Bocavirus Infection

  • Medical Author:
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Bocavirus facts

  • Bocavirus are members of the Parvoviridae virus family that are small (20 nm), non-enveloped viruses with single-stranded DNA.
  • Bocavirus is found usually in infants and children who are hospitalized with pneumonia or diarrheal symptoms.
  • Bocavirus is often detected in patients who are infected with other viruses.
  • Although some investigators suspect bocavirus to cause infection and disease, there is no definitive proof that bocavirus causes infection or disease, either alone or with other viruses.
  • There are no diagnostic tests or medical treatments for bocavirus; researchers detect bocavirus with a PCR test that is not widely available.
  • There is no vaccine available for bocavirus.
  • Research in the next few years should better define what role, if any, bocavirus plays in human infections and diseases.

What is bocavirus?

Bocavirus (also termed HBoV or human bocavirus) is a small (20 nm in size) non-enveloped virus with a single strand of DNA that comprises its genome. The bocavirus genus is a member of the Parvoviridae family, and to date, three strains have been identified: HBoV, HBoV-2, and HBoV-3. Bocavirus is a new viral genus that was discovered in 2005 in upper respiratory secretions from acutely ill children. The name bocavirus was derived by combining the names bovine parvovirus with canine minutevirus with which bocavirus shares some genetic and structural characteristics. The ICTVdB (International Committee on Taxonomy of Viruses database) has detailed its genome and structure.

Although this virus has been found worldwide in humans and animals, there is ongoing research and discussion about this virus as being a pathogen that causes infection, either alone or in conjunction with other virus types. Many investigators consider this newly discovered virus genus as an "emerging viral pathogen" because it is only proven to be associated with infections but not yet proven to be a cause of them, either alone or in conjunction with other viruses. However, another member of the Parvoviridae family, a parvovirus termed B19, causes erythema infectiosum (fifth disease or "slapped cheek" syndrome), hydrops fetalis (severe anemia in pregnant women), and aplastic crisis (cessation of red blood cell production) in individuals that have sickle cell disease. Bocavirus has not been associated with these conditions caused by parvovirus B19.

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What are the symptoms and signs of bocavirus infection?

Because bocavirus is usually only found in individuals (usually infants, children, and infrequently in young adults) with lower respiratory infections or diarrhea, these are the following symptoms and signs associated with the presence of bocavirus:

  • ARTI (also termed RTIs, acute respiratory tract infections), especially in infants and children
  • Cough
  • Wheezing
  • Fever
  • Cyanosis (bluish or grayish tint to skin due to lack of oxygen)
  • Rhinorrhea (runny nose)
  • Diarrhea
  • Vomiting

The infants and children with these nonspecific symptoms often are very ill and require hospitalization. It is important to note that it is not clear yet that bocavirus is either completely or partially responsible for these signs and symptoms. Currently, most of the clinical articles that discuss bocavirus describe patients with at least several of the symptoms and signs listed above, with pneumonia as the major problem. Some investigators report months of bocavirus shedding (having tests demonstrate the presence of the virus in body secretions) in patients with cancer (leukemia), but the significance of this shedding is not clear.

How is bocavirus infection spread?

Because bocavirus is a newly detected virus, many basic studies are still being planned or are ongoing. Consequently, conclusions about how the virus is spread are based on suppositions that are supported by some scientific findings, but not yet proved by scientific tests. Since the virus can be detected in high numbers in the respiratory tract and in respiratory secretions of some hospitalized patients, investigators suggest that bocavirus is mainly spread to other humans by respiratory secretions. However, it can also be found in stools (diarrhea) and in blood, so these may be alternative ways for the virus to spread. Unfortunately, to date, there are no animal or viral cell culture systems to investigate bocavirus strains. It is clear, however, that from the few epidemiological studies done that bocavirus can be found worldwide in about 1.5%-19% of the population, usually in sick children.

How is bocavirus infection diagnosed?

