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Pediatrics, Fifth Disease or Erythema Infectiosum: Differential Diagnoses & Workup

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
Contributor Information and Disclosures

Updated: Mar 19, 2009

Differential Diagnoses

Pediatrics, Hand-Foot-and-Mouth Disease
Pediatrics, Scarlet Fever
Pediatrics, Measles
Systemic Lupus Erythematosus
Pediatrics, Mumps
Pediatrics, Roseola Infantum
Pediatrics, Rubella

Other Problems to Be Considered

Pediatrics, drug eruption
Pediatrics, allergic rashes
Pediatrics, viral exanthem unspecified

Workup

Laboratory Studies

  • Because of the usual classic exanthem and the benign course of disease in healthy patients, routine laboratory studies are not indicated.1
    • The leukocyte count is usually within the reference range. Mild eosinophilia may occur.
    • Consider determination of the CBC and serologic testing in the presence of coexisting hemolytic disease, pregnancy, or arthropathy.
  • Human parvovirus B19 does not grow in standard blood or tissue culture systems.

Other Tests

  • Ab testing by means of radioimmunoassay (RIA) and/or enzyme-linked immunosorbent assay (ELISA) is most commonly used.
    • Immunoglobulin M (IgM) Ab is usually detectable within 3 days of onset of symptoms. It peaks at about 3 weeks and always indicates acute infection.
    • IgG Ab confirms previous infection and is observed 2-3 weeks after exposure.  It persists for life.
    • Ab testing usually is available only through commercial reference laboratories or state health and research laboratories.
    • These tests are unreliable for diagnosing infection in immunosuppressed patients.
  • Other nonemergency diagnostic tests are antigen testing and DNA polymerase chain reaction (PCR) testing (the best method for detecting chronic infection in immunosuppressed patients).

More on Pediatrics, Fifth Disease or Erythema Infectiosum

Overview: Pediatrics, Fifth Disease or Erythema Infectiosum
Differential Diagnoses & Workup: Pediatrics, Fifth Disease or Erythema Infectiosum
Treatment & Medication: Pediatrics, Fifth Disease or Erythema Infectiosum
Follow-up: Pediatrics, Fifth Disease or Erythema Infectiosum
Multimedia: Pediatrics, Fifth Disease or Erythema Infectiosum
References
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References

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

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

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

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

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

  6. 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].

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

  8. 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.

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

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

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

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

  13. 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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Further Reading

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Keywords

fifth disease, erythema infectiosum, parvovirus, parvovirus infection, slapped cheek, fifth disease treatment, fifth disease symptoms, contagious, EI, human parvovirus B19, human parvovirus B19 infection, HPV B19, HPV B19 infection, aplastic anemia, lacy exanthem, Parvoviridae, polyarthropathy, hydrops fetalis

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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 Pediatrics, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Wayne Wolfram, MD, MPH, Clinical Associate Professor, Departments of Pediatrics, Children's Hospital and University of Cincinnati
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.

CME Editor

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.

 
 
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