shutdown” in the giant proerythroblast phase, but also, through molecular biology techniques, the virus in the marrow.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Treatment</span><p id="par0170" class="elsevierStylePara elsevierViewall">There are currently no antiviral drugs that are effective against parvovirus B19. In anaemia associated with parvovirus B19 infection, different therapeutic options can be considered: decreasing immunosuppression (reduction/withdrawal of drugs), changing the immunosuppressant (substituting tacrolimus for cyclosporin – some authors have described the defective clearance of the virus in patients treated with tacrolimus<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">17</span></a> or, in order to provide virus-neutralising antibodies,<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">18</span></a> administering IVIG at doses of 0.4–0.5<span class="elsevierStyleHsp" style=""></span>g/kg, from 2 to 10 days<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a> with a cumulative dose that usually ranges between 2 and 5<span class="elsevierStyleHsp" style=""></span>g/kg).<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a> Anaemia is corrected in more than 90% of cases with only one course of treatment, but the risk of relapse ranges from 23% to 33%.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">19</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Our patient was treated by a change in immunosuppression, temporarily suspending MMF together with intravenous immunoglobulin (IVIg; Flebogamma) daily for 10 days, with a good clinical and lab-value outcome, helping Hb, lymphocyte and leucocyte values to recover gradually, and discontinuing erythropoietin (EPO) (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–3</a>). Although adverse reactions to IVIg<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">20</span></a> have been described, our patient did not have any of these disorders, and tolerated the drug very well.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Although he had a good initial therapeutic response, it is recommended to closely monitor patients where relapse and reappearance of the anaemia is possible; this would require them to be treated with a new immunoglobulin cycle every 3 months to prevent them.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">The possibility of treating these patients with mTOR inhibitors could be a promising option, but there are no current publications that support their use. In our case, we did not use it due to the post-transplant proteinuria observed, which reached 2<span class="elsevierStyleHsp" style=""></span>g/24<span class="elsevierStyleHsp" style=""></span>h. We did not know the specific diagnosis of kidney disease that led to haemodialysis, so the possibility of focal segmental glomerulosclerosis could not be ruled out. In addition, the histological report on the first graft biopsy reveals the presence of a glomerulus with segmental sclerosis and mild-moderate IgM and C3 positivity in 7 glomeruli. This was a reason for not using mTOR inhibitors, since focal segmental glomerulosclerosis associated with mTOR use has been described in transplant patients.</p><p id="par0190" class="elsevierStylePara elsevierViewall">The impact of this infection on the patient's survival or long-term morbidity is not known.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a> No specific strategies have proved useful in preventing parvovirus B19 infection.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">20</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">The relatively low incidence of this infection and the adverse effects of the therapeutic measures make donor/recipient <span class="elsevierStyleItalic">screening</span> for this virus non-viable, and the development of vaccines for parvovirus B19 is still under investigation.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">20</span></a></p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="par0200" class="elsevierStylePara elsevierViewall">Here it is described a kidney transplant patient with anaemia refractory to EPO and subsequent hyperthermia, with the diagnosis of parvovirus B19 infection. Due to the patient's immunosuppression, the serological anti-parvovirus IgM/IgG tests performed were always negative. Suspected acute Q fever infection delayed an accurate diagnosis, but given that there was no clinical improvement with the treatment and no seroconversion occurred, the diagnosis of Q fever infection was ruled out. Then bone marrow aspiration was performed that revealed parvovirus B19 infection, so the diagnosis was finally made since the first blood PCR did not show positive results.</p><p id="par0205" class="elsevierStylePara elsevierViewall">Our patient was studied thoroughly, and cancer and other infections were also ruled out; the symptoms disappeared after adjusting the immunosuppressive treatment and starting IV Ig.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors declare that they have no potential conflicts of interest related to the content of this manuscript.