1. Dr. Hasan Hüseyin Gümüşcü1, Dr. Kevser Onbaşı1, Dr. Nilgün Kaşifoğlu2
Parvovirus B 19 infection may have a role have a role in the etiopathogenesis of type 1 DM
Dr. Hasan Hüseyin Gümüşcü1, Dr. Kevser Onbaşı1, Dr. Nilgün Kaşifoğlu2
Faculty of Medicine, Department of Internal Medicine and Endocrinology1 , Dumlupınar University, Kütahya, and Department of Microbiology 2, Eskişehir Osmanagzi University, Turkey.
INTRODUCTION
Parvovirus (Erythrovirus) B19 (EVB19) infection may trigger autoimmune diseases like SLE, RA, and vasculitis. Parvovirus B19 belongs to the parvoviridae family and to the erythrovirus genus (1,2). The etiopathogenesis of autoimmune diabetes mellitus could not been explained yet. The aim of our study was to investigate whether EVB19 may have a role in the etiopathogenesis of type 1 DM. Therefore have we examined whether EVB19 is more frequent among type 1 diabetics.
Methods:
32 patients with type 1 diabetes and 30 control patients were included in the study. 25 of the 32 type 1 diabetic patients had parvovirus B19 IgG positive sera. The seroprevalence of IgG parvovirus B19 among controls were in 16 of 30 persons. This was statistically significant (p level was 0,039). 25-OH vitamin D levels were lower among Parvovirus B19 IgG seropositive patients than seronegative patients. This may be related to the fact that the immune status is impaired in vitamin D insufficiency.
None of our patients had IgM positive sera for parvovirus B 19. This suggests that there was no acute infection.
There was no significant change of HbA1c levels between the negative and positive patients.
Table 1: Mean Vit D levels for seropositive and negative patients
Table 2: Mean vit D levels for patients and control group
DISCUSSION
Erythrovirus B19 (EVB19) has been incriminated, over recent years, in the onset and/or pathogenesis of many autoimmune diseases (3). Human parvovirus B19 is a single-stranded DNA virus which preferentially targets the erythroblasts in the bone marrow. B19 infection generally causes erythema infectiosum, arthralgia, fetal death, transient aplastic crisis in patients with shortened red cell survival, and persistent infection in people who are immunocompromised. Less observed clinical manifestations may atypical skin rashes, neurological syndromes, cardiac syndromes, and various cytopenias. B19 infection has also been associated with development of a variety of different autoimmune diseases, including rheumatological, neurological, neuromuscular, cardiovascular, haematological, nephrological and metabolic. Production of a variety of autoantibodies has been demonstrated to occur during B19 infection and these have been shown to be key to the pathogenesis of the particular disease process in a significant number of cases, for example, production of rheumatoid factor in cases of B19-associated rheumatoid arthritis and production of anti-glutamic acid decarboxylase (GAD) in patients with B19-associated type 1 diabetes mellitus (4). Similarity in amino acid sequence between parvovirus B19 proteins and human proteins may be related to such diseases that have been implicated in the pathogenesis of autoimmune disorders triggered by this virus.Although the pathophysiology of type 1 diabetes mellitus remains unclear, immunologic processes triggered by viral infection may have a role. Further studies showing the possible mechanistic link between viral infection and B-cell destruction should provide further insight into the pathogenesis of this condition (5).
In our study, Parvovirus B19 infection has been more frequently observed among type 1 diabetic patients.
CONCLUSION
In conclusion, parvovirus B19 infection may play a role in triggering type 1 diabetes and low vitamin D levels may increase susceptibility to parvovirus B 19 infection.
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