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

Management and Treatment of Fifth Disease (Erythema Infectiosum)

Fifth disease is a self-limited viral illness that requires only supportive care in most cases, with treatment focused on symptom relief and monitoring for complications in high-risk populations. 1, 2

General Management Approach

For otherwise healthy children and adults, no specific antiviral treatment exists or is necessary. The illness resolves spontaneously within 1-3 weeks without sequelae. 2

Symptomatic Treatment

• Analgesics (acetaminophen or ibuprofen) for fever, headache, and myalgia 1
• Antihistamines may help with pruritus, which occurs in approximately 50% of cases 2
• Rest and hydration during the acute phase 1
• Patients are no longer contagious once the rash appears, so isolation is unnecessary at this stage 2

High-Risk Populations Requiring Specific Management

Pregnant Women

If a pregnant woman is exposed to Fifth disease, immediately assess her immune status with parvovirus B19 IgG antibody testing. 3

• If IgG positive (immune): No risk to fetus; reassure the patient 3
• If IgG negative (non-immune):
  • Risk of fetal complications is very low (hydrops fetalis occurs in <5% of maternal infections) 3
  • Perform serial ultrasound examinations every 1-2 weeks for 8-12 weeks to monitor for fetal hydrops 3
  • Repeat IgG and IgM testing to confirm infection if exposure occurred 3
  • If fetal hydrops develops: Refer immediately to tertiary care center for intrauterine transfusion 3

Patients with Hemolytic Anemia

Patients with sickle cell disease, hereditary spherocytosis, or other chronic hemolytic anemias are at risk for transient aplastic crisis. 4, 1

• Monitor complete blood count if symptomatic 1
• Red blood cell transfusions may be required for severe anemia 1
• Hospitalization may be necessary for supportive care 1

Immunocompromised Patients

Immunocompromised individuals (HIV/AIDS, chemotherapy, transplant recipients) may develop chronic anemia from persistent parvovirus B19 infection. 4, 1

• Confirm diagnosis with serum antibody testing (IgM and IgG) 1
• Intravenous immunoglobulin (IVIG) is the treatment of choice for chronic parvovirus B19 infection in immunocompromised patients 1
• May require repeated IVIG doses depending on clinical response 1

Adults with Arthropathy

Adults frequently develop polyarthropathy (arthritis or arthralgia), which is more common and severe than in children. 4, 1, 2

• Joint symptoms typically affect hands, wrists, knees, and ankles symmetrically 1
• Treat with NSAIDs for pain and inflammation 1
• Symptoms usually resolve within weeks but may persist for months 1
• Differentiate from rheumatoid arthritis through serologic testing if symptoms are prolonged 4

Diagnostic Confirmation

Diagnosis is primarily clinical based on the characteristic "slapped cheek" appearance and lacy reticular rash on extremities. 2

• Laboratory confirmation with parvovirus B19 IgM and IgG antibodies is indicated when:
  • Pregnant women are exposed 3
  • Immunocompromised patients present with anemia 1
  • Patients with hemolytic disorders develop aplastic crisis 1
  • Atypical presentations require confirmation 2

Key Clinical Pitfalls to Avoid

• Do not isolate patients once the rash appears—they are no longer contagious at this stage, though they were highly contagious during the prodromal phase before rash onset 2
• Do not dismiss joint complaints in adults as these can be severe and prolonged, requiring appropriate symptomatic management 1
• Do not overlook pregnancy status in women of childbearing age with suspected Fifth disease—immediate immune status assessment is critical 3
• Do not assume all facial rashes are Fifth disease—the differential includes scarlet fever, Kawasaki disease, drug reactions, and other viral exanthems 5, 2
• Recognize that adults often lack the classic "slapped cheek" appearance (only 20% have facial rash), presenting instead with lacy rash on legs, trunk, and arms 2