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres842793" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec838003" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres842794" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec838004" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Discussion" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "The reason for anaemia" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Treatment" ] ] ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-12-26" "fechaAceptado" => "2016-08-25" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec838003" "palabras" => array:3 [ 0 => "Renal transplant" 1 => "Human parvovirus B19" 2 => "Post-transplant anaemia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec838004" "palabras" => array:3 [ 0 => "Trasplante renal" 1 => "Parvovirus B19 humano" 2 => "Anemia postrasplante" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Infections remain an issue of particular relevance in renal transplant patients, particularly viral infections.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Human parvovirus B19 infection causes severe refractory anaemia, pancytopenia and thrombotic microangiopathy. Its presence is recognised by analysing blood polymerase chain reaction (PCR) and by the discovery of typical giant proerythroblasts in the bone marrow.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We report the case of a 65 year-old man with a history of deceased donor renal transplant in September 2014. At 38 days after the transplant, the patient presented progressive anaemia that was resistant to erythropoiesis-stimulating agents. At 64 days after transplant, hyperthermia occurred with progressive deterioration of the patient's general condition. The viral serology and the first blood PCR for human parvovirus B19 were both negative. At 4 months and 19 days after, a bone marrow biopsy was conducted, showing giant erythroblasts with nuclear viral inclusions that were compatible with parvovirus; a PCR in the tissue confirmed the diagnosis. A second blood PCR was positive for parvovirus. After treatment with intravenous immunoglobulin and the temporary discontinuation of mycophenolate mofetil, a complete remission of the disease occurred, although the blood PCR for parvovirus B19 remained positive, so monitoring is necessary for future likely recurrence.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Las infecciones continúan siendo un problema relevante en el paciente trasplantado renal, en especial las infecciones virales.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La infección por el parvovirus humano B19 causa anemia refractaria grave, pancitopenia y microangiopatía trombótica. Dicha infección se diagnostica mediante el análisis de la reacción en cadena de la polimerasa (PCR) en sangre y por la presencia de proeritroblastos gigantes típicos en la médula ósea.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Presentamos el caso clínico de un varón de 65 años con trasplante renal de donante cadáver en septiembre de 2014. A los 38 días del trasplante comienza con anemia progresiva y resistente a los agentes estimulantes de la eritropoyesis. A los 64 días se produce hipertermia, con deterioro progresivo de su estado general. La serología vírica resultó negativa, al igual que la PCR inicial en sangre del parvovirus humano B19. A los 4 meses y 19 días se realiza una biopsia de médula ósea en la que se observan eritroblastos gigantes con inclusiones víricas nucleares compatibles con parvovirus, por lo que se realiza una PCR en dicho tejido que confirma el diagnóstico. Una segunda PCR en sangre resultó positiva. Tras el tratamiento con inmunoglobulinas intravenosas (IGIV) y la suspensión temporal del micofenolato de mofetilo, se produce una remisión completa de la enfermedad, aunque persistía positiva la PCR para el parvovirus B19 en sangre, lo que hace necesario vigilar probables recidivas.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Parodis López Y, Santana Estupiñán R, Marrero Robayna S, Gallego Samper R, Henríquez Palop F, Rivero Vera JC, et al. Anemia y fiebre en el postrasplante renal: su relación con el parvovirus humano B19. Nefrologia. 2017;37:206–212.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1062 "Ancho" => 2375 "Tamanyo" => 103447 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Changes in haemoglobin values (g/dl).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1246 "Ancho" => 2521 "Tamanyo" => 97711 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Changes in lymphocyte values (10×<span class="elsevierStyleSup">3</span>/μl).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 960 "Ancho" => 2501 "Tamanyo" => 94585 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Changes in leukocytes (10×<span class="elsevierStyleSup">3</span>/μl).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 146023 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Image of bone marrow showing immature erythroid cells with signs of parvovirus B19 infection (haematoxylin and eosin; 100x).</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 121874 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Image of bone marrow showing proerythroblast with nuclear viral inclusion characteristic of parvovirus B19 infection (haematoxylin and eosin; 400x).