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

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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.

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.

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