Fifth Disease
(Parvovirus)
Medical Author: David Perlstein, MD, FAAP
Medical Editor: William C. Shiel Jr., MD, FACP, FACR
Fathoming Fifth Disease
Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: Barbara
K. Hecht, PhD
Fifth disease is a mild viral illness that is common in
children. It is caused by infection with the human parvovirus B19. The name
fifth
disease reflects the historical belief that it was one of the five diseases that
produced a rash in children.
Fifth disease is also called erythema infectiosum. Erythema (redness) refers to the
characteristic "slapped cheek" red rash on the face. This rash may itch. There
may also be a lacy red rash on the trunk, arms, and legs. Before there is
any rash, the child may have a low-grade fever and symptoms of a cold for
several days. The rash itself goes away in seven to 10 days.
The causative virus, parvovirus B19, is thought to be transmitted
from person to person via secretions from the mouth or nose. Sharing contaminated
drinking cups or toothbrushes may transmit the virus. Unlike some other
illnesses with rash, the contagious period in fifth disease is the time before
the rash appears, when the child appears to just have a cold or a mild, nonspecific illness.
Fifth disease is very contagious. The CDC (U.S. Centers for
Disease Control and Prevention) states that during an outbreak of fifth disease in a school, up to
60% of exposed children can contract the disease.
What is "fifth disease"?
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 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.
What are the symptoms of fifth disease?
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.
Next: What are the serious complications of fifth
disease? »
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