Medical Care

Treatment may include the following:

Acetaminophen or ibuprofen is effective for treating fever in patients with parvovirus B19 (B19V) infection. Fever does not always require treatment with antipyretics; however, consider antipyretics if a patient appears clinically uncomfortable.
Resolution of infection depends on the presence of immunoglobulins against parvovirus B19. Intravenous immunoglobulin (IVIG) has been used with good results for patients suffering pure red cell aplasia (PRCA). Patients should be monitored for relapsed viremia.^{[8, 2, 28, 41]}
Patients in aplastic crisis require packed RBC transfusions.^[9]In some studies, more than 80% of patients with sickle cell disease in transient aplastic crisis (TAC) have required transfusion.^[8]IVIG is not recommended for TAC.
In patients receiving immunosuppressive agents, temporarily decreasing the dose of immunosuppressive agents usually enables the immune system to produce sufficient immunoglobulin G (IgG) to eradicate the infection and confer lifelong protection. In some individuals with human immunodeficiency virus (HIV) infection, highly active antiretroviral therapy restores immune function, enabling resolution of chronic parvovirus B19 infection.^[28]
Although its use is controversial and carries many risks, intrauterine blood transfusions may be helpful in cases of hydrops fetalis.^{[2, 14, 22, 25, 42]}

Consultations

Consultations may include the following:

Hematologist: Patients who present with aplastic crisis require intensive monitoring and RBC transfusions to prevent death and should be evaluated by a hematologist.
Pediatric infectious disease specialist or immunologist: Patients with long-term or unusual parvovirus B19 infections can benefit from consultation with a pediatric subspecialist in infectious diseases or immunology. These patients may benefit from treatment with IVIG.

Diet

No dietary restrictions are necessary.

Activity

Patients with classic erythema infectiosum are no longer contagious after the rash has appeared.^[9]

Patients with aplastic crisis, papular-purpuric "gloves and socks" syndrome (PPGSS), or immunosuppression and chronic parvovirus B19 infection with anemia should be isolated with droplet and standard precautions due to ongoing viremia.^[9]

Maintain precaution for patients with TAC for 7 days or until the reticulocyte count rebounds to at least 2%, whereas those with chronic infection should be isolated for the duration of their stay.^[9]

Pregnant staff should be alerted to the potential risks of parvovirus B19 infection when caring for these patients.^[9]

