Erythema Infectiosum Fifth Disease

Basic Facts

Fifth's disease is also called Erythema Infectiosum or "slapped cheek disease". It is an infection caused by the human Parvovirus B19. Although there are animal parvoviruses, Parvovirus B19 infects only humans. A person cannot catch parvovirus from an animal. It is called fifth disease because it is number five of six classic exanthemas, or rash-associated diseases, of childhood. The other five are:

Measles
Scarlet fever
Rubella
Duke's disease (which is now thought to have been another form of either measles, scarlet fever, a Staphylococcal infection, or one of several unspecified enteroviral infections)
Roseola

It has also been referred to in the past as "Hungarian Measles" although the rash itself does not resemble measles.

Symptoms

Fifth disease usually starts with cold symptoms such as a runny nose, and respiratory ailments and can include:

Malaise: a general feeling of illness or sickness without any specific diagnostic significance
Fever: occurs in approximately one-third of patients, and is usually low-grade
A rash: The rash commonly starts on the face and gives the patient a "slapped cheek" appearance. After appearing on the face, the rash then travels to the trunk, arms, and legs. The rash begins as red blotches, and as these fade it takes on the appearance of a net-like lace. Usually there is no itching associated with the rash.

Other symptoms, which are usually associated with adults and older children who contract the disease are:

Swollen glands
Red eyes
Sore throat
Diarrhea
Joint swelling and/or pain (the hands, wrists, knees and ankles are affected most often)
Blistering type of rash

Infection has also been associated with arthritis in adults.

Contagion

Fifth disease is contracted through bodily fluids, specifically by coughing or sneezing. However, it can also be transmitted through the blood. The rash itself usually appears 6 to 11 days after the initial symptoms, and is actually an immune reaction after the infection passes. A child with the rash is not usually contagious. The contagious period lasts either during incubation or during the time of mild respiratory symptoms. The incubation period ranges from 4 to 28 days, and the rash lasts for 1 to 3 weeks, but can be reactivated by sunlight, heat, exercise, and stress. As with the other exanthemas, once infected by the Parvovirus B19, a person usually will be immune throughout the rest of his/her lifetime.

Complications:

In the past, Fifth disease has been viewed as an unimportant childhood disease. However, recent studies have shown that the virus may cause severe complications in children with immune deficiency, leukemia, or other blood disorders such as sickle cell disease or hemolytic anemia. (Hemolytic refers to the destruction of red blood cells and the release of the hemoglobin they contain.) All people with hemolytic anemias rely on high erythrocyte (red blood cell) production rates to maintain adequate hemoglobin levels. If the capacity of the bone marrow to manufacture new red cells is compromised, hematrocrit can dramatically fall to levels that are potentially fatal. In patients with hemolytic anemia, parvovirus B19 suppresses bone marrow erythropoietic activity, leading to transient aplastic crisis. (Transient aplastic anemia refers to the inability to produce red blood cells or tissue and is of short duration.) Parvovirus B19 infections

can also produce serious complications in patients who are immune compromised. Also, exposure to the virus by pregnant women can occasionally produce a congenital anemia in the fetus, therefore, it is recommended that anyone exposed to Parvovirus B19, or Fifth disease, immediately contact his or her health provider.

It was stated in a New York State Department of Health Communicable Disease Fact sheet, while there is no evidence that Parvovirus B19 infection is a significant cause of fetal defects, studies have shown that infection may increase the risk of miscarriage or spontaneous abortion, and in people with chronic red blood cell disorders, infection may result in severe anemia.

Prevention

There are no current measures to effectively control Fifth disease.

In an article by the National Center for Infectious diseases, it was stated that about fifty percent of pregnant women are already immune to the disease, and complications with the fetus or the pregnancy occurs in less than five percent of all pregnant women who are infected with Parvovirus B19. However, pregnant women or people with blood disorders should contact their health provider and/or the local state health department for advice. Blood testing is available at some private laboratories and at the New York State Health Department laboratory to determine if you are already immune or infected with Parvovirus B19. In addition to your health provider, information can be obtained from your local health department or the New York State Department of Health Healthy Baby Hotline at 1 (800) 522-5006.

Prevention is difficult since the rash does not appear until after the infection is gone, and there is no vaccine for Fifth disease. Also, giving immunoglobulin is not recommended for those who have been exposed to Fifth disease. The best prevention is hand washing.

Treatment

Usually only the symptoms of Fifth disease are treated; such as fever, pain or itching. Adults with joint pain and swelling should contact their health care providers for the proper treatment. People who have severe anemia caused by Parvovirus B19 may need to be hospitalized and given blood transfusions, including treatment with immune globulin (antibodies), to help rid them of the infection, and bridge the gap between marrow suppression and recovery. Usually the bone marrow is poised for a rapid response once the virus is tamed. Again, it is imperative to contact your health care provider in order to receive the best possible treatment.

Other resources include:

Respiratory and Enteric Viruses Branch, National Center for Infectious Diseases, at 404-639-3607 (telephone) or 404-639-4960 (facsimile)
New York State Department of Health
New York State Department of Health Healthy Baby Hotline at (800) 522-5006

Always Your Choice Updated August 2001