eMedicine Specialties > Emergency Medicine > Pediatric

Pediatrics, Fifth Disease or Erythema Infectiosum: Follow-up

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

Follow-up

Further Inpatient Care

  • Most children with aplastic crisis require hospitalization and probable transfusion and/or IVIG therapy.
  • Hospitalized patients with erythema infectiosum need no special isolation precautions; however, patients with aplastic crisis or immunosuppression with human parvovirus B19 infection should be isolated.
  • Pregnant health care workers should be informed of the potential risks to the fetus from parvovirus B19 infections. They should not be involved in treatment of immunocompromised patients with chronic parvovirus infection or patients with human parvovirus B19 – associated aplastic crisis.

Further Outpatient Care

  • Children with erythema infectiosum are not infectious and may attend childcare or school.
  • Pregnant women in contact with patients in the incubation period of erythema infectiosum or with aplastic crisis have a relatively low potential risk of infection. They can be referred for obstetric follow-up care for possible serologic testing and close fetal monitoring. 
  • Routine exclusion of pregnant women from the workplace where erythema infectiosum is occurring is not recommended, due to high prevalence of human parvovirus B19 infection and low incidence of fetal effects.

Inpatient & Outpatient Medications

  • Administer antipyretics, analgesics, antipruritics, and anti-inflammatories as needed.

Deterrence/Prevention

  • Avoid excessive heat or sunlight, which can cause rash flare-ups.

Complications

  • Arthralgias/arthropathies occur in up to 10% of pediatric patients and up to 50% of adult patients.

Prognosis

  • The rash of erythema infectiosum usually is self-resolving but may last several weeks or months with exacerbations from heat or sunlight.
  • Arthropathy usually lasts 2-4 weeks and on rare occasions can last months to years.
  • Erythroid cell line suppression usually lasts up to 2 weeks but may be chronic and last months to years.
  • The onset of erythema infectiosum rash usually indicates that reticulocytosis has returned and aplastic crisis will not occur.

Patient Education

  • Emphasize in discussion with parents that otherwise healthy patients with erythema infectiosum are not infectious once the rash appears; therefore, they do not need to be isolated or restricted from school/day care.
  • Infected children with hemolytic disease or immunosuppression may be quite infectious. Therefore, respiratory isolation, especially from other pregnant, chronically anemic, or immunosuppressed individuals, should be observed.
  • Good handwashing and infection control techniques should be encouraged.
  • For excellent patient education resources, visit eMedicine's Children's Health Center. Also, see eMedicine's patient education articles Fifth Disease and Skin Rashes in Children.

Miscellaneous

Medicolegal Pitfalls

  • Misdiagnosis as another childhood exanthem that requires intervention (eg, scarlet fever)
  • Failure to recognize special needs of patients prone to potentially serious complications of parvovirus infection
 


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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