Sections

Sections Parvovirus B19 Infection
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
- Medical Care
- Consultations
- Diet
- Activity
- Show All
Medication
Follow-up
Questions & Answers
Media Gallery
References

Medication

Medication Summary

No antiviral therapy is available to treat parvovirus B19 (B19V) infections. Children rarely require specific therapy other than acetaminophen for fever.

In patients with postinfectious arthritis, acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) usually provide symptomatic relief. Because the use of aspirin in children with other viral illnesses has been associated with Reye syndrome, aspirin use is not recommended in children with B19V infection. If children have pruritus from the parvovirus B19 rash, oral antihistamines (eg, diphenhydramine) and starch baths typically provide relief.

Class Summary

These agents decrease or eliminate fever by acting at the level of the hypothalamus (acetaminophen) or by decreasing the activity of the enzyme cyclooxygenase, thereby decreasing the production of prostaglandins (NSAIDs).

Acetaminophen (Tylenol, Feverall, Tempra, Aspirin Free Anacin, Panadol)

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Reduces fever by acting directly on hypothalamic heat-regulating centers, which increases dissipation of body heat via vasodilation and sweating.

Ibuprofen (Motrin, Ibuprin, Advil)

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One of the few NSAIDs indicated for reduction of fever.

Class Summary

These agents are purified preparations of gamma globulin. Immunologic effectors are derived from large pools of human plasma and comprise 4 subclasses of antibodies, approximating the distribution of human serum.

Immunity to B19V infection appears to be purely humoral (ie, mediated via immunoglobulins). The role, if any, that cell-mediated immunity plays in providing immunity to B19V is unknown. As a result of the high seroprevalence of IgG against parvovirus among adults in the general population who have recovered from infection, the antiparvovirus IgG titer in IVIG is probably sufficient to provide passive immunity for the clearance of virus in immunocompromised hosts with chronic B19V infection.

Immune globulin, intravenous (Gammagard S/D, Carimune NF, Gammar-P)

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Provides passive immunization against a broad spectrum of infectious agents. Neutralizes circulating myelin antibodies through anti-idiotypic antibodies; down-regulates proinflammatory cytokines, including INF-gamma; blocks Fc receptors on macrophages; suppresses inducer T and B cells and augments suppressor T cells; blocks complement cascade; promotes remyelination; may increase CSF IgG (10%).

Class Summary

These agents decrease or prevent allergic symptoms caused by histamine receptors from mast cells.

Diphenhydramine (Benadryl)

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First-generation antihistamine that binds to H1 receptors in the CNS and the body.

Competitively blocks histamine from binding to H1 receptors. As a result of CNS penetration, diphenhydramine frequently causes drowsiness. A small percentage of children paradoxically respond to diphenhydramine with agitation.

Follow-up

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Media Gallery

Note the right side of this boy's face displaying signs of erythema infectiosum, or Fifth disease. Image courtesy of CDC.
Elementary school child with Fifth Disease. Image courtesy of CDC.

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Author

David J Cennimo, MD, FAAP, FACP, FIDSA, AAHIVS Associate Professor of Medicine and Pediatrics, Adult and Pediatric Infectious Diseases, Rutgers New Jersey Medical School

David J Cennimo, MD, FAAP, FACP, FIDSA, AAHIVS is a member of the following medical societies: American Academy of HIV Medicine, American Academy of Pediatrics, American College of Physicians, American Medical Association, HIV Medicine Association, Infectious Diseases Society of America, Medical Society of New Jersey, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Coauthor(s)

Arry Dieudonne, MD Associate Professor of Pediatrics, Division of Pulmonology, Allergy, Immunology and Infectious Diseases, Rutgers New Jersey Medical School; Clinical Director, Francois-Xavier Bagnold Center for Children, University Hospital

Arry Dieudonne, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa

Disclosure: Received research grant from: Pfizer;GlaxoSmithKline;AstraZeneca;Merck;American Academy of Pediatrics, Novavax, Regeneron, Diassess, Actelion<br/>Received income in an amount equal to or greater than $250 from: Sanofi Pasteur.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Glenn Fennelly, MD, MPH Director, Division of Infectious Diseases, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center; Clinical Associate Professor of Pediatrics, Albert Einstein College of Medicine

Glenn Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthor Dennis Cunningham, MD, to the original writing and development of this article.

Sections Parvovirus B19 Infection
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
- Medical Care
- Consultations
- Diet
- Activity
- Show All
Medication
Follow-up
Questions & Answers
Media Gallery
References

Parvovirus B19 Infection Medication

Medication Summary

Antipyretic agents

Class Summary

Acetaminophen (Tylenol, Feverall, Tempra, Aspirin Free Anacin, Panadol)

Acetaminophen (Tylenol, Feverall, Tempra, Aspirin Free Anacin, Panadol)

Ibuprofen (Motrin, Ibuprin, Advil)

Ibuprofen (Motrin, Ibuprin, Advil)

Immunologic effectors

Class Summary

Immune globulin, intravenous (Gammagard S/D, Carimune NF, Gammar-P)

Immune globulin, intravenous (Gammagard S/D, Carimune NF, Gammar-P)

Antihistamines

Class Summary

Diphenhydramine (Benadryl)

Diphenhydramine (Benadryl)

Parvovirus B19 Infection Medication

Medication Summary

Antipyretic agents

Class Summary

Acetaminophen (Tylenol, Feverall, Tempra, Aspirin Free Anacin, Panadol)

Acetaminophen (Tylenol, Feverall, Tempra, Aspirin Free Anacin, Panadol)

Ibuprofen (Motrin, Ibuprin, Advil)

Ibuprofen (Motrin, Ibuprin, Advil)

Immunologic effectors

Class Summary

Immune globulin, intravenous (Gammagard S/D, Carimune NF, Gammar-P)

Immune globulin, intravenous (Gammagard S/D, Carimune NF, Gammar-P)

Antihistamines

Class Summary

Diphenhydramine (Benadryl)

Diphenhydramine (Benadryl)

References

Tables

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