Fifth Disease or Erythema Infectiosum Clinical Presentation

  • Author: Kenneth T Kwon, MD; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Apr 18, 2012
 

History

Erythema infectiosum is usually a biphasic illness.

  • Mild prodromal symptoms begin approximately 1 week after exposure and last 2-3 days.
    • Headache (20% of pediatric patients)
    • Fever (20%)
    • Sore throat (15%)
    • Pruritus (15%)
    • Coryza (10%)
    • Abdominal pain (10%)
    • Arthralgias (10%)
    • The symptoms above occur more frequently in adults than in children, especially joint symptoms (up to 50%).
  • These symptoms precede a symptom-free period of about 7-10 days, followed by a typical exanthem that occurs in 3 phases.
    • Phase 1: A bright red, raised, slapped-cheek rash with circumoral pallor develops.[5] The nasolabial folds are usually spared.
    • Phase 2: This phase occurs 1-4 days later and is characterized by an erythematous maculopapular rash on proximal extremities (usually arms and extensor surfaces) and trunk, which fades into a classic lace-like reticular pattern as confluent areas clear.[5] The palms and soles usually are spared.
    • Phase 3: Frequent clearing and recurrences for weeks, and occasionally months, may be due to stimuli such as exercise, irritation, or overheating of skin from bathing or sunlight. Pathognomonic reticulated lacy-appearing eruption Pathognomonic reticulated lacy-appearing eruption of fifth disease.
  • The rash is often pruritic, especially in adults.
  • Enanthems are virtually never observed.
  • The rash is observed in approximately 75% of human parvovirus B19 – infected pediatric patients but in less than 50% of infected adults.
  • The patient is no longer infectious when the rash appears. Patients with aplastic crisis continue to be viremic and infectious until RBC recovery occurs.
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Physical

  • Look for involved arthritis.
  • In decreasing order of frequency, site of involvement are the following:
    • Metacarpophalangeal and/or interphalangeal areas
    • Knees
    • Wrists
    • Ankles
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Causes

  • Human parvovirus B19 is the cause.
  • Complications of parvovirus infection are observed in patients with underlying chronic hemolytic anemias, congenital or acquired immunodeficiency states, and pregnancy.
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Contributor Information and Disclosures
Author

Kenneth T Kwon, MD  Director of Pediatric Emergency Medicine, Associate Clinical Professor, Department of Emergency Medicine, University of California at Irvine Medical Center, Co-Director, Pediatric Emergency Services, Mission Regional Medical Center/Children's Hospital of Orange County at Mission

Kenneth T Kwon, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Megan Boysen, MD  Resident Physician, Department of Emergency Medicine, University of California Irvine Medical Center

Megan Boysen, MD, is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Debra Slapper, MD  Consulting Staff, Department of Emergency Medicine, St Anthony's Hospital

Debra Slapper, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

References

  1. Cossart YE, Field AM, Cant B, Widdows D. Parvovirus-like particles in human sera. Lancet. Jan 11 1975;1(7898):72-3. [Medline].

  2. Anderson MJ, Higgins PG, Davis LR, Willman JS, Jones SE, Kidd IM. Experimental parvoviral infection in humans. J Infect Dis. Aug 1985;152(2):257-65. [Medline].

  3. American Academy of Pediatrics. Red Book: 2006 Report on the Committee of Infectious Diseases. 2006:484-487.

  4. Young NS, Brown KE. Parvovirus B19. N Engl J Med. Feb 5 2004;350(6):586-97. [Medline].

  5. Servey JT, Reamy BV, Hodge J. Clinical presentations of parvovirus B19 infection. Am Fam Physician. Feb 1 2007;75(3):373-6. [Medline].

  6. B-19 Parvovirus Vaccine Study. ClinicalTrials.gov. Available at http://clinicaltrials.gov/ct2/show/results/NCT00379938. Accessed 05/23/2010.

  7. Anderson LJ. Human parvovirus. In: Richman DD, Whitley RJ, Hayden FG, eds. Clinical Virology. New York: Churchill Livingston Inc; 1997:613-31.

  8. Cherry JD. Parvoviruses. In: Feigin RD, Cherry JD, eds. Textbook of Pediatric Infectious Diseases. Philadelphia: WB Saunders Co; 1992:1626-33.

  9. Cohen B. Parvovirus B19: an expanding spectrum of disease. BMJ. Dec 9 1995;311(7019):1549-52. [Medline].

  10. Feder HM Jr, Anderson I. Fifth disease. A brief review of infections in childhood, in adulthood, and pregnancy. Arch Intern Med. Oct 1989;149(10):2176-8. [Medline].

  11. Hall CJ. Parvovirus B19 infection in pregnancy. Arch Dis Child Fetal Neonatal Ed. Jul 1994;71(1):F4-5. [Medline].

  12. Hammond GW. Parvovirus. In: Long SS, Pickering LK, Prober CG, eds. Principles and Practice of Pediatric Infectious Diseases. New York: Churchill Livingston Inc; 1997:1205-9.

  13. Heegaard ED, Hornsleth A. Parvovirus: the expanding spectrum of disease. Acta Paediatr. Feb 1995;84(2):109-17. [Medline].

  14. Jones MF, Wold AD, Espy MJ, Smith TF. Serologic diagnosis of parvovirus B19 infections. Mayo Clin Proc. Nov 1993;68(11):1107-8. [Medline].

  15. Keeler ML. Human parvovirus B-19: not just a pediatric problem. J Emerg Med. Jan-Feb 1992;10(1):39-44. [Medline].

  16. Kirchner JT. Erythema infectiosum and other parvovirus B19 infections. Am Fam Physician. Aug 1994;50(2):335-41. [Medline].

  17. Qari M, Qadri SM. Parvovirus B19 infection. Associated diseases, common and uncommon. Postgrad Med. Jul 1996;100(1):239-43, 246, 252. [Medline].

 
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Classic slapped-cheek appearance of fifth disease.
Pathognomonic reticulated lacy-appearing eruption of fifth disease.
 
 
 
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