{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T17:36:16Z","timestamp":1793122576963,"version":"4.5.0"},"reference-count":50,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Background: Human parvovirus B19 causes a broad spectrum of clinical manifestations, ranging from the classic \u201cfifth disease\u201d to severe presentations. Clinical presentation varies considerably across age groups. In 2023\u20132024, a notable increase in parvovirus B19 cases was reported across Europe. Methods: We retrospectively analyzed pediatric patients with serum serology and\/or plasma PCR-confirmed parvovirus B19 infection treated at the tertiary infectious diseases center (University Hospital for Infectious Diseases, Zagreb) in 2023 (January\u2013August). Demographic, laboratory, viral load, and clinical characteristics were assessed, with emphasis on cutaneous manifestations. Results: A total of 102 patients were included (median age 10 years; 54.9% male), of whom 7.8% required hospitalization. Rash was present in 94 (92.2%) of the patients of whom 75 had erythema infectiosum and petechiae, while the rest had a combination of both. Patients with petechial rash were significantly older (p = 0.013) and exhibited lower platelet counts (p &lt; 0.001) compared with those with erythema. A higher proportion of anti-B19V IgM (p = 0.027) and IgG (p &lt; 0.001) antibodies was detected in patients with erythema. Petechial rash was associated with higher viral loads (p &lt; 0.001). In univariate analysis, the presence of anti-B19V IgG antibodies was correlated with the absence of petechial rash (OR = 0.09; p &lt; 0.001), whereas higher viral load was associated with its presence (OR = 1.7; p &lt; 0.001). In multivariate analysis, viral load emerged as the only predictor of petechial rash (aOR = 1.4, p = 0.042). Conclusions: Parvovirus B19 remains a self-limiting illness in healthy children, despite frequent atypical presentations. Higher viremia is associated with atypical rash morphology and suggests age-related differences in immune clearance.<\/jats:p>","DOI":"10.3390\/v18020223","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T15:23:14Z","timestamp":1770736994000},"page":"223","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Parvovirus B19 in Children: Clinical Spectrum, Viral Load Patterns, and Atypical Cutaneous Presentations in the Post-Pandemic Outbreak"],"prefix":"10.3390","volume":"18","author":[{"given":"Sanda","family":"\u0160krbina","sequence":"first","affiliation":[{"name":"Pediatric Infectious Disease Department, University Hospital for Infectious Diseases \u2018Dr. Fran Mihaljevi\u0107\u2019, Mirogojska 8, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Ljubas","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Disease Department, University Hospital for Infectious Diseases \u2018Dr. Fran Mihaljevi\u0107\u2019, Mirogojska 8, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana","family":"Valen\u010dak","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Disease Department, University Hospital for Infectious Diseases \u2018Dr. Fran Mihaljevi\u0107\u2019, Mirogojska 8, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leo","family":"Markovinovi\u0107","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Disease Department, University Hospital for Infectious Diseases \u2018Dr. Fran Mihaljevi\u0107\u2019, Mirogojska 8, 10000 Zagreb, Croatia"},{"name":"School of Medicine, University of Zagreb, \u0160alata 3, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8023-4314","authenticated-orcid":false,"given":"Oktavija","family":"\u0110akovi\u0107 Rode","sequence":"additional","affiliation":[{"name":"Department of Virology, University Hospital for Infectious Diseases \u201cDr. Fran Mihaljevi\u0107\u201d, Mirogojska 8, 10000 Zagreb, Croatia"},{"name":"School of Dental Medicine, University of Zagreb, Gunduli\u0107eva 5, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Snje\u017eana","family":"Zidovec-Lepej","sequence":"additional","affiliation":[{"name":"Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases \u2018Dr. Fran Mihaljevi\u0107\u2019, Mirogojska 8, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5153-5027","authenticated-orcid":false,"given":"Goran","family":"Te\u0161ovi\u0107","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Disease Department, University Hospital for Infectious Diseases \u2018Dr. Fran Mihaljevi\u0107\u2019, Mirogojska 8, 10000 Zagreb, Croatia"},{"name":"School of Medicine, University of Zagreb, \u0160alata 3, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1128\/microbiolspec.DMIH2-0008-2015","article-title":"Parvovirus B19","volume":"4","author":"Landry","year":"2016","journal-title":"Microbiol. Spectr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1128\/CMR.15.3.485-505.2002","article-title":"Human parvovirus B19","volume":"15","author":"Heegard","year":"2002","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1186\/s13052-024-01831-6","article-title":"Parvovirus B19 infection in children: A comprehensive review of clinical manifestations and management","volume":"50","author":"Bloise","year":"2024","journal-title":"Ital. J. Pediatr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"462","DOI":"10.2174\/1573396320666230428104619","article-title":"Erythema Infectiosum: A Narrative Rewiev","volume":"20","author":"Leung","year":"2024","journal-title":"Curr. Pediatr. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e70380","DOI":"10.1002\/jmv.70380","article-title":"Parvovirus B19 Rebound","volume":"97","author":"Ranno","year":"2025","journal-title":"J. Med. Virol."},{"key":"ref_6","first-page":"283","article-title":"Atypical exanthems associated with parvovirus B19 infection: Similarities and differences between adults and children","volume":"23","author":"Drago","year":"2015","journal-title":"Infez. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1053\/hp.2000.6714","article-title":"The cutaneous manifestations of human parvovirus B19 infection","volume":"31","author":"Magro","year":"2000","journal-title":"Hum. Pathol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1111\/j.1365-2141.1994.tb06743.x","article-title":"Parvovirus B19 as a cause of acquired chronic pure red cell aplasia","volume":"87","author":"Frickhofen","year":"1994","journal-title":"Br. J. Haematol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1002\/rmv.395","article-title":"Parvovirus B19 and the pathogenesis of anaemia","volume":"13","author":"Chisaka","year":"2003","journal-title":"Rev. Med. Virol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"100007","DOI":"10.1016\/j.amolm.2023.100007","article-title":"Parvovirus B19: Insights and implication for pathogenesis, prevention and therapy","volume":"1","author":"Zakrzewska","year":"2023","journal-title":"Mol. Aspects Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"102829","DOI":"10.1100\/2012\/102829","article-title":"Parvovirus B19 infection and severe anemia in renal transplant recipients","volume":"2012","author":"Carraturo","year":"2012","journal-title":"Sci. World J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"ofv049","DOI":"10.1093\/ofid\/ofv049","article-title":"Congenital Parvovirus B19 Infection: Persistent Viremia and Red Blood Cell Aplasia","volume":"2","author":"Nadimpalli","year":"2015","journal-title":"Open Forum Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1086\/505082","article-title":"Parvovirus B19 infection contributes to severe anemia in young children in Papua New Guinea","volume":"194","author":"Wildig","year":"2006","journal-title":"J. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1002\/jvc2.239","article-title":"Parvovirus in dermatology: A review","volume":"2","author":"Pudasaini","year":"2023","journal-title":"JEADV Clin. Pract."},{"key":"ref_15","unstructured":"(2025, December 05). European Centre for Disease Prevention and Control (ECDC)\u2014Risks Posed by Reported Increased Circulation of Human Parvovirus B19 in the EU\/EEA. Available online: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/risks-posed-reported-increased-circulation-human-parvovirus-b19-eueea."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Patalon, T., Saciuk, Y., Trotzky, D., Pachys, G., Ben-Tov, A., Segal, Y., and Gazit, S. (2023). An Outbreak of Parvovirus B19 in Israel. Viruses, 15.","DOI":"10.3390\/v15112261"},{"key":"ref_17","first-page":"2400339","article-title":"An unusual outbreak of parvovirus B19 infections, France, 2023 to 2024","volume":"29","author":"Fouillet","year":"2024","journal-title":"Eur. Surveill."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Beligni, G., Alessandri, G., and Cusi, M.G. (2025). Genotypic Characterization of Human Parvovirus B19 Circulating in the 2024 Outbreak in Tuscany, Italy. Pathogens, 14.","DOI":"10.3390\/pathogens14020121"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2400299","DOI":"10.2807\/1560-7917.ES.2024.29.24.2400299","article-title":"Epidemic of parvovirus B19 and disease severity in pregnant people, Denmark, January to March 2024","volume":"29","author":"Nordholm","year":"2024","journal-title":"Eur. Surveill."