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

Management and Treatment of Fifth Disease (Erythema Infectiosum)

Primary Management Approach

Fifth disease is a self-limiting viral illness that requires only supportive care in immunocompetent individuals, with treatment focused on symptom relief rather than antiviral therapy. 1

Treatment by Patient Population

Healthy Children and Adults

• No specific antiviral treatment is indicated 1
• Provide symptomatic relief with antipyretics for fever and analgesics for discomfort 1
• NSAIDs or acetaminophen can be used for associated arthralgia, which occurs in approximately 50% of adults 1
• Pruritus, present in approximately 50% of cases, can be managed with antihistamines 1
• The rash typically resolves spontaneously within 3 weeks without sequelae 1

Pregnant Women

• Assess maternal immune status immediately with parvovirus B19 IgG serology 2
• If IgG positive (immune): No further intervention needed; fetal risk is nil 2
• If IgG negative (non-immune): Initiate serial fetal surveillance despite low risk 2
  • Perform repeated ultrasonographic examinations to detect hydrops fetalis 2, 3
  • Reevaluate maternal immune status (IgM and IgG) 2
  • If fetal hydrops develops, refer immediately to tertiary care center for intrauterine evaluation and potential intrauterine transfusion 2
• Continue ultrasound monitoring throughout pregnancy even if initial scans are normal 3

Immunocompromised Patients

• Monitor for chronic anemia and persistent infection 4
• Consider intravenous immunoglobulin (IVIG) for persistent parvovirus B19 infection causing chronic anemia 4
• Serial complete blood counts to detect aplastic crisis 4

Patients with Hemolytic Anemia

• Monitor closely for transient aplastic crisis 4
• Obtain immediate complete blood count if patient develops sudden pallor, fatigue, or decreased hemoglobin 4
• Hospitalization may be required for severe anemia with transfusion support 4

Critical Complications Requiring Intervention

Refractory Status Epilepticus from Encephalitis

• High-dose corticosteroids are indicated for parvovirus B19 encephalitis complicated by refractory status epilepticus 5
• This is an extremely rare complication but requires aggressive management 5

Arthropathy in Adults

• Joint symptoms are more common in adults than children, with arthralgia or arthritis occurring frequently 4, 1
• NSAIDs provide adequate symptom control in most cases 1
• Symptoms typically resolve within weeks but may persist for months 4

Diagnostic Confirmation When Needed

• Clinical diagnosis is sufficient in typical cases with characteristic "slapped cheek" appearance and lacy reticular rash 1
• Serologic testing (IgM and IgG antibodies) is reliable and should be used when diagnosis is uncertain or in high-risk populations (pregnant women, immunocompromised, hemolytic anemia patients) 4, 2
• IgM indicates acute infection; IgG indicates past infection or immunity 2

Key Clinical Pitfalls to Avoid

• Do not prescribe antibiotics; this is a viral illness that does not respond to antimicrobial therapy 1
• Do not miss the diagnosis in pregnant women—always inquire about pregnancy status and exposure history 2
• Do not overlook atypical presentations in adults, where facial rash may be absent in 80% of cases 1
• Do not dismiss joint complaints in adults as unrelated; arthropathy is a recognized manifestation 4, 1

Infection Control

• Patients are most contagious during the prodromal phase before rash appears 1
• Once rash develops, patients are generally no longer infectious and do not require isolation 1
• Transmission occurs primarily through respiratory secretions 1