Fifth Disease
(Parvovirus)

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Medical Author:

David Perlstein, MD, MBA, FAAP

David Perlstein, MD, MBA, FAAP

Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

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Medical Editor:

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 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 have complications.
• Fifth disease in pregnant women can cause a miscarriage.

Fifth disease is a viral illness caused by parvovirus B19. Fifth disease is also known as "erythema infectiosum" and "slapped cheek disease." The clinical illness was described in the 1880s and was named fifth disease because of its "fifth" position in the numerical classification of childhood illnesses associated with rashes (exanthems). Other numbered diseases included measles, scarlet fever, and rubella -- and these did not get renamed until the molecular era, when it became possible to isolate viruses and bacteria. Fifth disease was number five of six diseases named. It is a very common infection, and almost 50% of adults have been infected with the virus but do not remember having it because it often does not cause symptoms.

Though fifth disease generally occurs in children between 4-10 years of age, it can affect any age group, including adults. It most commonly occurs during the winter and spring. The illness classically begins with a low-grade fever and malaise (a sense of not feeling well). After about a week, this is followed by a characteristic bright red rash on the cheeks (the so-called "slapped cheeks" rash). 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 days to a week and occasionally comes and goes for up to three weeks. The other symptoms are usually gone by the time the rash appears, and 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 not always predictable.

While the illness is not serious in children, around 5% of children and around 50% of adults with fifth disease can have joint aches and pains. This arthritis or arthropathy is more common in females than males and is usually temporary, lasting days to weeks, but 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 (a "symmetrical" arthritis). The joints most commonly involved are the knees, fingers, and wrists.