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib0115" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anemia en paciente trasplantado renal secundaria a infección por parvovirus B19" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Marín-Valencia" 1 => "M. Perelló-Carrascosa" 2 => "D. Serón-Micas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Nefrologia" "fecha" => "2012" "volumen" => "3" "numero" => "Sup Ext 5" "paginaInicial" => "22" "paginaFinal" => "26" "itemHostRev" => array:3 [ "pii" => "S0091674910002836" "estado" => "S300" "issn" => "00916749" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0120" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Posttransplantation anemia: mechanisms and management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.M. Yabu" 1 => "W.C. Winkelmayer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2215/CJN.01190211" "Revista" => array:6 [ "tituloSerie" => "Clin J Am Soc Nephrol" "fecha" => "2011" "volumen" => "6" "paginaInicial" => "1794" "paginaFinal" => "1801" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21734096" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0125" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tratamiento de la anemia postrasplante renal" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Moreso" 1 => "R. Alegre" 2 => "G. Ariceta" 3 => "I. Beneyto" 4 => "C. Bernis" 5 => "N. Calvo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Nefrologia" "fecha" => "2011" "volumen" => "2" "numero" => "Sup Ext 2" "paginaInicial" => "16" "paginaFinal" => "24" "itemHostRev" => array:3 [ "pii" => "S0091674908018678" "estado" => "S300" "issn" => "00916749" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0130" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infección por parvovirus B19: diagnóstico y tratamiento en un paciente sometido a trasplante renal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.R. León" 1 => "D. Curcio" 2 => "D. Casadei" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3265/Nefrologia.pre2010.Aug.10617" "Revista" => array:5 [ "tituloSerie" => "Nefrologia" "fecha" => "2010" "volumen" => "30" "paginaInicial" => "704" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21113226" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0135" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence and clinical significance of human parvovirus B19 infection in kidney transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.S. Ki" 1 => "I.S. Kim" 2 => "J.W. Kim" 3 => "N.Y. Lee" 4 => "S.H. Kim" 5 => "K.W. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1399-0012.2005.00415.x" "Revista" => array:6 [ "tituloSerie" => "Clin Transplant" "fecha" => "2005" "volumen" => "19" "paginaInicial" => "751" "paginaFinal" => "755" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16313320" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0140" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infección por parvovirus B19 en trasplante renal. Diagnóstico por detección del genoma viral en sangre periférica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Gómez Huertas" 1 => "S. Melón" 2 => "A.S. Laurés" 3 => "M. de Oña" 4 => "J. Álvarez-Grande" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nefrología" "fecha" => "2005" "volumen" => "25" "paginaInicial" => "67" "paginaFinal" => "72" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16050406" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0145" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anemia as a complication of parvovirus B19. Infection in renal transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Čapenko" 1 => "S. Kozireva" 2 => "I. Folkmane" 3 => "K. Bernarde" 4 => "R. Rozentāls" 5 => "M. Murovska" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Medicina (Kaunas)" "fecha" => "2012" "volumen" => "48" "paginaInicial" => "299" "paginaFinal" => "304" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0150" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aplasia adquirida de la serie roja por infección por parvovirus B19 en una adolescente con trasplante renal" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Portillo-Carrillo" 1 => "L. Velásquez-Jones" 2 => "R. Gómezchico-Velasco" 3 => "M. Medeiros-Domingo" 4 => "S. Valverde-Rosas" 5 => "V. Reséndiz-Núñez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Bol Med Hosp Infant Mex" "fecha" => "2006" "volumen" => "63" "paginaInicial" => "255" "paginaFinal" => "263" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0155" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pure red-cell aplasia of 10 years’ duration due to persistent parvovirus B19 infection and it's cure with immunoglobulin therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Kurtzman" 1 => "N. Frickhofen" 2 => "J. Kimball" 3 => "D.W. Jenkins" 4 => "A.W. Nienhuis" 5 => "N.S. Young" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM198908243210807" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1989" "volumen" => "321" "paginaInicial" => "519" "paginaFinal" => "522" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2548098" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0160" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pure red cell aplasia associated with parvovirus B19 infection occurring late