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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In response to the previously published <span class="elsevierStyleItalic">Letter to the Editor</span>&#44; we would like to thank the authors for their input and apologize for any misunderstandings that may have been caused by our article&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We concluded our article&#44; which was aimed primarily at dermatologists&#44; by saying that acute parvovirus B19 infection &#8220;should be suspected in any patient with a purpuric rash&#44; regardless of its distribution&#44; and particularly if the patient is a young woman&#44; seen in the spring or summer months&#44; with fever and joint pain&#8221;&#46; We added that &#8220;the presence of skin lesions&#44; presenting as either nonpalpable purpura &#40;papular-purpuric gloves and socks syndrome&#41; or palpable purpura &#40;probably vasculitis&#41;&#44; is particularly suggestive&#46;&#8221;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> We stressed the importance of this dermatologic sign&#44; not only because it was the most common clinical finding in our series&#44; but also because it prompts patients to visit their dermatologist&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">That said&#44; at no time did we wish to suggest that cutaneous lesions are the only manifestation of parvovirus B19 infection as&#44; as was also demonstrated in our series&#44; these lesions are present in just 55&#37; of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We also took the article by Parra et al&#46; into account&#44; which&#44; as can be seen&#44; is cited in our study&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We are afraid that we do not agree that papular-purpuric gloves and socks syndrome is a nondermatologic manifestation of parvovirus B19 infection&#46; As we explain in our article&#44; this syndrome is characterized by &#8220;erythema and swelling of the feet and hands that can cause pruritus&#44; pain&#44; and a burning sensation&#8221; and by &#8220;erythema that is sharply demarcated at the wrists and ankles and that progresses to purpuric lesions that spread centripetally and may be accompanied by mucosal lesions and systemic involvement&#46;&#8221;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Finally&#44; we believe that we refer throughout the article to the different clinical manifestations &#40;dermatologic or otherwise&#41; and diseases with which parvovirus B19 infection has been associated&#44; both in our series and in reports in the literature&#46; We drew attention to the potential complications of parvovirus B19 infection&#44; such as chronic anemia in immunodepressed patients&#44; aplastic crisis in patients with hemoglobinopathies&#44; and hydrops fetalis in pregnant women&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> While none of the patients in our series had severe disease associated with acute parvovirus B19 infection&#44; we did draw readers&#8217; attention to isolated reports in the literature of&#44; among others&#44; &#8220;acute fulminant hepatitis&#44; acute glomerulonephritis&#44; acute encephalitis and peripheral neuropathy&#44; myocarditis&#44; and aplastic anemia in immunocompetent patients&#8221;&#46; We also mentioned the possible association between parvovirus B19 infection and a range of autoimmune disorders described in the literature&#46; Nevertheless&#44; given the nature of our series&#44; we cannot draw any conclusions in this respect&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">We sincerely appreciate the interest the authors have shown in our article and hope to have clarified any misunderstandings that may have arisen&#46; We do&#44; however&#44; believe that any doubts can be dispelled by a careful&#44; in-depth reading of our article&#44; and of course we will be more than happy to hear any further contributions&#46;</p></span>"
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Letter to the Editor
Response to “Acute Parvovirus B19 Infection in Adults: A Retrospective Study of 49 Cases”
Réplica a «Estudio retrospectivo de 49 casos de infección aguda por parvovirus B19 en adultos»
A.I. Rodríguez Banderaa,
Autor para correspondencia
anarb85@gmail.com

Corresponding author.
, M. Mayor Arenala, K. Vorlickaa, E. Ruiz Bravo-Burguilllosb, D. Montero Vegac, C. Vidaurrázaga Díaz-Arcayaa
a Servicio de Dermatología, Hospital Universitario La Paz, Madrid, Spain
b Servicio Anatomía Patológica, Hospital Universitario La Paz, Madrid, Spain
c Servicio Microbiología, Hospital Universitario La Paz, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In response to the previously published <span class="elsevierStyleItalic">Letter to the Editor</span>&#44; we would like to thank the authors for their input and apologize for any misunderstandings that may have been caused by our article&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We concluded our article&#44; which was aimed primarily at dermatologists&#44; by saying that acute parvovirus B19 infection &#8220;should be suspected in any patient with a purpuric rash&#44; regardless of its distribution&#44; and particularly if the patient is a young woman&#44; seen in the spring or summer months&#44; with fever and joint pain&#8221;&#46; We added that &#8220;the presence of skin lesions&#44; presenting as either nonpalpable purpura &#40;papular-purpuric gloves and socks syndrome&#41; or palpable purpura &#40;probably vasculitis&#41;&#44; is particularly suggestive&#46;&#8221;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> We stressed the importance of this dermatologic sign&#44; not only because it was the most common clinical finding in our series&#44; but also because it prompts patients to visit their dermatologist&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">That said&#44; at no time did we wish to suggest that cutaneous lesions are the only manifestation of parvovirus B19 infection as&#44; as was also demonstrated in our series&#44; these lesions are present in just 55&#37; of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We also took the article by Parra et al&#46; into account&#44; which&#44; as can be seen&#44; is cited in our study&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We are afraid that we do not agree that papular-purpuric gloves and socks syndrome is a nondermatologic manifestation of parvovirus B19 infection&#46; As we explain in our article&#44; this syndrome is characterized by &#8220;erythema and swelling of the feet and hands that can cause pruritus&#44; pain&#44; and a burning sensation&#8221; and by &#8220;erythema that is sharply demarcated at the wrists and ankles and that progresses to purpuric lesions that spread centripetally and may be accompanied by mucosal lesions and systemic involvement&#46;&#8221;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Finally&#44; we believe that we refer throughout the article to the different clinical manifestations &#40;dermatologic or otherwise&#41; and diseases with which parvovirus B19 infection has been associated&#44; both in our series and in reports in the literature&#46; We drew attention to the potential complications of parvovirus B19 infection&#44; such as chronic anemia in immunodepressed patients&#44; aplastic crisis in patients with hemoglobinopathies&#44; and hydrops fetalis in pregnant women&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> While none of the patients in our series had severe disease associated with acute parvovirus B19 infection&#44; we did draw readers&#8217; attention to isolated reports in the literature of&#44; among others&#44; &#8220;acute fulminant hepatitis&#44; acute glomerulonephritis&#44; acute encephalitis and peripheral neuropathy&#44; myocarditis&#44; and aplastic anemia in immunocompetent patients&#8221;&#46; We also mentioned the possible association between parvovirus B19 infection and a range of autoimmune disorders described in the literature&#46; Nevertheless&#44; given the nature of our series&#44; we cannot draw any conclusions in this respect&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">We sincerely appreciate the interest the authors have shown in our article and hope to have clarified any misunderstandings that may have arisen&#46; We do&#44; however&#44; believe that any doubts can be dispelled by a careful&#44; in-depth reading of our article&#44; and of course we will be more than happy to hear any further contributions&#46;</p></span>"
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