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Updated: Dec 25 2021

Erythema Infectiousum (Fifth Disease)

  • Snapshot
    • A 4-year-old boy presents to the urgent care clinic for a new rash. His mother reports that the rash started on both his cheeks yesterday, but since then he has developed a rash on his trunk. On physical exam, he has a slapped cheeks appearance and has a maculopapular rash on his trunk with some areas having a lacy or reticular appearance. The physician advises him to stay home while he is still contagious and to stay away from pregnant women.
  • Introduction
    • Classification
      • parvovirus B19
        • a nonenveloped, linear, single-stranded DNA virus
        • causes a variety of diseases
          • aplastic crisis in patients with red blood cell disorders
          • pure red blood cell aplasia in adults
          • rheumatoid arthritis-like symptom in adults
          • erythema infectiosum (fifth disease) in children
          • hydrops fetalis in fetuses if pregnant women are infected
        • transmission via respiratory droplets
  • Epidemiology
    • Incidence
      • highest in winter and spring
    • Demographics
      • children > adults
    • Risk factors
      • sickle cell disease
      • thalassemia
      • hereditary spherocytosis
      • close proximity to others (e.g., school or daycare centers)
    • Pathogenesis
      • infects red blood cells through the P antigen
      • viral replication in bone marrow causes the death of erythroid progenitor cells
      • causes hydrops fetalis in fetuses due to severe fetal anemia
  • Presentation
    • Symptoms
      • prodrome with flu-like symptom
      • hydrops fetalis and fetal death in pregnant women
      • polyarthropathy
        • small joints (e.g., hands) - typically the only symptom in adults 
    • Physical exam
      • erythema infectiosum
        • first rash appears as slapped cheeks
        • subsequent rash is an erythematous maculopapular rash on the trunk and limbs, which may appear reticular or lacy
  • Studies
    • Labs
      • parvovirus-specific immunoglobulin M
      • detection of parvovirus on polymerase chain reaction
      • anemia
  • Differential
    • Measles
      • distinguishing factors
        • confluent maculopapular rash without slapped cheeks rash
        • Koplik spots on buccal mucosa
    • Rubella
      • distinguishing factor
        • non-confluent maculopapular rash that spreads from face to body
    • Making the diagnosis
      • based on clinical presentation
      • may be confirmed with laboratory studies
  • Treatment
    • Management approach
      • mainstay of treatment is supportive care
    • Conservative
      • supportive care
        • indication
          • all patients
        • modalities
          • analgesics
          • hydration
    • Medical
      • non-steroidal anti-inflammatory drugs
        • indication
          • polyarthropathy
  • Complications
    • Myocarditis
    • Behcet syndrome
    • Aplastic crisis
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