Women infected during pregnancy with TORCH (Toxoplasmosis, Other, Rubella, Cytomegalovirus, and Herpes simplex viruses) pathogens have a higher risk of adverse birth outcomes including stillbirth / miscarriage because of mother-to-child transmission. To investigate these risks in pregnant women in Kenya, we analyzed serum specimens from a pregnancy cohort study at three healthcare facilities. A sample of 481 participants was selected for TORCH pathogen antibody testing to determine seroprevalence. A random selection of 285 from the 481 participants was selected to measure seroconversion. These sera were tested using an IgG enzyme-linked immunosorbent assay against 10 TORCH pathogens. We found that the seroprevalence of all but three of the 10 TORCH pathogens at enrollment was >30%, except for Bordetella pertussis (3.8%), Treponema pallidum (11.4%), and varicella zoster virus (0.5%). Conversely, very few participants seroconverted during their pregnancy and were herpes simplex virus type 2 (n = 24, 11.2%), parvovirus B19 (n = 14, 6.2%), and rubella (n = 12, 5.1%). For birth outcomes, 88% of the participant had live births and 12% had stillbirths or miscarriage. Cytomegalovirus positivity at enrolment had a statistically significant positive association with a live birth outcome (p = 0.0394). Of the 10 TORCH pathogens tested, none had an association with adverse pregnancy outcome.

Parvovirus B19 (B19V) infection during pregnancy may have serious consequences like fetal anaemia, hydrops fetalis, and fetal loss. Since epidemiological data on B19V infection are generally lacking in Sudan, the current study aimed to determine the seroprevalence of B19V in Sudanese pregnant women. Five hundred women, attending antenatal clinics in Khartoum state between November 2008 and March 2009, were enrolled and screened for B19V IgG and IgM antibodies by enzyme immunoassays. The study revealed a B19V IgG seroprevalence of 61·4%, with one subject positive for IgM. B19V DNA was not detected by PCR in any of the tested individuals. B19V IgG seroprevalence was significantly correlated with multigravidity (P = 0·046). Our data showed that B19V infection is prevalent in Sudan and we recommend further studies in Sudanese women, particularly in those with complications and adverse outcomes of pregnancy.

We describe a case of an 11-year-old boy who underwent orthotopic heart transplant for dilated cardiomyopathy. He developed a normocytic, normochromic anaemia with a low reticulocyte count 1 month after transplant. A bone marrow biopsy was performed, which showed a mildly hypocellular bone marrow with few red blood cell precursors with giant pro-erythroblasts indicative of a pure red cell aplasia. Parvovirus B19 polymerase chain reaction in the blood was positive 2 months after transplant. Intravenous immunoglobulin administration resulted in a resolution of the anaemia over several months. Unexplained pure red cell aplasia in immunosuppressed patients should alert one to the possibility of parvovirus B19 infection.

Maternal infection with parvovirus B19 during pregnancy can cause aplastic anemia in the fetus and may lead to nonimmune fetal hydrops and fetal demise. Twin pregnancies complicated by infection due to parvovirus B19 are very rare clinical events. We present a dichorionic, diamniotic, dizygotic twin pregnancy after in vitro fertilization with parvovirus B19 infection and viral transmission to both twins, but different outcomes. At 19 weeks gestation, hydrops fetalis was diagnosed for male twin A, female twin B did not show any abnormalities. At 22 weeks gestation an acute parvovirus B19 infection was detected and twin A was diagnosed with intrauterine fetal death (IUFD) by ultrasound at 23 weeks gestation. Viral DNA was detected in maternal blood as well as in placenta and liver tissue of this twin. Twin B was born at 35 weeks gestation asymptomatically and no signs of hydrops or other congenital anomalies but viral DNA was detected by PCR in serum. At the age of 2 years, both IgG titres against B19 and parvovirus DNA amplification copies were still positive in plasma of the surviving twin, but no clinical signs were detectable. It is remarkable that both twins were infected with parvovirus B19 early in pregnancy but showed a discordant clinical outcome. Our case report describes the rare occurrence of an intrauterine fetal death (IUFD) of one twin and the asymptomatic infection of the other in a twin pregnancy.