Erythema infectiosum

Alternative names
Parvovirus B19; Fifth disease; Slapped cheek

Definition
Fifth disease is a viral illness with mild symptoms and a blotchy rash. The rash begins on the cheeks and spreads to the arms and legs.

Causes, incidence, and risk factors

Fifth disease is caused by human parvovirus B19. It often affects preschoolers or school-age children during the spring. The disease is spread by contact with respiratory secretions and usually lasts for five days. However, the rash associated with fifth disease may recur for several weeks. Recurrences may be brought on by exposure to sunlight, heat, exercise, fever, or emotional stress.

The first sign of the disease noticed by parents is usually bright red cheeks, which look as though the child has been recently slapped on both sides of the face. Following this, a rash appears on the extremities and trunk. The rash fades from the center outwards, giving it a lacy appearance. Over a period of 1-2 weeks, the rash disappears entirely. This illness is also sometimes associated with fever.

If a pregnant woman becomes infected with parvovirus, it can cause significant harm to her unborn baby. Any pregnant woman who believes that she may have been in contact with a person who has parvovirus should consult with her physician.

Parvovirus B19 is also thought to cause other diseases. In healthy adults (particularly women), it may be responsible for an infectious form of arthritis. In people with AIDS, a weakened immune system, or hereditary anemia such as sickle cell disease, it may produce a profound anemia (deficiency of certain blood cells) called “transient aplastic crisis.”

The majority of adults seem to have antibodies to parvovirus B19 in their bodies. This indicates that most people have been exposed to the virus, and also suggests that many infections go unnoticed.

Symptoms

• Rash, first appearing on the cheeks, often looks like “slapped cheeks”
  
• A rash spreading to the arms and legs about one day later, often has a “lacy” appearance
  
• Fever
  
• Joint pain

The appearance and pattern of the rash is examined. A classic appearance of the rash may make the diagnosis straightforward.

Blood tests for antibodies against parvovirus B19, which may indicate infection, are available, although they are not commonly necessary. They may be of use in the diagnosis of “aplastic crisis” and persistent anemia. Testing may also be done when there is a question of exposure in a pregnant mother whose immune status is not known.

Treatment
No treatment is usually required for fifth disease in children. If fever or joint discomfort is present then oral acetaminophen (such as Tylenol) may be given.

Expectations (prognosis)
Since this is a mild and generally benign viral infection, complete recovery can be expected.

Complications
There are generally no complications in normally healthy children.

Calling your health care provider
Call your health care provider if symptoms suggestive of fifth disease develop (to rule out other disorders that could be causing the symptoms).

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