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
• Hospitalize for supportive care including potential blood transfusion if aplastic crisis occurs 4

Critical Complications Requiring Intervention

Refractory Status Epilepticus from Encephalitis

• Administer high-dose corticosteroids if parvovirus B19 encephalitis is confirmed 5
• This rare complication requires intensive care management 5

Arthropathy in Adults

• Joint symptoms are more common in adults than children, with the rash being less pronounced 1
• Only 20% of affected adults develop facial erythema 1
• NSAIDs provide adequate symptom control in most cases 1
• Arthralgia typically resolves without long-term sequelae 4

Diagnostic Confirmation When Needed

• Clinical diagnosis is sufficient in typical presentations with "slapped cheek" appearance and lacy reticular rash on extremities 1
• Serologic testing (IgM and IgG) is available and reliable for atypical cases or high-risk patients 4, 2
• Laboratory confirmation is essential for pregnant women, immunocompromised patients, and those with hemolytic disorders 2

Key Clinical Pitfalls to Avoid

• Do not prescribe antibiotics; this is a viral illness 1
• Do not overlook pregnancy status in women of childbearing age with exposure 2
• Do not dismiss joint complaints in adults as unrelated; arthropathy occurs in the majority of adult cases 1
• Do not assume immunity without serologic confirmation in high-risk exposures 2