Erythema Infectiosum - Causes, Symptoms and Treatment

Common Name: Fifth Disease

What is Erythema Infectiosum?

Erythema infectiosum, commonly known as fifth disease, is an acute parvovirus infection that mostly occurs in children but can affect adults as well. Infection is most likely at 4 to 12 years of age, but nearly 60% of the population is seropositive by adulthood. During outbreaks in schools, 10% to 60% of students may be infected. Fifth disease occurs most often during late winter or early spring. It is known worldwide. Although highly contagious, fifth disease resolves spontaneously in 7 to 10 days without serious complications in healthy individuals. It can, however, cause serious illness in persons with sickle cell disease or similar forms of chronic anemia; once the infection is controlled, the anemia resolves.

Erythema Infectiosum can also cause serious illness in those with leukemia or cancer, in those who have received an organ transplant, and in those with human immunodeficiency virus (HIV). Fifth disease causes the majority of episodes of transient aplastic crisis (TAC) in persons with chronic hemolytic anemia. Occasionally, serious complications may develop from parvovirus B 19 infection during pregnancy.

What are the Causes of Erythema Infectiosum?

The disease is caused by human parvovirus B 19 and is transmitted via respiratory secretions. The incubation period is usually 4 to 10 days.

What are the Signs and Symptoms of Erythema Infectiosum?

The classic sign of fifth disease is erythema over the cheeks (slapped-cheek appearance) and a lacy red rash on the trunk and limbs. Low-grade fever, malaise, or upper respiratory symptoms develop a few days before the rash appears. In adults, mild joint pain and swelling occurs (usually in the hands, wrists, and knees) and can last or recur for weeks to months.

Diagnosis for Erythema Infectiosum

Diagnosis is usually made from the typical appearance and pattern of spread of the rash. Light and electron microscopy are also helpful in detecting BI9 infections. The IgM-antibody assay test detects antibodies to parvovirus and can be performed when it is important to confirm the diagnosis.

Other conditions to consider are rubella, enteroviral disease, systemic lupus erythematosus, drug reaction, Lyme disease, and rheumatoid arthritis. Parvovirus B 19 infection should be included in the differential diagnosis of chronic anemia in immunodeficient patients.

Treatment of Erythema Infectiosum

Symptomatic treatment of fever, pain, or itching is all that is required. Adults with joint involvement should rest, restrict activities, and take anti-inflammatory medications (aspirin or ibuprofen.) Those with severe anemia may require blood transfusions and those with immune deficiencies may be treated with immune globulin.

Special Considerations and Prevention Tips for Erythema Infectiosum

• Follow standard precautions. Always wash your hands thoroughly before and after any contact with patients.
  
• Patients with TAC or chronic B 19 infection should be considered infectious and placed on isolation precautions in private rooms for the duration of their illness or until the infection has cleared. B 19-infected patients may share a room if there are no other contraindications. Persons in close contact with these individuals should wear masks, gowns if soiling is likely, and gloves.
  
• To avoid the risk of fetal loss and other complications of parvovirus infection, pregnant health care workers should consult their health care professional if there is an outbreak in the workplace.
  
• Because persons with fifth disease were already contagious before their rash appeared, it is not necessary to exclude them from work, school, or child care centers.
  
• Instruct patients with chronic hemolytic diseases to be aware of the risk of aplastic crisis if exposed to erythema infectiosum.
  
• Teach patients that frequent and proper hand washing helps reduce the risk of becoming infected with fifth disease.