What is the treatment for fifth disease?

Treatment of Fifth Disease (Erythema Infectiosum)

Fifth disease is typically a self-limited viral illness that requires only supportive care in most cases, as there is no specific antiviral treatment available for parvovirus B19 infection. 1, 2

General Management Approach

Immunocompetent Children and Adults

• Supportive care is the mainstay of treatment, including rest, adequate hydration, and symptomatic relief 2
• Analgesic medications (acetaminophen or ibuprofen) can be used to manage fever, headache, and joint pain that may accompany the illness 2
• No isolation is necessary once the characteristic rash appears, as patients are no longer contagious at this stage 1, 3
• The prognosis is generally excellent, with complete resolution expected in immunocompetent individuals 2

Specific Clinical Scenarios Requiring Intervention

Patients with hemolytic anemia (such as sickle cell disease, hereditary spherocytosis, or thalassemia) who develop transient aplastic crisis require:

• Red blood cell transfusions to manage severe anemia 2
• Close monitoring of hemoglobin levels and reticulocyte counts 1

Immunocompromised patients with chronic parvovirus B19 infection and persistent anemia should receive:

• Intravenous immunoglobulin (IVIG) as the treatment of choice 2
• This provides passive antibodies that can clear the viral infection in patients unable to mount their own immune response 2

Pregnant Women

Pregnant women exposed to fifth disease require specific evaluation and monitoring, not treatment of the disease itself:

• Assess maternal immune status with parvovirus B19 IgG and IgM antibodies 4
• If IgG positive (immune), reassure the patient that risks are nil 4
• If non-immune (IgG negative) with confirmed acute infection (IgM positive), implement serial fetal surveillance with ultrasonography every 1-2 weeks for 8-12 weeks to detect hydrops fetalis 4
• If fetal hydrops develops, intrauterine transfusion at a tertiary care center may be lifesaving 4, 2
• The actual risk of fetal complications is very low (less than 5% of infected pregnant women) 4

Important Clinical Caveats

• The characteristic "slapped cheek" rash indicates the patient is past the contagious phase and viral shedding has ceased 1, 3
• Conjunctivitis may occasionally accompany fifth disease and requires only supportive care 5
• Adult patients more commonly develop arthropathy (joint pain and swelling) rather than the typical childhood rash, which may persist for weeks but is self-limited 1, 2
• Diagnosis can be confirmed with serum antibody testing (IgM for acute infection, IgG for past infection or immunity) when clinical presentation is atypical 2