Medication

Cossart YE, Field AM, Cant B et al. Parvovirus-like particles in human sera. Lancet. 1975. 1:72.
Young NS, Brown KE. Parvovirus B19. N Engl J Med. 2004 Feb 5. 350(6):586-97. [QxMD MEDLINE Link].
Pattison JR,Jones SE, Hodgson J et al. Parvovirus infections and hypoplastic crisis in sickle cell anaemia. Lancet. 1981. 1:664.
Serjeant GR, Topley JM, Mason K, Serjeant BE, Pattison JR, Jones SE, et al. Outbreak of aplastic crises in sickle cell anaemia associated with parvovirus-like agent. Lancet. 1981 Sep 19. 2(8247):595-7.
Cherry JD, Schulte DJ. Human Parvovirus B19. Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL, eds. Feigin & Cherry's Textbook of Pediatric Infectious Diseases. 6th ed. Philadelphia, PA: Saunders Elsevier; 2009. Vol 2: 1902-1920.
Servey JT, Reamy BV, Hodge J. Clinical presentations of parvovirus B19 infection. Am Fam Physician. 2007 Feb 1. 75(3):373-6. [QxMD MEDLINE Link].
Anderson LJ, Hurwitz ES. Human parvovirus B19 and pregnancy. Clin Perinatol. 1988. 15:273.
Brown KE. Parvovirus B19. Bennet JE, Dolin R, Blaser M. Mandell, Douglas and Bennett's Principals and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Churchill Livingstone Elsevier; 2015. Vol 2: 1840-1847.
American Academy of Pediatrics Committee on Infectious Diseases. Parvovirus B19. Kimberlin DW, Brady M, Jackson SA, Long SS, eds. 2015 Red Book: Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Peiatrics; 2015. 593-596.
Landry ML. Parvovirus B19. Microbiol Spectr. 2016 Jun. 4 (3):1-13. [QxMD MEDLINE Link].
Schneider, E. Human Parvoviruses. Long SS, Pickering LK, Prober CG, eds. Principles and Practice of Pediatric Infectious Diseases. 4th ed. Philadelphia, PA: Churchill Livingstone Elsevier; 2012. 1087-1091.
Burns K, Parish CR. Parvoviridae. Knipe DM, Howley PM, eds. Fields Virology. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007. Vol 2: 65.
Mustafa MM, McClain KL. Diverse hematologic effects of parvovirus B19 infection. Pediatr Clin North Am. 1996 Jun. 43(3):809-21. [QxMD MEDLINE Link].
Ergaz Z, Ornoy A. Parvovirus B19 in pregnancy. Reprod Toxicol. 2006 May. 21(4):421-35. [QxMD MEDLINE Link].
Luzzi GA, Kurtz JB. Human parvovirus arthropathy and rheumatoid factor(Letter). Lancet. 1985. 1:1218.
Conrad ME, Studdard H et al. Case report: aplastic crisis in sickle cell disorders: bone marrow necrosis and human parvovirus infection. Am J Med Sci. 1988. 295:212.
Eid AJ, Brown RA, Patel R, Razonable RR. Parvovirus B19 infection after transplantation: a review of 98 cases. Clin Infect Dis. 2006 Jul 1. 43(1):40-8. [QxMD MEDLINE Link].
Lindblom A, Heyman M, Gustafsson I, Norbeck O, Kaldensjo T, Vernby A. Parvovirus B19 infection in children with acute lymphoblastic leukemia is associated with cytopenia resulting in prolonged interruptions of chemotherapy. Clin Infect Dis. 2008 Feb 15. 46(4):528-36. [QxMD MEDLINE Link].
Young NS. Hematologic and hematopoietic consequences of B19 parvovirus infection. Semin Hematol. 1988. 25:159.
Bascietto F, Liberati M, Murgano D, Buca D, Iacovelli A, Flacco ME, et al. Outcome of fetuses with congenital parvovirus B19 infection: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018 Nov. 52 (5):569-576. [QxMD MEDLINE Link].
Mendelson E, Aboudy Y, Smetana Z, Tepperberg M, Grossman Z. Laboratory assessment and diagnosis of congenital viral infections:Rubella, cytomegalovirus (CMV), varicella-zoster virus (VZV),herpes simplex virus (HSV), parvovirus B19 andhuman immunodeficiency virus (HIV). Reprod Toxicol. 2006. 21:350-382.
Adler SP, Koch WC. Human Parvovirus Infections. Remington JS, Klein JO, Wilson CB, Baker CJ. Infectious Diseases of the Fetus and Newborn Infant. 6th ed. Philadelphia, PA: Saunders Elsevier; 2006. 868-892.
Tolfvenstam T, Broliden K. Parvovirus B19 infection. Semin Fetal Neonatal Med. 2009 Aug. 14(4):218-21. [QxMD MEDLINE Link].
