What are the symptoms and management of parvovirus B19 (Fifth disease) infection?

Parvovirus B19 Symptoms and Management

Parvovirus B19 most commonly presents as erythema infectiosum (fifth disease) in children with the characteristic "slapped-cheek" rash, though many infections are asymptomatic or cause only mild cold-like symptoms. 1

Clinical Presentations

In Children

• Classic "slapped-cheek" rash (erythema infectiosum/fifth disease) is the hallmark presentation 1, 2
• Mild, nonspecific cold-like symptoms often precede the rash 1
• Fever, fatigue, cough, nasal congestion, and headache may occur 2
• By the time the rash appears, the virus is no longer infectious 1

In Adults

• Acute or persistent arthropathy (joint pain and inflammation) is more common than in children 1
• Papular, purpuric eruptions on hands and feet ("gloves and socks" syndrome) 1
• Arthralgias and arthritis can be prominent features 3, 2

High-Risk Populations

In patients with chronic hemolytic conditions (sickle cell disease, thalassemia, spherocytosis, iron deficiency anemia), parvovirus B19 causes transient aplastic crisis characterized by:

• Acute cessation of red blood cell production 1, 2
• Exacerbation of baseline anemia with substantially decreased reticulocyte count (typically <1%) 4
• Infection usually occurs without the characteristic rash 4
• Red blood cell transfusions are often required 4, 1

In pregnancy, B19V infection poses serious risks:

• Spontaneous abortion 3, 5, 6
• Non-immune hydrops fetalis 5, 2, 6
• Fetal anemia, particularly when infection occurs between 9-20 weeks gestation 2, 6
• Intrauterine transfusion may be necessary for hydrops fetalis 6

Additional Complications

• Chronic red cell aplasia in immunocompromised patients 1, 2
• Cardiac, neurological, hepatic, and renal complications 2
• Leucopenia and thrombocytopenia 3
• Vasculitis and autoimmune phenomena 3

Diagnosis

A clinical diagnosis can be made without laboratory confirmation if the characteristic erythema infectiosum rash is present 1

When laboratory confirmation is needed:

• Serum IgM testing for immunocompetent patients 1
• Viral DNA (PCR) testing for patients in aplastic crisis and immunocompromised individuals 1
• Compare CBC and reticulocyte counts during acute illness with baseline values in patients with chronic hemolysis 4

Management

General Treatment

Treatment is primarily supportive, as most patients recover completely 1, 2

• Symptomatic care for fever and discomfort 2
• Rest and hydration 2

Specific Interventions

• Red blood cell transfusions for transient aplastic crisis 4, 1
  • Use 3-5 mg/kg aliquots in patients with sickle cell disease 4
  • Check post-transfusion hemoglobin before ordering next aliquot 4
• Intravenous immune globulin (IVIG) therapy for chronic infections in immunocompromised patients 1, 2
• Corticosteroids in select cases 2
• Intrauterine transfusion for hydrops fetalis in pregnancy 6

Critical Management Considerations

Parvovirus B19 is highly contagious and spreads through respiratory droplets 1

• Isolate suspected cases from at-risk persons, including pregnant healthcare professionals and others with chronic hemolysis 4
• Siblings and household contacts with sickle cell disease should have hemoglobin and reticulocyte counts checked, as they are at risk for concurrent or subsequent aplastic crisis 4

In pregnant women at high risk for exposure:

• Determine susceptibility through serologic testing 5
• Provide counseling regarding prevention, testing, and treatment options if exposed 5
• Monitor closely between 9-20 weeks gestation when fetal complications are most likely 2

No specific antiviral treatment or vaccine is currently available, making early recognition and prompt supportive management crucial 2