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"9630","DOI":"10.1038\/s41598-024-59582-7","article-title":"Changing epidemiology of parvovirus B19 in the Netherlands since 1990, including its re-emergence after the COVID-19 pandemic","volume":"14","author":"Russcher","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_21","first-page":"456","article-title":"Ongoing outbreak of maternal parvovirus B19 infections in Germany since end of 2023: Consequence of COVID-19 pandemic?","volume":"64","author":"Berg","year":"2025","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s00705-025-06228-2","article-title":"Seroepidemiology (2018\u20132024) and epidemic spread of an emerging human parvovirus B19 genotype 1 (subtype 1a2) variant in Hungary, 2023\/2024","volume":"170","author":"Moser","year":"2025","journal-title":"Arch. Virol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S319","DOI":"10.1093\/ofid\/ofx163.751","article-title":"Clinical and Laboratory Characteristics of Parvovirus B19 Infection During 2013\/2014 Outbreak in Zagreb, Croatia","volume":"4","author":"Ajdukovi","year":"2017","journal-title":"Open Forum. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Vilibi\u0107-\u010cavlek, T., Tabain, I., Kolaric, B., Mihulja, K., Blazevic, L., Bogdanic, M., Navolan, D., Beader, N., and Mrzljak, A. (2021). Parvovirus B19 in Croatia: A Large-Scale Seroprevalence Study. Medicina (Kaunas), 57.","DOI":"10.3390\/medicina57111279"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Vilibi\u0107-\u010cavlek, T., Barbi\u0107, K., Bogdani\u0107, M., Mija\u010d, M., Sankovi\u0107, A., Navolan, D., Motofelea, N., Stoian, D.L., and Ljubin-Sternak, S. (2025). Temporal, Spatial and Seasonal Patterns of Parvovirus B19 Seroepidemiology in Childbearing-Aged Women in Croatia, 2015\u20132024. Viruses, 17.","DOI":"10.3390\/v17111477"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2219","DOI":"10.1007\/s15010-025-02598-6","article-title":"Diverse clinical manifestations of Parvovirus B19 infections during the 2024 outbreak in Germany","volume":"53","author":"Holzem","year":"2025","journal-title":"Infection"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"105798","DOI":"10.1016\/j.jcv.2025.105798","article-title":"Insights into the clinical and molecular epidemiology of an infections outbreak of human parvovirus B19 in France, 2023\u20132024","volume":"178","author":"Creuzet","year":"2025","journal-title":"J. Clin. Virol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Tonon, M., Panaite, S.A., Gentili, D., Ferraresso, A., Da Re, F., Ballarin, D., Zanella, F., Padovan, M.T., Pascarella, M., and Mondino, S. (2025). Retrospective and Prospective Surveillance and Clinical Presentation of Parvovirus B19 in Veneto, Italy, 2024. Microorganisms, 16.","DOI":"10.3390\/microorganisms13020430"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"107865","DOI":"10.1016\/j.ijid.2025.107865","article-title":"The synergistic tapestry: Unraveling the interplay of parvovirus B19 with other viruses","volume":"154","author":"Akhtar","year":"2025","journal-title":"Int. J. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1086\/344773","article-title":"Papular purpuric rash due to parvovirus B19 with distribution on the distal extremities and the face","volume":"35","author":"Harel","year":"2002","journal-title":"Clin. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"S109","DOI":"10.1016\/j.jaad.2004.11.040","article-title":"Generalized petechial eruption induced by parvovirus B19 infection","volume":"52","author":"McNeely","year":"2005","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.jpeds.2020.09.033","article-title":"Unilateral Laterothoracic Exanthema","volume":"229","year":"2021","journal-title":"J. Pediatr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1111\/j.1468-3083.2006.01443.x","article-title":"Asymmetric periflexural exanthem of childhood: Report of two cases with parvovirus B19","volume":"20","author":"Fagundo","year":"2006","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.jcv.2011.08.004","article-title":"Parvovirus B19-associated purpuric-petechial eruption","volume":"52","author":"Hashimoto","year":"2011","journal-title":"J. Clin. Virol."},{"key":"ref_35","first-page":"250","article-title":"Petechial rash associated with Parvovirus B19 in children: Case report and literature review","volume":"22","author":"Tuccio","year":"2014","journal-title":"Infez. