Viral Infections

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Overview

Erythema infectiosum, also known as fifth disease, is a viral infection that mainly occurs in childhood, usually as an epidemic associated with outbreaks in schools.

Cause

Erythema infectiosum is caused by parvovirus B19. It is believed to be primarily transmitted by the respiratory route (the B19 virus has been isolated from respiratory secretions during the contagious phase). Once the rash appears, the child is no longer contagious. About one-half of adults are immune to the infection due to previous exposure.

Signs and Symptoms

The incubation period ranges from 1 to 2 weeks. Elevated quantities of the virus are found in the blood and secretions for about 1 to 2 weeks after exposure. During this time, low-grade fever and malaise may be present. About 2 weeks after exposure, a characteristic rash appears, in three stages. First a "slapped cheek", or "sunburned" appearance on the child's face occurs.

Second, pink, slightly elevated bumps appear on the arms and legs. Finally, after several days, the rash begins to fade, and an overall lacy or marble-like pattern occurs. This last phase of the rash is highly diagnostic of fifth disease. The lacy rash typically resolves in 1 1/2 weeks but can persist more than 3 weeks. After apparent resolution, it may resurface, especially during hot weather. There are some reports of itching.

In adults, especially women, sudden joint pain is the primary symptom, affecting the hands, wrists, feet, ankles, and knees. While it usually resolves quickly, it can persist or recur for months. Men more often present with flu-like symptoms. Sometimes fatigue and malaise can linger for weeks after the infection. Itching can occur as well, even without a rash.

Rarely, a "gloves and socks" syndrome can be seen in teenagers and adults. It presents with redness and swelling of the hands and feet as well as petechiae (pe-TE-ke-ay), minute red spots in the skin caused by blood leaking from the capillaries. This eruption resolves within 2 weeks.

Complications
Parvovirus B19 can cause massive decreased blood cell production, especially in people with a history of decreased production or increased destruction of blood cells. Fatigue, worsening anemia, and paleness can be seen. A blood transfusion may be needed, if the red blood cell count drops too low. Shortly after, the transfusion, bone marrow produces more red blood cells and recovery occurs.

Infected pregnant women with no prior B19 infection and no immunity to the virus are at risk for complications. The risk of infection following exposure is less than 10%. Most fetuses are not affected, however miscarriage, severe anemia, and death of the fetus have been reported. Parvovirus B19 is not a common cause of birth defects.

Diagnosis

Diagnosis is typically based on clinical presentation. A blood test can confirm the diagnosis by looking for particular antibodies (protective immune proteins) to parvovirus B19.

Treatment

No specific treatment is available for erythema infectiosum.

Prevention

There is no vaccine to prevent infection with parvovirus B19. Since people with the infection are usually contagious prior to the appearance of symptoms, isolation attempts have not been successful. Blood testing is offered to pregnant women with known exposure to determine whether the woman has lifelong immunity or if she has recently been infected. In the latter case, the pregnancy should be monitored closely with frequent ultrasound exams.

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