Simms RA, Liebling RE, Patel RR, et al. Management and outcome of pregnancies with parvovirus B19 infection over seven years in a tertiary fetal medicine unit. Fetal Diagn Ther. 2009. 25(4):373-8. [QxMD MEDLINE Link].
Infections. Cunningham FG, Leveno KL, Bloom SL, Hauth JC, Gilstrap III LC, Wenstrom KD, eds. Williams Obstetrics. 22nd Ed. USA: McGraw-Hill; 2001. chap 58.
Crane J, Mundle W, Boucoiran I, Gagnon R, Bujold E, Basso M, et al. Parvovirus B19 infection in pregnancy. J Obstet Gynaecol Can. 2014 Dec. 36(12):1107-16. [QxMD MEDLINE Link].
Ornoy A, Ergaz Z. Parvovirus B19 infection during pregnancy and risks to the fetus. Birth Defects Res. 2017 Mar 15. 109 (5):311-323. [QxMD MEDLINE Link].
Broliden K, Tolfvenstam T, Norbeck O. Clinical aspects of parvovirus B19 infection. Jrnl Internal Med. 2006. 260:285-304.
Hirai Y, Takeda Y. Atypical rashes in adult human Parvovirus B19 infection; atypical is typical. IDCases. 2016 Jun 23. 5:32-3. [QxMD MEDLINE Link].
Dollat M, Chaigne B, Cormier G, Costedoat-Chalumeau N, Lifermann F, Deroux A, et al. Extra-haematological manifestations related to human parvovirus B19 infection: retrospective study in 25 adults. BMC Infect Dis. 2018 Jul 4. 18 (1):302. [QxMD MEDLINE Link].
Grilli R, Izquierdo MJ, Farina MC, et al. Papular-purpuric "gloves and socks" syndrome: polymerase chain reaction demonstration of parvovirus B19 DNA in cutaneous lesions and sera. J Am Acad Dermatol. 1999 Nov. 41(5 Pt 1):793-6. [QxMD MEDLINE Link].
Fretzayas A, Douros K, Moustaki M, Nicolaidou P. Papular-purpuric gloves and socks syndrome in children and adolescents. Pediatr Infect Dis J. 2009 Mar. 28(3):250-2. [QxMD MEDLINE Link].
Ferrari B, Díaz MS, López M, Larralde M. Unusual skin manifestations associated with parvovirus B19 primary infection in children. Pediatr Dermatol. 2018 Nov. 35 (6):e341-e344. [QxMD MEDLINE Link].
Tschope C, Bock CT, Kasner M, Noutsias M, Westermann D, Schwimmbeck PL. High prevalence of cardiac parvovirus B19 infection in patients with isolated left ventricular diastolic dysfunction. Circulation. 2005 Feb 22. 111(7):879-86. [QxMD MEDLINE Link].
Douvoyiannis M, Litman N, Goldman DL. Neurologic manifestations associated with parvovirus B19 infection. Clin Infect Dis. 2009 Jun 15. 48(12):1713-23. [QxMD MEDLINE Link].
Kleinman SH, Glynn SA, Lee TH, et al. A linked donor-recipient study to evaluate parvovirus B19 transmission by blood component transfusion. Blood. 2009 Oct 22. 114(17):3677-83. [QxMD MEDLINE Link]. [Full Text].
Bredl S, Plentz A, Wenzel JJ, Pfister H, Möst J, Modrow S. False-negative serology in patients with acute parvovirus B19 infection. J Clin Virol. 2011 Jun. 51(2):115-20. [QxMD MEDLINE Link].
Soderlund-Venermo M, Hokynar K, Nieminen J et al. Undefined. Persistence of human parvovirus B 19 in human tissues. 2002. 50;:307-316.
Musiani M, Zerbini M et al.Gentilomi G et al. Parvovirus B19 clearance from peripheral blood after acute infection. J Infect Dis. 1995. 172:1360-1363.
Anderson MJ, Higgins PG, Davis LR, Willman JS, Jones SE, Kidd IM. Experimental parvoviral infection in humans. J Infect Dis. 1985 Aug. 152(2):257-65. [QxMD MEDLINE Link].
Onodera H, Nakagawa R, Nakagawa H, Urayama T, Haino K, Yunoki M. Long-term monitoring of virus antibody titers in human intravenous immunoglobulin lots derived from donors in Japan. Transfusion. 2018 Nov. 58 (11):2617-2626. [QxMD MEDLINE Link].
Failey CK, Smoleniec JS et al. Observational study of effect of intrauterine transfusions on outcome of fetal hydrops after parvovirus B 19 infection. Lancet. 1995. 346:1335-1337.
[Guideline] Center for Disease control and Prevention. Risk associated with human parvovirus infection. MMWR. 1989. 38:81.

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.

of 2

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.