What are the symptoms of parvovirus infection?

Parvovirus B19 Infection: Clinical Manifestations

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

Primary Clinical Presentations by Population

In Healthy Children

• Classic "slapped-cheek" rash (erythema infectiosum) is the hallmark presentation, appearing as bright red facial erythema 1, 2
• By the time the rash appears, the patient is no longer infectious 1
• Mild, nonspecific cold-like symptoms may precede or accompany the rash 1
• The infection is self-limited, resolving within 1-2 weeks 3, 4

In Adults

• Polyarthralgias and joint involvement are the most common manifestations, occurring in 65% of cases 3
• Joint symptoms can present as acute or persistent arthropathy 1
• Generalized maculopapular rash with fever occurs frequently 3
• "Gloves and socks" syndrome: papular, purpuric eruptions on hands and feet, seen in 6.5% of cases 3, 1
• Other skin manifestations include periflexural rash (4%) and edema (4%) 3
• Women are affected more than men (ratio 2.2:1), with mean age of 41 years 3

High-Risk Populations and Severe Manifestations

Patients with Hemolytic Disorders

• Transient aplastic crisis (TAC) is the critical complication in patients with underlying hemolytic conditions 4, 1, 2
• The virus has affinity for red blood cell precursors, causing temporary cessation of bone marrow RBC production 4
• This is particularly dangerous in patients with sickle cell disease, hereditary spherocytosis, thalassemia, or iron deficiency anemia 1, 2
• Substantially decreased reticulocyte count (typically below 1%) with worsening anemia indicates TAC 5
• Severe life-threatening anemia may require urgent blood transfusions 4
• Siblings or other contacts with sickle cell disease are at risk for concurrent or subsequent aplastic crisis 5

Immunocompromised Patients

• Persistent infection may develop, presenting as pure red cell aplasia and chronic anemia 2
• Treatment may require intravenous immune globulin therapy 1

Pregnant Women

• Non-immune pregnant women risk fetal infection, with greater complications in first or second trimester 6
• Fetal complications include severe anemia, hydrops fetalis, congenital anemia, or pregnancy loss 6, 2
• Most infected fetuses show no abnormalities 6
• Maternal symptoms include fever, rash, and joint pain if symptomatic 6

Hematological Manifestations

• Anemia is the main hematological alteration, occurring in 35% of acute infections 3
• Transient aplastic crisis represents acute cessation of red blood cell production 1, 2
• Chronic red cell aplasia can occur in immunosuppressed patients 1

Transmission and Infectivity

• Spreads mainly through respiratory droplets, making it highly infectious 1
• Also transmitted by hand-to-mouth contact, blood transfusion, or transplacental transmission 6
• Common in daycares and professions requiring close contact with children 4
• Critical pitfall: Patients are no longer infectious once the rash appears, but are highly contagious during the prodromal phase 1

Clinical Course

• Symptoms are typically self-limiting and resolve in 1-2 weeks in most immunocompetent patients 3, 4
• Treatment is usually supportive 1
• Some patients may require transfusions or intravenous immune globulin therapy, particularly those with aplastic crisis or immunocompromise 1
• Most patients recover completely 1