after allogeneic bone marrow transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B. Hayes-Lattin" 1 => "J. Seipei" 2 => "K. Gatter" 3 => "M.C. Heinrich" 4 => "T. Mariarz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ajh.10474" "Revista" => array:6 [ "tituloSerie" => "Am J Hematol" "fecha" => "2004" "volumen" => "75" "paginaInicial" => "142" "paginaFinal" => "145" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14978694" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0165" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Observations on human parvovirus B19 infection diagnosed in 2011" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Mihaly" 1 => "A. Trethon" 2 => "Z. Arányi" 3 => "A. Lukács" 4 => "T. Kolozsi" 5 => "G. Prinz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1556/OH.2012.29447" "Revista" => array:6 [ "tituloSerie" => "Orv Hetil" "fecha" => "2012" "volumen" => "153" "paginaInicial" => "1948" "paginaFinal" => "1957" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23204301" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0170" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Síndrome hemofagociticorreactivo asociado a parvovirus B19 en un paciente con trasplante renopancreático" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Tavera" 1 => "J. Petroni" 2 => "L. León" 3 => "E. Minue" 4 => "D. Casadei" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3265/Nefrologia.pre2011.Oct.11179" "Revista" => array:6 [ "tituloSerie" => "Nefrologia" "fecha" => "2012" "volumen" => "32" "paginaInicial" => "125" "paginaFinal" => "126" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22294016" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0175" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parvovirus-B19-associated complications in renal transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W. Meryl" 1 => "B.K. Jeffrey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ncpneph0609" "Revista" => array:6 [ "tituloSerie" => "Nat Clin Pract Nephrol" "fecha" => "2007" "volumen" => "3" "paginaInicial" => "540" "paginaFinal" => "550" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17895931" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0180" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aplasia pura de serie roja adquirida en trasplantado renal: infección por parvovirus B19 frente a timoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N.A. Polanco-Flores" 1 => "M.V. Soto-Abraham" 2 => "R. Izaguirre-Ávila" 3 => "F.E. Rodríguez-Castellanos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "NefroPlus" "fecha" => "2013" "volumen" => "5" "paginaInicial" => "19" "paginaFinal" => "24" "itemHostRev" => array:3 [ "pii" => "S0091674911011572" "estado" => "S300" "issn" => "00916749" ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0185" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "B19 virus infection in renal transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Cavallo" 1 => "C. Merlino" 2 => "D. Re" 3 => "C. Bollero" 4 => "M. Bergallo" 5 => "D. Lembo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Virol" "fecha" => "2003" "volumen" => "26" "paginaInicial" => "361" "paginaFinal" => "368" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12637086" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0190" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical presentations of parvovirus B19 infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.T. Servey" 1 => "B.V. Reamy" 2 => "J. Hodge" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am Fam Physician" "fecha" => "2007" "volumen" => "75" "paginaInicial" => "373" "paginaFinal" => "376" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17304869" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0195" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parvovirus B19 infection causing red cell aplasia in renal transplantation on tacrolimus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Wong" 1 => "P. Chan" 2 => "C. Leung" 3 => "C. Szeto" 4 => "J. Tam" 5 => "P. Li" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Kidney Dis" "fecha" => "1999" "volumen" => "6" "paginaInicial" => "1132" "paginaFinal" => "1136" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0200" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Engraftment failure associated with peripheral blood stem cell transplantation, after B19 parvovirus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Solano" 1 => "O. Juan" 2 => "C. Giemno" 3 => "J. Garcia-Conde" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Blood" "fecha" => "1996" "volumen" => "88" "paginaInicial" => "1515" "paginaFinal" => "1517" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8695875" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0205" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intravenous immunoglobulin therapy for pure red cell aplasia related to human parvovirus B19 infection: a retrospective study of 10 patients and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Crabol" 1 => "B. Terrier" 2 => "F. Rozenberg" 3 => "V. Pestre" 4 => "C. Legendre" 5 => "O. Hermine" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/cis1046" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2013" "volumen" => "56" "paginaInicial" => "968" "paginaFinal" => "977" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23243178" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0210" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Human parvovirus B19 in solid organ transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.J. Eida" 1 => "S.F. Chenb" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ajt.12111" "Revista" => array:6 [ "tituloSerie" => "Am J Transplant" "fecha" => "2013" "volumen" => "13" "paginaInicial" => "201" "paginaFinal" => "205" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23465012" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0215" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How many times can parvovirus B19-related anemia recur in solid organ transplant recipients?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Gosset" 1 => "D. Viglietti" 2 => "K. Hue" 3 => "C. Antoine" 4 => "D. Glotz" 5 => "E. Pillebout" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1399-3062.2012.00773.x" "Revista" => array:7 [ "tituloSerie" => "Transpl Infect Dis" "fecha" => "2012" "volumen" => "14" "paginaInicial" => "E64" "paginaFinal" => "E70" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22931551" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S009167491001571X" "estado" => "S300" "issn" => "00916749" ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0220" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postransplant chronic anemia: parvovirus B19" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N. Loss" 1 => "M. Carminatti" 2 => "M. Fabiano" 3 => "A. Hallack" 4 => "H. Sanders" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bras Nefrol" "fecha" => "2012" "volumen" => "34" "paginaInicial" => "303" "paginaFinal" => "308" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23099839" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003700000002/v1_201705250045/S2013251417300767/v1_201705250045/en/main.assets" "Apartado" => array:4 [ "identificador" => "43440" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case report" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003700000002/v1_201705250045/S2013251417300767/v1_201705250045/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417300767?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 10 | 22 |
| 2024 October | 81 | 48 | 129 |
| 2024 September | 78 | 33 | 111 |
| 2024 August | 85 | 63 | 148 |
| 2024 July | 94 | 34 | 128 |
| 2024 June | 92 | 32 | 124 |
| 2024 May | 103 | 34 | 137 |
| 2024 April | 99 | 42 | 141 |
| 2024 March | 61 | 26 | 87 |
| 2024 February | 67 | 37 | 104 |
| 2024 January | 62 | 37 | 99 |
| 2023 December | 50 | 25 | 75 |
| 2023 November | 84 | 28 | 112 |
| 2023 October | 68 | 58 | 126 |
| 2023 September | 50 | 29 | 79 |
| 2023 August | 81 | 28 | 109 |
| 2023 July | 87 | 27 | 114 |
| 2023 June | 59 | 17 | 76 |
| 2023 May | 85 | 28 | 113 |
| 2023 April | 76 | 17 | 93 |
| 2023 March | 95 | 22 | 117 |
| 2023 February | 49 | 19 | 68 |
| 2023 January | 66 | 23 | 89 |
| 2022 December | 87 | 35 | 122 |
| 2022 November | 77 | 27 | 104 |
| 2022 October | 84 | 52 | 136 |
| 2022 September | 71 | 38 | 109 |
| 2022 August | 70 | 52 | 122 |
| 2022 July | 104 | 58 | 162 |
| 2022 June | 61 | 43 | 104 |
| 2022 May | 76 | 34 | 110 |
| 2022 April | 75 | 50 | 125 |
| 2022 March | 115 | 56 | 171 |
| 2022 February | 146 | 52 | 198 |
| 2022 January | 156 | 54 | 210 |
| 2021 December | 100 | 49 | 149 |
| 2021 November | 85 | 48 | 133 |
| 2021 October | 85 | 49 | 134 |
| 2021 September | 75 | 40 | 115 |
| 2021 August | 114 | 43 | 157 |
| 2021 July | 94 | 35 | 129 |
| 2021 June | 95 | 26 | 121 |
| 2021 May | 147 | 50 | 197 |
| 2021 April | 186 | 83 | 269 |
| 2021 March | 142 | 38 | 180 |
| 2021 February | 137 | 31 | 168 |
| 2021 January | 95 | 20 | 115 |
| 2020 December | 81 | 22 | 103 |
| 2020 November | 91 | 24 | 115 |
| 2020 October | 64 | 23 | 87 |
| 2020 September | 59 | 17 | 76 |
| 2020 August | 71 | 12 | 83 |
| 2020 July | 68 | 17 | 85 |
| 2020 June | 70 | 26 | 96 |
| 2020 May | 84 | 23 | 107 |
| 2020 April | 83 | 27 | 110 |
| 2020 March | 83 | 13 | 96 |
| 2020 February | 99 | 20 | 119 |
| 2020 January | 93 | 30 | 123 |
| 2019 December | 96 | 41 | 137 |
| 2019 November | 78 | 27 | 105 |
| 2019 October | 65 | 20 | 85 |
| 2019 September | 63 | 16 | 79 |
| 2019 August | 53 | 25 | 78 |
| 2019 July | 55 | 29 | 84 |
| 2019 June | 76 | 32 | 108 |
| 2019 May | 89 | 24 | 113 |
| 2019 April | 129 | 50 | 179 |
| 2019 March | 60 | 24 | 84 |
| 2019 February | 49 | 27 | 76 |
| 2019 January | 58 | 28 | 86 |
| 2018 December | 237 | 49 | 286 |
| 2018 November | 492 | 30 | 522 |
| 2018 October | 494 | 18 | 512 |
| 2018 September | 207 | 23 | 230 |
| 2018 August | 67 | 16 | 83 |
| 2018 July | 95 | 20 | 115 |
| 2018 June | 109 | 17 | 126 |
| 2018 May | 194 | 12 | 206 |
| 2018 April | 169 | 12 | 181 |
| 2018 March | 363 | 12 | 375 |
| 2018 February | 171 | 2 | 173 |
| 2018 January | 126 | 10 | 136 |
| 2017 December | 203 | 7 | 210 |
| 2017 November | 93 | 18 | 111 |
| 2017 October | 62 | 13 | 75 |
| 2017 September | 88 | 11 | 99 |
| 2017 August | 119 | 13 | 132 |
| 2017 July | 84 | 14 | 98 |
| 2017 June | 63 | 15 | 78 |
| 2017 May | 71 | 13 | 84 |
| 2017 April | 8 | 1 | 9 |
Show all
