What are the symptoms, treatment, and prevention of parvovirus B19 (fifth disease)?

Parvovirus B19 (Fifth Disease): Symptoms, Treatment, and Prevention

Parvovirus B19 infection typically presents with a characteristic "slapped-cheek" rash (erythema infectiosum or fifth disease) in children, while adults more commonly experience joint pain and arthropathy, and treatment is primarily supportive with focus on symptom management. 1

Clinical Manifestations

Common Symptoms

• Children:

  • Classic "slapped-cheek" rash (bright red rash on cheeks)
  • Lacy, reticular rash on trunk and extremities that may appear 1-4 days after facial rash
  • Mild, nonspecific cold-like symptoms (low-grade fever, malaise)
  • Usually self-limiting and resolves within 1-3 weeks 1, 2

• Adults:

  • Arthralgia and arthropathy (joint pain and swelling) - more common than rash
  • "Gloves and socks" syndrome (papular, purpuric eruptions on hands and feet)
  • Fever and flu-like symptoms
  • Joint symptoms may persist for weeks to months 1

Severe Complications

1. Hematologic complications:

   • Transient aplastic crisis in patients with underlying hemolytic disorders (sickle cell disease, thalassemia, spherocytosis)
   • Characterized by severe anemia, reticulocytopenia (<1%), and exacerbation of baseline anemia 3
   • May require urgent red blood cell transfusions

2. Pregnancy-related complications:

   • Fetal hydrops (non-immune hydrops fetalis)
   • Fetal anemia
   • Spontaneous abortion (highest risk between 9-20 weeks gestation) 2, 4

3. Other organ involvement:

   • Cardiac manifestations (myocarditis)
   • Neurological complications
   • Hepatic and renal involvement 2

Diagnosis

1. Clinical diagnosis is sufficient in immunocompetent patients with classic erythema infectiosum 1

2. Laboratory confirmation:

   • Serum immunoglobulin M (IgM) testing for immunocompetent patients
   • Viral DNA testing for patients in aplastic crisis or who are immunocompromised 1

Treatment Approach

Treatment is primarily supportive as most infections are self-limiting:

1. Mild cases (typical fifth disease):

   • Symptomatic relief with antipyretics and analgesics
   • Adequate hydration
   • Rest as needed 1, 2

2. Arthralgia/arthropathy:

   • Non-steroidal anti-inflammatory drugs (NSAIDs)
   • Symptoms typically resolve within 1-3 weeks, but may persist longer in adults 1

3. Severe complications:

   • Transient aplastic crisis: Red blood cell transfusions may be required 3
   • Immunocompromised patients with persistent infection: Intravenous immunoglobulin (IVIG) therapy 5
   • Fetal hydrops: Intrauterine blood transfusions may be necessary 3

Prevention Strategies

1. General preventive measures:

   • Frequent handwashing
   • Respiratory hygiene (covering mouth and nose when coughing or sneezing)
   • Avoiding close contact with infected individuals 1

2. Special considerations:

   • Pregnant women: Should avoid contact with known cases, especially if serologically susceptible
   • Healthcare workers: Follow universal precautions when caring for infected patients 6
   • School settings: Children with fifth disease are no longer contagious once the rash appears, so exclusion from school is not necessary 1

3. High-risk populations:

   • Patients with chronic hemolytic disorders should be educated about symptoms of transient aplastic crisis
   • Pregnant women exposed to parvovirus B19 should be monitored with serial ultrasounds for signs of fetal hydrops 4

Important Clinical Pearls

• By the time the characteristic rash appears, patients are typically no longer contagious 1
• Parvovirus B19 infection can trigger serious complications in patients with underlying hemolytic disorders, immunocompromised individuals, and fetuses 3, 2
• Currently, no specific antiviral treatment or vaccine is available for parvovirus B19 infection 2, 5
• Isolation of suspected cases from pregnant healthcare workers and patients with chronic hemolytic disorders is recommended 3

Remember that while most parvovirus B19 infections resolve without complications, early recognition of high-risk patients and prompt management of severe manifestations are essential to prevent morbidity and mortality.