Erythema Infectiosum (Fifth Disease)

Fifth Disease (Erythema Infectiosum)

Parvovirus B 19 Infection

  • Fifth disease is a viral illness with 3 stages                                  

    Fifth Disease Source: CDC

    Fifth Disease
    Source: CDC

  • Caused by Human parvovirus B19
  • Occurs in late winter & early spring
  • Highest incidence seen in children ages 5 to 15 years
  • Transmitted by droplets
  • Incubation period is 4-14 days
  • Contagious prior to rash. Isolation not necessary one rash appearance
  • Fifth disease during pregnancy can result in spontaneous abortion & stillbirth
  • Fetal abnormalities have not been associated with B19 viral infections
  • Immunity happens after one attack
  • Rash may reoccur weeks to months after exposure
  • Arthritis is the most common complication in adults but rare in children
  • Learn more about signs, symptoms, treatments, & prevention.

 

Pregnancy

  • The most significant effect of human parvovirus on the fetus is fetal hydrops from aplastic anemia
  • If the IgM is positive, the fetus should be monitored weekly.  Refer this patient to OBGYN.
  • Level II sonogram should be done in a pregnant women with suspicion of parvovirus infection

 

Clinical Signs & Symptoms

  • Patient often reports mild systemic symptoms: low-grade fever, headache,chills,malaise, myalgia, pharyngitis, conjunctivitis
  • Prodromal phase: 1-4 days. Mildly erythematous pharynx or conjunctiva
  • Second stage: 4-7 days asymptomatic
  • Third stage: exanthema appears in 3 stages

 

Exanthema appears in 3 stages:

  • 1st stage- “slapped-cheek” rash which appears 4-7 days after symptoms. Photos of slapped-cheek rash. Rash is fiery red with circumoral pallor on cheeks. Rash is exacerbated by heat.
  • 2nd stage- happens 1-2 days after onset of facial rash-erythematous maculopapular discrete rash on trunk & extremities that fades leaving a lacy rash
  • 3rd stage- last 1-2 weeks-lacy rash characterized by evanescence & recrudescence

Diagnosis

  • Diagnosis is generally made by the appearance of the characteristic exanthem
  • Serology can be done to confirm diagnosis

 

Differential Diagnosis

  • Measles
  • Rubella
  • Roseola
  • Scarlet Fever
  • Enteroviruses
  • Drug Reactions
  • Allergic Responses

 

Treatments

  • No specific treatment
  • Acetaminophen or Ibuprofen for associated myalgias

 

References

Boynton, R., Dunn, E.S., & Stephens, G.R. (2009). 6th edition.  Manual of Ambulatory

Pediatrics.  Philadelphia:  Lippincott.

Center for Disease Control and Prevention (CDC) (n.d.). Public health image library (PHIL). Retrieved August 22, 2016, from https://phil.cdc.gov/phil/home.asp

Centers for Disease Control and Prevention (CDC) (n.d.). Fifth Disease. Retrieved August 22, 2016, from https://www.cdc.gov/rmsf/

Dunphy, L.M., Winland-Brown, J. E. (2015).  Primary Care:  The Art and Science of

Advanced Practice Nursing. (4th ed).   Philadelphia, PA.  F.A. Davis 

Uphold, C.R., & Graham, M.V. (2013). Clinical guidelines in family practice. (5th ed.)      Gainesville, Fl.: Barmarrae Books, Inc.

Youngkin, E.Q., & Davis, M.S. (2012). Women’s health: A primary care clinical guide

 (4th. ed ). Norwalk, CT: Appleton and Lange.