Erythema infectiosum, or “fifth disease,” is an infection that results in a mild rash on the face, trunk, and limbs. In healthy
people, fifth disease usually resolves without medical treatment, but pregnant women and people who have an impaired
immune system, sickle cell anemia, or other blood disorders may need to consult a physician.
Causes
Fifth disease is caused by a parvovirus B19 infection. (This is not the same parvovirus that infects dogs and cats;
parvovirus B19 only infects humans.) It is estimated that about half of all adults have been infected with parvovirus B19 at
some time.
Since parvovirus is found in respiratory secretions (eg, saliva, sputum, nasal mucus), it is usually spread from
person-to-person through direct contact with these secretions.
Risk Factors
An adult who is not immune can be infected with parvovirus B19 and either have no symptoms or develop the typical rash of fifth disease, joint pain or swelling, or both. Usually, joints on both sides of the body are affected. The joints most frequently affected are the hands, wrists, and knees. The joint pain and swelling usually resolve in a week or two, but they may last several months. About 50% of adults, however, have been previously infected with parvovirus B19, have developed immunity to the virus, and cannot get fifth disease. The following factors increase your chance of developing fifth disease. If you have any of these risk factors, tell your doctor:
Symptoms
If you experience any of these symptoms, do not assume it is due to fifth disease. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.
Fifth disease is a mild rash illness that occurs most commonly in children. The ill child typically has a "slapped-cheek" rash on the face and a lacy red rash on the trunk and limbs. Occasionally, the rash may itch. An ill child may have a low-grade fever, malaise, or a "cold" a few days before the rash breaks out. The child is usually not very ill, and the rash resolves in 7 to 10 days. These symptoms include:
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Low-grade fever
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Headache
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A stuffy or runny nose
A few days after these symptoms pass, a bright red rash begins to develop on the face (known as a slapped cheek rash). Several days later, this rash spreads as a lighter red, blotchy rash down the trunk and limbs. The rash usually resolves within 7-10 days. In previously uninfected adults, there may be no symptoms or development of a typical rash. Some adults
may also have joint pain and swelling.
Diagnosis
A physician can often diagnose fifth disease by seeing the typical rash during a physical examination. In cases in which it is important to confirm the diagnosis, a blood test may be done to look for antibodies to parvovirus. Antibodies are proteins produced by the immune system in response to parvovirus B19 and other germs. If immunoglobulin M (IgM) antibody to parvovirus B19 is detected, the test result suggests that the person has had a recent infection.
Tests may include the following:
Treatment
Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Medications
Since fifth disease is caused by a virus, antibiotics are ineffective in treating it, and there are currently no antiviral
medications that will treat fifth disease.
Usually, fifth disease does not require any treatment other than rest. Medications such as acetaminophen may be used to
relieve joint pain and reduce fever. Anti-itch medications may be used to relieve itching associated with the rash.
People With Chronic Anemia
In people with sickle cell disease or other types of chronic anemia, parvovirus B19 can sometimes cause acute, severe
anemia. In this case, the anemia will require treatment, which may include hospitalization and blood transfusion.
People With Immune Problems
People with immune problems may need special medical care, such as treatment with antibodies, to help cure the infection.
Women Who Are Pregnant
Sometimes, a parvovirus B19 infection in pregnant women will cause severe anemia in the unborn baby or possibly miscarriage. This is infrequent (less than 5% of the time). Usually, there are no serious complications; however, if you are pregnant and believe that you may have parvovirus B19 infection or if you have been exposed to someone with parvovirus
B19 infection, then you should be seen by your obstetrician for evaluation.
Prevention
There is no vaccine or medicine that prevents parvovirus B19 infection. Frequent handwashing is recommended as a practical and probably effective method to decrease the chance of becoming infected. Excluding persons with fifth disease from work, child care centers, or schools is not likely to prevent the spread of the virus, since people are contagious before they develop the rash.
It is difficult to prevent the spread of fifth disease since the virus is most contagious before the rash appears.
To help reduce your chances of getting fifth disease, practice good hygiene, especially hand washing, which can help prevent the spread of many infections.
RESOURCES:
American Academy of Family Physicians
http://familydoctor.org
Nemours Foundation
http://www.kidshealth.org
US Centers for Disease Control and Prevention
http://www.cdc.gov
CANADIAN RESOURCES:
AboutKidsHealth
http://www.aboutkidshealth.ca
BC Health Guide
http://www.bchealthguide.org
References:
Fifth disease. Nemours Foundation website. Available at: http://kidshealth.org/parent/infections/bacterial_viral/fifth.html.
Accessed July 14, 2005.
Fifth disease in the child-care setting. Medem website. Available at: http://www.medem.com/search/article_display.cfm?path=\\TANQUERAY\M_ContentItem&mstr=/M_ContentItem/ZZZRHO
ZUHCC.html&soc=CDC&srch_typ=NAV_SERCH. Accessed July 14, 2005.
Parvovirus B19 (fifth disease). US Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncidod/dvrd/revb/respiratory/parvo_b19.htm. Accessed July 14, 2005.
Parvovirus B19 infection and pregnancy. US Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncidod/dvrd/revb/respiratory/B19&preg.htm. Accessed July 14, 2005.
Parvovirus B19 infection and pregnancy. US Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncidod/dvrd/revb/respiratory/B19&preg.htm. Accessed December 1, 2006.
