Erythema infectiosum

Erythema infectiosum: Description:A mild infectious exanthema of childhood characterized by an erythematous maculopapular eruption, resulting in a lace-like facial rash or “slapped cheek” appearance. Fever and arthritis may also accompany infection; caused by Parvovirus B 19. Syn: fifth disease.Alternative name: Fifth disease.Erythema infectiosum is caused by a virus called parvovirus B19. The virus is transferred from one person to another via airborne droplets from the nose and throat, for example when coughing or sneezing. An infected pregnant woman can transfer the virus to her unborn baby.The incubation period for parvovirus B19 is between one and three weeks and the person will be infectious for about a week before the illness actually becomes apparent. By the time symptoms are present, the person is no longer infectious.The illness usually clears up without complications. The rash will normally last for up to a week. It may return several times in the following weeks as a response to stress, dramatic changes in temperature or physical exertion. The swelling in the joints is also temporary, but can last longer. Erythema infectiosum can also cause short-term anemia. The illness gives immunity which means that you can only have it once.Pregnant women who are infected with erythema infectiosum have a 5 per cent risk of passing on the illness to their baby. If a foetus is infected with erythema infectiosum it could lead to a miscarriage or stillbirth, but the risk is small. If the foetus is infected and becomes seriously anemic, a blood transfusion in the uterus is possible.Because children with erythema infectiosum (fifth disease) are contagious prior to the onset of the classic-appearing rash, preventing the spread of this common childhood exanthem is difficult. Attentive parents can only give their children the general good advice to frequently wash their hands and to avoid the sneezes, coughs, and discarded tissues of children who appear sick.Symptoms:Erythema infectiosumTypical initial manifestations are nonspecific flu-like symptoms (eg, low-grade fever, slight malaise). Several days later, an indurated, confluent erythema appears over the cheeks (“slapped-cheek” appearance) and a symmetric rash appears that is most prominent on the arms, legs, and trunk, usually sparing the palms and soles. The rash is maculopapular, tending toward confluence; it forms reticular or lacy patterns of slightly raised, blotchy areas with central clearing, usually most prominent on exposed areas. The rash, and the entire illness, generally lasts 5 to 10 days. However, the rash may recur for several weeks, exacerbated by sunlight, exercise, heat, fever, or emotional stress. Mild joint pain and swelling (nonerosive arthritis) that may persist or recur for weeks to months sometimes occurs in adults.Immunocompromised patients can develop protracted viremia (lasting 10 to 12 days), leading to severe anemia (chronic pure RBC aplasia). Erythema infectiosum can be transmitted transplacentally, sometimes resulting in stillbirth or severe fetal anemia with widespread edema (hydrops fetalis). However, about of pregnant women are immune because of previous infection. The risk of fetal death is 5 to 9% after maternal infection, with risk greatest during the 2nd trimester.Additional symptoms may include:Cough. Causes and Risk factors:The virus responsible for erythema infectiosum is parvovirus B19, a virus that lives only in humans. It seems to be transmitted mainly by body fluids, including droplets produced when you cough or sneeze but also including blood. Many people (adults and children) are infected with parvovirus B19 and show no symptoms whatever. However, some people with immune system problems may develop chronic parvovirus B19 infection, and may remain contagious for up to a week after the symptoms begin. Although very rare, parvovirus B19 infection can produce more severe results. These include anemia caused by hemolysis (breakdown of red blood cells). People with abnormalities in their hemoglobin, such as those with sickle-cell disease, may develop an "aplastic crisis". It is also possible for parvovirus B19 infection during pregnancy to cause "hydrops" (fluid overload and heart failure) in the developing fetus; however, this happens in less than 10% of mothers with proven parvovirus infection in the first trimester (which probably means that the risk is much less than 10%, since many infections go unnoticed). The risk of fetal death is about 2-6%, with the greatest risk in the first half of pregnancy. No one has shown that parvovirus B19 infection during pregnancy is associated with birth defects.Diagnosis:The diagnosis of fifth disease is made on the basis of a medical history and physical examination. When an exact diagnosis is important, the healthcare provider can order an antibody titer blood test.The diagnosis of erythema infectiosum (fifth disease) usually is based on clinical presentation alone, and a workup for patients with the classic presentation is not necessary.For patients with other PV-B19-associated signs or symptoms, or for exposure in a woman who is pregnant, confirmation of infection may be helpful and can be accomplished with the following specialized tests:IgM assays (enzyme-linked immunoassay, radioimmunoassay).
  • Dot blot hybridization.
  • Polymerase chain reaction (PCR).
  • Loop-mediated isothermal amplification.
Tests that may be used to evaluate erythema infectiosum include:Strep screen.
  • Complete blood count.
  • Monospot.
  • Blood cultures.
  • Cold agglutinins.
  • Chicken pox antibodies.
  • Rubella antibodies.
  • Measles antibodies.
Treatment:Since fifth disease is a mild illness, it usually does not require treatment. Home care for a child whose rash itches may include oatmeal baths or other over-the-counter bath treatments. Adolescents with joint pain may be treated with over-the-counter pain relievers such as acetaminophen (Tylenol and others) or ibuprofen (Advil, Motrin and others). Aspirin should never be given to children with fever or flu-like illness, including fifth disease, because of the risk of Reye's syndrome, a serious brain problem that develops in some children who have had certain viral illnesses and have been treated with aspirin.Children and adults with blood disorders (sickle cell anemia, hemolytic anemia), and children who have cancer or an immune deficiency, are at increased risk of serious illness as a result of fifth disease. Patients with an immune deficiency may be given intravenous immunoglobulin (IVIG) that contains antibodies against parvovirus B19.Symptomatic relief of erythema infectiosum (fifth disease) may be provided using nonsteroidal anti-inflammatory drugs (NSAIDs), antihistamines, and topical antipruritics, along with plenty of fluids and rest. For an acute aplastic crisis, supplemental oxygen and blood transfusions may be necessary. Intravenous immunoglobulin (IVIG) is helpful for chronic anemia in patients who are immunocompromised. Nonsteroidal anti-inflammatory drugs provide relief for fever, malaise, headache, and arthralgia. Although the effects of NSAIDs in the treatment of pain tend to be patient specific, ibuprofen usually is the drug of choice (DOC) for initial therapy. Other options include fenoprofen, flurbiprofen, mefenamic acid, ketoprofen, indomethacin, and piroxicam.Medicine and medications:Ibuprofen (Ibuprin, Advil, Motrin).
  • Hydroxyzine (Atarax, Vistaril).
Note: The following drugs and medications are in some way related to, or used in the treatment. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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