Fifth Disease (Parvovirus)

  • Medical Author:

    Robert Ferry Jr., MD, is a U.S. board-certified Pediatric Endocrinologist. After taking his baccalaureate degree from Yale College, receiving his doctoral degree and residency training in pediatrics at University of Texas Health Science Center at San Antonio (UTHSCSA), he completed fellowship training in pediatric endocrinology at The Children's Hospital of Philadelphia.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Fifth disease facts

  • Fifth disease is caused by a virus.
  • Symptoms include low fever, fatigue, a "slapped cheeks" rash, joint aches, and a whole body rash.
  • Diagnosis is made based on clinical features.
  • Rarely, fifth disease can become complicated.
  • Fifth disease in pregnant women can cause a miscarriage.

What is fifth disease? What causes fifth disease?

Fifth disease is a viral illness caused by parvovirus B19. Fifth disease has also been known as erythema infectiosum and "slapped cheek disease." The clinical illness was described in 1896 and named fifth disease because of its fifth position in the numerical classification of six childhood illnesses associated with rashes (exanthems). Other numbered viral exanthems included measles (rubeola or first disease), rubella (German measles or third disease), and roseola infantum (sixth disease). Scarlet fever was called "second disease" and is due to the bacterium Streptococcus pyogenes. Fourth disease is no longer classified as a clinical entity. These did not get renamed until the molecular era, when it became possible to isolate viruses and bacteria. Fifth disease is a very common infection. Almost 50% of adults have been infected with parvovirus B19 but often do not remember having it because this infection frequently does not cause symptoms.

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Fathoming Fifth Disease

Fifth disease is also called erythema infectiosum. Erythema (redness) refers to the characteristic "slapped cheek" red rash on the face. This rash may itch.

What are fifth disease symptoms and signs in children and adults?

Fifth disease generally occurs in children between 4-10 years of age, but it can affect any age group. Fifth disease most commonly occurs during the winter and spring. The illness classically begins with a low-grade fever, headache, runny nose, and malaise (a sense of not feeling well). Of course, these symptoms mimic any other viral illness, so it is impossible to determine the cause early in the illness. After about a week, initial symptoms are followed by a characteristic bright red rash on the cheeks (the so-called "slapped cheeks"). Finally, after three to four days, a fine, red, lacelike rash can develop over the rest of the body. This rash may last for five to seven days and occasionally comes and goes for up to three weeks. The other symptoms are usually gone by the time the rash appears. Patients with the rash are usually not contagious. Unfortunately, as with many other viral illnesses, the features and timing of the different stages of illness are often unpredictable.

Unlike other viral infections that usually cause "hand, foot, and mouth disease" (namely coxsackievirus A16 and enterovirus 71), fifth disease does not involve the palms and soles.

Are there other symptoms that can occur with fifth disease?

Around 5% of children and about half of adults with fifth disease experience joint aches and pains. This arthritis or arthropathy is more common in females than males, is usually temporary, lasts days to weeks, and may become a long-term problem for months. People with arthritis from fifth disease usually have stiffness in the morning, with redness and swelling of the same joints on both sides of the body ("symmetrical" arthritis). The joints most commonly involved are the knees, fingers, and wrists.

What are the serious complications of fifth disease? Is infection with fifth disease dangerous during pregnancy?

Rarely, these patients develop erythrocyte aplasia, meaning the bone marrow stops forming a normal number of red blood cells. This complication is rare and usually transient, but can be fatal. Patients who are immunocompromised (by disease or treatment) are at high risk of this complication.

Pregnant women (who have not previously had the illness) should avoid contact with patients who have fifth disease. The fifth disease virus can infect the fetus prior to birth. Although no birth defects have been reported as a result of fifth disease, for 2%-10% of B19-infected pregnant women, fifth disease can cause severe anemia and even the death of the unborn fetus (by hydrops fetalis).

What is the treatment for fifth disease?

The only available treatment is supportive. Fluids, acetaminophen (Tylenol), and rest provide relief. Antibiotics are useless against fifth disease, because it is a viral illness. For those with persistent arthritis, anti-inflammatory medications such as ibuprofen (Advil) or naproxen (Aleve) can be used.

How is fifth disease spread? When is the contagious stage, and should I be isolated if I have fifth disease?

Parvovirus B19 is usually spread by droplets. The virus can be spread whenever an infected person coughs or sneezes. However, once the rash is present, that person is usually no longer contagious and need not be isolated.

Is it possible to prevent the spread of fifth disease?

Similar to most viral illnesses, the best way to prevent the spread of the disease is by proper hand washing, by covering your mouth and nose when you sneeze or cough, and by staying home when you become sick.

Medically reviewed by Robert Cox, MD; American Board of Internal Medicine with subspecialty in Infectious Disease

REFERENCES:

American Academy of Pediatrics. "Parvovirus B19 (Erythema Infectiosum, Fifth Disease)." In: Pickering LK, ed. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2009: 491-493. Available at: http://aapredbook.aappublications.org/cgi/content/full/2009/1/3.92.

Broliden, K et. al. "Clinical Aspects of Parvovirus B19 Infection." Journal of Internal Medicine 260.4 Oct. 2006: 285-304.

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Reviewed on 3/7/2016
References
Medically reviewed by Robert Cox, MD; American Board of Internal Medicine with subspecialty in Infectious Disease

REFERENCES:

American Academy of Pediatrics. "Parvovirus B19 (Erythema Infectiosum, Fifth Disease)." In: Pickering LK, ed. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2009: 491-493. Available at: http://aapredbook.aappublications.org/cgi/content/full/2009/1/3.92.

Broliden, K et. al. "Clinical Aspects of Parvovirus B19 Infection." Journal of Internal Medicine 260.4 Oct. 2006: 285-304.

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