Erythema Infectiosum (fifth disease)

Question 1

What is erythema infectiosum (5th disease) caused by?

Answer 1

Caused by human parvovirus B19

Question 2

How is it transmitted?

Answer 2

Transmitted by large droplet spread from nasopharyngeal viral shedding or percutaneous exposure to blood and blood products. Also transmitted from mother to fetus

Question 3

What are the s/s?

Answer 3

• Prodromal phase: mild symptoms, low-grade fever, headache, mild upper respiratory infection
• Characteristic rash occurs in three stages:
• Begins with erythematous flushing often described as “slapped-cheek” appearance, often with circumoral pallor
• Spreads to trunk
• Moves peripherally, appearing as a maculopapular, lace-like appearance; often pruritic
• Palms and soles are usually spared.
• Rash fluctuates in intensity and will disappear and reappear with environmental changes such as exposure to sunlight.
• Resolves spontaneously over 1–3 weeks
• Pain or swelling in joints may be present (more common in older adolescents)
• Children with pre-existing anemias may develop aplastic crisis (will have fever, malaise, myalgia, but usually no rash).

Question 4

What is the management?

Answer 4

• Usually benign and self-limited; supportive treatment is all that is needed
• Blood transfusion may be necessary in children with aplastic crisis.
• Comfort measures, such as antipyretics, antipruritics
• Inform pregnant women (including health care workers) of the potential risks to the fetus and preventive measures to decrease these risks (strict infection control practices, not caring for those likely to be contagious). The CDC does not recommended routine exclusion from a workplace where an outbreak is occurring.
• Droplet precautions are required in the hospitalized child.

Question 5

What are the complications?

Answer 5

• Complications: arthritis and arthralgia
• May result in fetal loss, hydrops fetalis in pregnant woman