What is the management and treatment of Fifth disease (erythema infectiosum)?

Management and Treatment of Fifth Disease (Erythema Infectiosum)

Fifth disease (erythema infectiosum) is a self-limiting viral illness caused by parvovirus B19 that typically requires only supportive care, with treatment focused on symptom management rather than antiviral therapy.

Clinical Presentation and Diagnosis

• Fifth disease primarily affects school-aged children between 4-10 years and presents with a characteristic three-stage rash 1:

  • Stage 1: "Slapped cheek" appearance with bright red erythema on the cheeks
  • Stage 2: Lacy, reticular rash spreading to trunk, extremities, and buttocks (palms and soles typically spared)
  • Stage 3: Evanescence and recrudescence of the rash, which may fluctuate with environmental factors

• Prodromal symptoms are usually mild and may include low-grade fever, headache, malaise, and myalgia 1

• Diagnosis is primarily clinical based on the characteristic rash pattern; laboratory confirmation is generally unnecessary for uncomplicated cases 1

Treatment Approach

Supportive Care (First-line Management)

• Most cases of fifth disease are self-limiting and require only symptomatic treatment 1:

  • Acetaminophen or NSAIDs for fever and discomfort
  • Adequate hydration
  • Rest as needed

• For pruritus (occurs in approximately 50% of cases), topical antipruritic lotions or oral antihistamines may provide relief 1

• Conjunctivitis associated with fifth disease typically resolves without specific treatment beyond lubricating eye drops if needed 2

Special Populations and Complications

Arthritis/Arthralgia

• Joint pain and swelling occur more commonly in adults (especially women) than in children 1
• Management includes:
  • NSAIDs for pain and inflammation
  • Rest and limited activity during acute symptoms
  • Symptoms typically resolve within 1-3 weeks without long-term joint damage 3

Patients with Hemolytic Anemia

• Patients with underlying hemolytic disorders (e.g., sickle cell disease) are at risk for transient aplastic crisis 1
• These patients require:
  • Close monitoring of hemoglobin levels
  • Possible blood transfusion for severe anemia
  • Hospitalization may be necessary in severe cases 3

Immunocompromised Patients

• Immunocompromised individuals may develop chronic anemia due to persistent parvovirus B19 infection 3
• These patients may require:
  • Intravenous immunoglobulin (IVIG) therapy
  • Regular monitoring of blood counts
  • Consultation with hematology specialists 1

Pregnant Women

• Approximately 50% of pregnant women are already immune to parvovirus B19 4
• For pregnant women exposed to fifth disease:
  • Evaluate immune status with IgG and IgM testing 5
  • If already immune (IgG positive), no further action is needed 5
  • If not immune or acutely infected, fetal surveillance with repeated ultrasound examinations is recommended due to risk of fetal hydrops 5, 4
  • Referral to maternal-fetal medicine specialists for high-risk cases 4
  • Intrauterine transfusion may be considered for affected fetuses with hydrops 4

Prevention

• Fifth disease spreads primarily through respiratory secretions and, to a lesser extent, saliva 1
• Preventive measures include:
  • Regular handwashing
  • Covering mouth and nose when coughing or sneezing
  • Avoiding close contact with infected individuals when possible
  • Note that patients are most contagious during the prodromal phase, before the rash appears, making prevention challenging 1

Follow-up and Return to School/Work

• Children with fifth disease can return to school once the rash appears, as they are no longer contagious at this stage 1
• Adults should follow similar guidance for returning to work
• Follow-up is generally not required for uncomplicated cases 1
• Patients with complications (arthritis, hematologic issues) may need follow-up until resolution of symptoms 3

Common Pitfalls in Management

• Misdiagnosis as other exanthems (e.g., rubella, scarlet fever) leading to unnecessary treatment 1
• Unnecessary antibiotic prescription (ineffective against viral infections)
• Failure to recognize potential complications in high-risk groups (pregnant women, immunocompromised patients, those with hemolytic disorders) 3, 4
• Overlooking the need for fetal monitoring in pregnant women exposed to fifth disease 5, 4