Most investigators agree that bocavirus "infection" is a diagnosis by association as the virus has not yet proven to be definitively responsible for a disease state. There are no commercially available tests for any bocavirus strains. Researchers, however, use a polymerase chain reaction (PCR) to detect virus in nasopharyngeal aspirates (NPA) and samples of blood and diarrhea. These PCR tests detect the genetic material of the viruses, but the PCR tests are not widely available. Many researchers use the terms "detected bocavirus" or "associated with" instead of "definitively diagnosed with bocavirus infection" when they discuss the patients with symptoms described above. However stated, many investigators who work with these ill children clearly suspect bocavirus is playing some role in the disease process.

What is the treatment for bocavirus infection?

There is no treatment, medical or antiviral, that is known to effectively target bocavirus strains. A few investigators suggest that since there is no definitive evidence that bocavirus causes infection or disease, either alone or in combination with other viruses, there should be no treatment directed toward bocavirus. Other investigators believe that since bocavirus strains are usually associated with patients with respiratory or gastrointestinal symptoms, treatments should be considered. Currently, the only available treatments (for example, oxygen, respiratory support, and hydration) are for the relief of symptoms since no specific anti-bocavirus treatments are available.

What is the prognosis of bocavirus infection?

The prognosis of patients with bocavirus detected is unclear because it is not known if bocavirus is responsible, alone or in part, for any disease or infection. However, when bocavirus strains are detected, they are frequently found associated (from about 45%-93% of patients tested by experienced investigators) with other viruses known to cause infections. The viruses that are identified in association with bocavirus are of several different types:

As research on bocavirus progresses, other types of associated viruses are likely to be found. The prognosis for patients with these viruses is usually good, especially if patients are seen and treated by a medical caregiver early in the infection. However, for a few patients who develop severe symptoms with these viral infections, the prognosis may range from fair to poor.

Can bocavirus infection be prevented?

Bocavirus strains have not yet been shown definitively to cause infection; prevention methods await development and are likely to be investigated if these viruses are shown to participate in causing infection. Currently, there is no vaccine in development for human use.

Medically reviewed by Margaret Walsh, MD; American Board of Pediatrics

REFERENCES:

Allander, T., M.T. Tammi, M. Eriksson, et al. "Cloning of a Human Parvovirus by Molecular Screening of Respiratory Tract Samples." Proc Natl Acad Sci USA 102.36 Sept. 6 2005: 12891-12896.

Bennett, Nicholas John, and Joseph Domachowske. "Bocavirus." eMedicine.com. Oct. 6, 2008. <http://emedicine.medscape.com/article/1355393-overview>.

Song, J., Y. Jin, Z. Xie, et al. "Novel Human Bocavirus in Children With Acute Respiratory Tract Infection." Emerg Infect Dis 16.2 (2010): 324-327.

United States. Centers for Disease Control and Prevention. "Human Bocavirus 2 in Children, South Korea." Oct. 23, 2009. <http://www.cdc.gov/EID/content/15/10/1698.htm>.

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Reviewed on 6/10/2015
References
Medically reviewed by Margaret Walsh, MD; American Board of Pediatrics

REFERENCES:

Allander, T., M.T. Tammi, M. Eriksson, et al. "Cloning of a Human Parvovirus by Molecular Screening of Respiratory Tract Samples." Proc Natl Acad Sci USA 102.36 Sept. 6 2005: 12891-12896.

Bennett, Nicholas John, and Joseph Domachowske. "Bocavirus." eMedicine.com. Oct. 6, 2008. <http://emedicine.medscape.com/article/1355393-overview>.

Song, J., Y. Jin, Z. Xie, et al. "Novel Human Bocavirus in Children With Acute Respiratory Tract Infection." Emerg Infect Dis 16.2 (2010): 324-327.

United States. Centers for Disease Control and Prevention. "Human Bocavirus 2 in Children, South Korea." Oct. 23, 2009. <http://www.cdc.gov/EID/content/15/10/1698.htm>.

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