What is the treatment for fifth disease (erythema infectiosum)?

Treatment of Fifth Disease (Erythema Infectiosum)

Fifth disease (erythema infectiosum) is primarily treated with supportive care as it is typically a self-limited condition that resolves spontaneously without specific antiviral therapy.

Clinical Presentation and Diagnosis

• Fifth disease is caused by human parvovirus B19 and is characterized by a distinctive "slapped cheek" appearance on the face followed by a lacy or reticulated rash on the trunk and extremities 1
• The incubation period is usually 4-14 days, with mild prodromal symptoms including low-grade fever, headache, malaise, and myalgia 1
• The rash typically evolves in 3 stages: initial erythematous "slapped cheek" appearance, followed by spread to trunk and extremities with a lacy pattern, and finally a stage of evanescence and recrudescence 1
• Diagnosis is primarily clinical, though serological testing for parvovirus B19 can confirm the diagnosis in uncertain cases 2

Treatment Approach

• Supportive care is the mainstay of treatment for fifth disease as it is generally a self-limited condition 2
• Specific antiviral therapy is not indicated for immunocompetent individuals with uncomplicated fifth disease 1
• Treatment focuses on symptom management:
  • Antipyretics for fever (acetaminophen or ibuprofen) 2
  • Adequate hydration and rest 1
  • Antihistamines may help relieve pruritus if present (occurs in approximately 50% of cases) 1

Special Considerations

Arthralgia/Arthritis

• Arthropathy is more common in adults, particularly women, and may require:
  • Non-steroidal anti-inflammatory drugs (NSAIDs) for joint pain 2
  • Symptoms typically resolve within 1-3 weeks but can occasionally persist for months 1

Immunocompromised Patients

• Patients with compromised immune systems may develop chronic anemia requiring:
  • Intravenous immunoglobulin (IVIG) administration 2
  • Regular monitoring of hemoglobin levels 1
  • Possible red blood cell transfusions in severe cases 2

Patients with Hemolytic Disorders

• Patients with sickle cell disease, hereditary spherocytosis, or other hemolytic anemias are at risk for transient aplastic crisis:
  • Hospitalization may be required 1
  • Red blood cell transfusions may be necessary 2
  • Close monitoring of hematologic parameters 1

Pregnant Women

• Parvovirus B19 infection during pregnancy carries risk of fetal hydrops and fetal loss:
  • Pregnant women exposed to fifth disease should have their immune status evaluated 3
  • If not immune (IgG negative), fetal surveillance with repeated ultrasonographic examination is recommended 3
  • Referral to maternal-fetal medicine specialists for high-risk pregnancies 3

Common Pitfalls to Avoid

• Unnecessary antibiotic use, as fifth disease is viral and antibiotics are ineffective 1
• Failure to recognize potential complications in high-risk groups (pregnant women, immunocompromised individuals, and those with hemolytic disorders) 1, 2
• Misdiagnosis of the rash as other exanthems, leading to inappropriate management 1
• Overlooking the need for isolation precautions in healthcare and school settings during the contagious period (before rash appearance) 1

Follow-up Recommendations

• Most immunocompetent patients require no specific follow-up as the disease is self-limited 1
• Patients with persistent symptoms beyond 3 weeks, particularly arthralgia, may benefit from follow-up evaluation 2
• High-risk patients (immunocompromised, hemolytic disorders) require close monitoring until resolution of symptoms and normalization of laboratory parameters 1, 2