From the Guidelines
Parvovirus B19 fifth disease typically presents with a distinctive "slapped cheek" rash on the face, followed by a lacy red rash on the trunk and limbs that may come and go for several weeks. Before the rash appears, patients often experience mild flu-like symptoms including low-grade fever, headache, fatigue, sore throat, and mild body aches. Some individuals may also experience joint pain and swelling, particularly in adults, which can last for weeks to months. In children, the illness is usually mild and resolves on its own within 1-3 weeks. Treatment focuses on symptom relief with acetaminophen or ibuprofen for fever and discomfort, rest, and adequate fluid intake. No specific antiviral medication exists for fifth disease. The condition is most contagious before the rash appears, and by the time the characteristic rash develops, most patients are no longer contagious. Parvovirus B19 spreads through respiratory secretions and close contact, with the virus targeting rapidly dividing cells, particularly in the bone marrow, which explains its potential serious effects in people with certain blood disorders or compromised immune systems, as seen in cases of transient aplastic crisis 1. Key symptoms to watch out for include:
- Distinctive "slapped cheek" rash on the face
- Lacy red rash on the trunk and limbs
- Mild flu-like symptoms such as low-grade fever, headache, fatigue, sore throat, and mild body aches
- Joint pain and swelling, particularly in adults It's essential to note that while the provided study 1 discusses the effects of parvovirus B19 in patients with sickle cell disease, the general symptoms of fifth disease remain the same across different populations.
From the Research
Symptoms of Parvovirus B19 Infection
The symptoms of parvovirus B19 infection, also known as fifth disease, can vary in severity and presentation. Some common symptoms include:
- A "slapped-cheek" rash, which is a characteristic sign of the infection 2
- Mild, nonspecific, cold-like symptoms, such as fever, headache, and fatigue 2
- Arthropathy, or joint pain and swelling, which can occur in adults 2
- Papular, purpuric eruptions on the hands and feet, also known as "gloves and socks" syndrome 2
- Transient aplastic crisis, which is a temporary cessation of red blood cell production 2
Cutaneous Manifestations
The cutaneous manifestations of parvovirus B19 infection can be diverse and include:
- Petechial eruption in a glove and stocking distribution 3
- Reticular truncal erythema 3
- The "slapped cheek" sign 3
- Atypical clinical presentations, such as asymptomatic papular eruption, Sweet's syndrome, and lupus erythematosus-like syndromes 3
- Skin biopsy specimens showing interstitial histiocytic infiltrates, piecemeal fragmentation of collagen, and a mononuclear cell-predominant vascular injury pattern 3
Laboratory Diagnosis and Treatment
A clinical diagnosis of parvovirus B19 infection can be made without laboratory confirmation if erythema infectiosum is present 2. However, laboratory confirmation may be necessary in some cases, and serum immunoglobulin M testing is recommended for immunocompetent patients, while viral DNA testing is recommended for patients in aplastic crisis and for those who are immunocompromised 2. Treatment is usually supportive, although some patients may require transfusions or intravenous immune globulin therapy 2.