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Erythema Infectiosum – Fifth Disease Explained

Erythema infectiosum is a contagious viral illness that mainly affects children, characterized by a distinctive rash and bright red cheeks.

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Things worth knowing about "Erythema infectiosum"

Erythema infectiosum is a contagious viral illness that mainly affects children, characterized by a distinctive rash and bright red cheeks.

What is Erythema infectiosum?

Erythema infectiosum, commonly known as fifth disease, is a mild and common viral infection caused by Parvovirus B19. It primarily affects school-age children and is recognized by a characteristic facial rash that gives the appearance of slapped cheeks, followed by a lace-like rash on the body and limbs. In most healthy children, the illness resolves on its own without specific treatment.

Causes

The condition is caused by Parvovirus B19, a DNA virus belonging to the Parvoviridae family. Transmission occurs mainly through:

Respiratory droplets: Breathing in virus-containing droplets from an infected person who coughs or sneezes
Direct contact: Touching contaminated surfaces and then touching the mouth or nose
Blood transfusions: Rarely through infected blood products
Vertical transmission: From a pregnant mother to her unborn child

The incubation period is typically 4 to 21 days. Infected individuals are most contagious before the rash appears, meaning the illness can spread before it is recognized.

Symptoms

The clinical course of erythema infectiosum typically unfolds in distinct stages:

Prodromal phase

Early symptoms may include mild fever, headache, fatigue, runny nose, and a general feeling of being unwell. These symptoms are often mild and may go unnoticed.

Rash phase

Slapped cheek appearance: Bright red, warm cheeks are the hallmark sign, giving the face a distinctive flushed look
Body and limb rash: A few days later, a red, lacy or ring-shaped rash appears on the arms, legs, and trunk
Itching: The rash may be mildly itchy and can recur or worsen with sun exposure, heat, or physical activity

Symptoms in adults

Adults who develop the infection often experience more pronounced symptoms, including joint pain and swelling (arthralgia and arthritis), particularly affecting the small joints of the hands and feet. These symptoms can last for several weeks.

Complications

Aplastic crisis: In individuals with underlying blood disorders such as sickle cell disease, Parvovirus B19 can temporarily suppress red blood cell production, leading to a severe drop in hemoglobin levels.
Hydrops fetalis: Infection during pregnancy can cause life-threatening fluid accumulation in the unborn baby.
Immunocompromised individuals: May develop chronic anemia due to persistent viral infection.

Diagnosis

Diagnosis is usually made clinically based on the characteristic appearance of the rash. When confirmation is needed, the following tests may be used:

Blood tests: Detection of Parvovirus B19-specific antibodies (IgM and IgG)
PCR testing: Direct detection of viral DNA in the blood, especially useful in immunocompromised patients or during pregnancy
Full blood count: To assess red blood cell levels when an aplastic crisis is suspected

Treatment

There is no specific antiviral treatment for erythema infectiosum. Management focuses on relieving symptoms:

Fever reducers: Paracetamol or ibuprofen can be used to manage fever and discomfort
Antihistamines: May help relieve itching if needed
Rest and hydration: Supportive care to aid recovery
Aplastic crisis: Hospitalization and possible blood transfusions may be required
During pregnancy: Close monitoring by a specialist is essential; in severe cases, intrauterine blood transfusion for the baby may be considered

Children with erythema infectiosum generally do not need to be excluded from school or childcare, as they are typically no longer contagious once the rash has appeared.

References

Centers for Disease Control and Prevention (CDC): Parvovirus B19 and Fifth Disease. www.cdc.gov (2023).
Young N.S., Brown K.E.: Parvovirus B19. New England Journal of Medicine, 350(6):586-597, 2004. DOI: 10.1056/NEJMra030840.
World Health Organization (WHO): Parvovirus B19 infection in pregnancy. WHO Guidelines, Geneva 2014.

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