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.



  • 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 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



  • No specific treatment
  • Acetaminophen or Ibuprofen for associated myalgias



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Pediatrics.  Philadelphia:  Lippincott.

Center for Disease Control and Prevention (CDC) (n.d.). Public health image library (PHIL). Retrieved August 22, 2016, from

Centers for Disease Control and Prevention (CDC) (n.d.). Fifth Disease. Retrieved August 22, 2016, from

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.