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.jcv.2012.06.013","article-title":"PVB19-associated purpuric\u2013petechial eruption with Henoch Sch\u00f6nlein-like distribution","volume":"55","year":"2012","journal-title":"J. Clin. Virol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Takeuchi, M., Shiozawa, R., Hangai, M., Takita, J., and Kitanaka, S. (2013). Cephalhematoma and petechial rashes associated with acute parvovirus B19 infection: A case report. BMC Infect. Dis., 13.","DOI":"10.1186\/1471-2334-13-465"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1097\/INF.0000000000004541","article-title":"Clinical Presentations of Parvovirus B19: A Case Series","volume":"44","author":"Tricella","year":"2025","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e136","DOI":"10.1097\/INF.0000000000004669","article-title":"Petechial and Purpuric Rashes During a Parvovirus B19 Outbreak: Are Skin Symptoms Differentiated?","volume":"44","author":"Kus","year":"2024","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"7942","DOI":"10.1128\/JVI.00891-08","article-title":"Human parvovirus B19 NS1 protein modulates inflammatory signaling by activation of STAT3\/PIAS3 in human endothelial cells","volume":"82","author":"Duechting","year":"2008","journal-title":"J. Virol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"731","DOI":"10.2217\/fvl.10.56","article-title":"Parvovirus infection-induced cell death and cell cycle arrest","volume":"5","author":"Chen","year":"2010","journal-title":"Future Virol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"199","DOI":"10.4149\/av_2014_03_199","article-title":"Human parvovirus B19: A review","volume":"58","author":"Rogo","year":"2014","journal-title":"Acta Virol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1997","DOI":"10.1182\/blood.V76.10.1997.1997","article-title":"Parvovirus B19-induced perturbation of human megakaryocytopoiesis in vitro","volume":"76","author":"Srivastava","year":"1990","journal-title":"Blood"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e117","DOI":"10.1086\/430442","article-title":"Recurrent erythema in patients with long-term parvovirus B19 infection","volume":"40","author":"Musiani","year":"2005","journal-title":"Clin. Infect. Dis."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/j.idnow.2021.05.004","article-title":"Pediatric Infectious Disease Group (GPIP) position paper on the immune debt of the COVID-19 pandemic in childhood, how can we fill the immunity gap?","volume":"51","author":"Cohen","year":"2021","journal-title":"Infect. Dis. Now"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1873","DOI":"10.1086\/382963","article-title":"B cell memory is directed toward conformational epitopes of parvovirus B19 capsid proteins and the unique region of VP1","volume":"189","author":"Corcoran","year":"2004","journal-title":"J. Infect. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"12017","DOI":"10.1128\/JVI.01435-06","article-title":"Conformational changes in the VP1-unique region of native human parvovirus B19 lead to exposure of internal sequences that play a role in virus neutralization and infectivity","volume":"80","author":"Ros","year":"2006","journal-title":"J. Virol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"106409","DOI":"10.1016\/j.jinf.2025.106409","article-title":"Virological characterization of Parvovirus B19 isolated during the atypical 2023-2024 outbreak in France","volume":"90","author":"Veyrenche","year":"2025","journal-title":"J. Infect."},{"key":"ref_49","first-page":"515","article-title":"Surveillance of blood donors detects an exceptional Parvovirus B19 outbreak in Switzerland in 2023\/2024","volume":"23","author":"Serricchio","year":"2025","journal-title":"Blood Transfus."},{"key":"ref_50","unstructured":"Pecek, L. (2024). Molecular Typing of Parvovirus B19 Isolates from 2023. Epidemic in Croatia. [Master\u2019s Thesis, Department of Biology, Faculty of Science, University of Zagreb]. Available online: https:\/\/urn.nsk.hr\/urn:nbn:hr:217:648131."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/18\/2\/223\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T15:30:09Z","timestamp":1770737409000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/18\/2\/223"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,10]]},"references-count":50,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["v18020223"],"URL":"https:\/\/doi.org\/10.3390\/v18020223","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,10]]}}}