Erythema infectiosum (fifth disease)

Erythema Infectiosum
(Fifth Disease)
Prof. Dr. Saad S Al Ani
Prof. of Pediatrics
Senior Pediatric Consultant
Saad’s Kids Clinic
anahbaghdad@gmail.com
12/3/2020
Erythema infectiosum
Pro. Dr. Saad S Al Ani
1

(fifth disease)
Is caused by the human parvovirus
B19, a single-stranded DNA virus
producing a benign viral exanthem in
healthy children
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The viral affinity for red blood cell progenitor cells
makes it an important cause of aplastic crisis in
patients with hemolytic anemias, including:
• Sickle cell disease
• Spherocytosis
• Thalassemia
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Parvovirus B19 also causes fetal
anemia and hydrops fetalis after
primary infection during pregnancy
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The cell receptor for parvovirus B19 is the
erythrocyte P antigen, a glycolipid present
on erythroid cells.
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The virus replicates in actively dividing
erythroid stem cells, leading to cell death
that results in erythroid aplasia and anemia.
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Cont.)

Erythema infectiosum is common
Seroprevalence is :
*2% to 9% in children <5 years of age
* 15% to 35% in children 5 to 18 years
* 30% to 60% in adults
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Parvovirus B19
Seroprevalence

Community epidemics usually occur in the spring.
The virus is transmitted by:
• respiratory secretions
• blood product transfusions..
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The incubation period is typically
4 to 14 days and rarely may last 21
days
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Virological events
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Parvovirus B19 sets up a systemic infection with copious viremia
one week after inoculation. At the same time, virus is shed from
the respiratory tract. As the viral titres fall IgM appears
http://virology-online.com/viruses/Parvoviruses3.htm

Hematological events
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During viremia, reticulocyte numbers fall to undetectable numbers,
recovering 7 to 10 days later. There is a fall of 1g of Hb in normal
people. Lymphopenia, neutropenia and thrombocytopenia also occur

Clinical events
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The symptoms of erythema infectiosum occurs late in the course
of events, with the rash appearing 17 - 18 days after inoculation,
and arthralgia a day or so later

Parvovirus B19 infections usually begin
with a mild, nonspecific illness
characterized by :
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In some cases, the characteristic rash appears
7 to 10 days later.
fever, malaise, myalgias, and headache

Erythema infectiosum is manifested by:
–Rash
–Low grade or no fever
–Occasionally pharyngitis and mild
conjunctivitis
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The stages of the rash
The rash appears in three stages:
1. “Slapped cheek” rash
2. Truncal rash
3. Lacy, reticulated rash

The initial
stage with
circumoral
pallor
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1.“Slapped cheek” rash
https://myhealth.alberta.ca

• A bright red rash occurs on the sides of
the face and sometimes on the forehead
and chin.
• This rash usually is gone within 5 days.
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1. “Slapped cheek” rash
(Cont.)

• This rash starts as
round red spots and
begins to take on a
lacy look.
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2.Truncal rash (Cont.)

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2.Truncal rash
• appears on the neck,
trunk, forearms, upper
legs, and buttocks.
https://pediatric-house-calls.djmed.net/numbered-diseases-
childhood-fifth-disease-erythema-infectiosum
• This second stage
lasts a week or less.
• It can be itchy, especially in older
children

The rash fades as
central clearing takes
place, giving distinctive
lacy, reticulated rash
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https://nursingcrib.com/communicable-
diseases/erythema-infectiosum-fifth-disease

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https://nursingcrib.com/communicable-
diseases/erythema-infectiosum-fifth-disease
• Lasts 2 to 40 days
(mean, 11 days).
• This rash:
- may be pruritic
- does not desquamate
- may recur with exercise,
bathing , rubbing, or stress

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Adolescents and adults may experience:
myalgia pharyngitis
headache coryza
significant arthralgias
or arthritis
gastrointestinal
upset

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Transient aplastic crisis
• Children with shortened erythrocyte
life span (e.g., sickle cell disease ,
spherocytosis) are the victims
• A Characteristic ineffective erythroid
production typically lasting 7 to 10
day

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Red arrows: spherocytes in the patient's peripheral smear
showing dense staining and small rounded appearance
https://www.cureus.com/articles/33357-parvovirus-induced-transient-aplastic-crisis-
in-a-patient-with-newly-diagnosed-hereditary-spherocytosis

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Transient aplastic crisis (cont.)
Most children have multiple symptoms,
including:
fever pallor
lethargy headache
respiratory
symptoms
gastrointestinal
symptoms
malaise

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Hematologic abnormalities occur
with parvovirus infection, including :
• reticulocytopenia lasting 7 to 10
days
• mild anemia
• thrombocytopenia
• lymphopenia
• neutropenia

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• Parvovirus B19 can be detected by
-PCR
- electron microscopy of erythroid
precursors in the bone marrow
• Serologic tests showing specific IgM
antibody to parvovirus are diagnostic,
demonstrating infection that probably
occurred in the prior 2 to 4 months.

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https://www.cancertherapyadvisor.com/home/decision-support-in-
medicine/hospital-medicine/parvovirus-

• The diagnosis is established on
the basis of the clinical findings
of:
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• typical facial rash with absent or mild
prodromal symptoms
• followed by a reticulated rash over
the body that waxes and wanes

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measles rubella
enteroviral or adenoviral infection
scarlet fever Kawasaki disease
infectious
mononucleosis
systemic lupus
erythematosus
drug reaction serum sickness

There is no specific therapy
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• Routine supportive care
includes maintaining
adequate hydration and
antipyretics.
• ?Transfusions may be required
for transient aplastic crisis

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• ?Intrauterine transfusion has
been performed for hydrops
fetalis associated with fetal
parvovirus B19 infection
• Intravenous immunoglobulin may be
used for immunocompromised persons
with severe anemia or chronic infection.

The prognosis for erythema infectiosum
is excellent
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Fatalities associated with transient aplastic
crisis are rare

• Parvovirus B19 is not teratogenic.
• In utero infection of fetal erythroid
cells may result in:
- fetal heart failure
- hydrops fetalis
- fetal death
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• ~50% of women of childbearing age
susceptible to parvovirus B19 infection
• 30% of exposed women develop infection
• 25% of exposed fetuses becoming infected
• 10% of these culminating in fetal death.
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• The greatest risk is to pregnant women
• Effective control measures are limited
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• Exclusion of affected children from school
is not recommended, because children
generally are not infectious by the time the
rash is present

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• Good handwashing and hygiene
are practical measures that should
help reduce transmission

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• http://virology-online.com/viruses/Parvoviruses3.htm
• https://myhealth.alberta.ca
• https://nursingcrib.com/communicable-diseases/erythema-infectiosum-fifth-disease
• https://pediatric-house-calls.djmed.net
• https://www.cureus.com/articles/33357-parvovirus-induced-transient-aplastic-crisis-in-a-patient-with-newly-
diagnosed-hereditary-spherocytosis
• https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/hospital-medicine/parvovirus
• https://emedicine.medscape.com/article/1132078-overview
• https://en.wikipedia.org/wiki/Fifth_disease
• https://www.malacards.org/card/erythema_infectiosum
• https://www.thechildren.com/health-info/conditions-and-illnesses/understanding-fifth-disease-erythema-
infectiosum

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Erythema infectiosum (fifth disease)

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