Erythema Infectiosum
Fifth Disease
"Slap-Cheek Syndrome"
| Summary: | The "Fifth" disease is so called because its rash is similar to four previously described illnesses; Rubella, measles, scarlet fever, and Filatov-Dukes. Erythema Infectiosum is the clinical manifestation of human parvovirus disease; parvovirus B19. Typically found in elementary school age children, it is transmitted by airborne droplets. Sneezing and coughing is the main mode of transmission. Incubation period is a week. By the time the rash appears, the infectious stage has passed. Typically no school is missed because by the time the symptoms appear, the child is no longer infectious. | |
| Contact a Health Care Professional Immediately: | If you are pregnant and exposed to Fifth disease, see your health care provider immediately. | |
| Source of Infection/ Mode of Transmission: | Fifth Disease is transmitted by airborne droplets. Sneezing and coughing is the main mode of transmission. | |
| Symptoms: | During
the infectious stage, there is either a low-grade fever or no fever
lasting two or three days. 17 to 18 days after exposure (or
about a week after the fever onset) illness begins with a sudden
appearance of very red cheeks. This is where the term
"Slap-Cheek Syndrome" comes from. The rash is fiery red
with slightly raised borders. There may be some circumoral
pallor. It is at this stage that the rash may be confused for
scarlet fever, drug sensitivity, allergic reaction or collagen vascular
disease. One to four days after the onset of the facial redness a
red maculopapular rash appears on the child's trunk, arms and legs.
Sometimes the rash will start on the trunk and then spread to the
face. The way you can tell it is Fifth Disease is by the way the
rash disappears. It starts with central clearing of the redness
giving a lacy like appearance on the skin. The rash last from 2 to
20 days (average about 11 days). The duration of the rash is
dependent on many factors including but not limited to; sun exposure,
activity level, ambient temperature. The child may also experience
headache, sore throat, joint pain, bone pain, and stomach ache.
An adult may or may not have this Slap-Cheek appearance. Almost always adult symptoms include rash, fever, and joint pain. |
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| Epidemiology: | Outbreaks of Erythema Infectiosum have been reported throughout the non-tropical world. The outbreaks are very similar to rubella. Typically outbreaks occur in the winter and spring and last three to six months. It has been reported in schools that during an outbreak as many as 25% of the students are affected. The outbreaks typically occur in children age 5 to 14 years of age. Secondary outbreaks can occur in preschool children, parents, and teachers. Secondary outbreaks are more common with mothers than with fathers. And in school, the infection rate is considerably higher in girls than in boys. | |
| Diagnosis: | No test are necessary, however, immunoglobulin studies as well as DNA determinations can confirm the disease. | |
| Treatment: | There
is no treatment for Human Parvovirus infection. Relief from itching
can be obtained by using baking soda baths, oatmeal baths and calamine
lotion. Joint pain, fever, sore throat, and other symptoms may be
treated with Tylenol or other analgesics.
On rare occasions, typically in immunocompromised children, arthritis, anemia, pneumonitis, and encephalopathy have been reported. For these patients, IV-Ig is indicated. |
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| Protections: | ||
| Bibliography: | "Nelson Textbook of Pediatrics", Fourteenth edition, by Behrman, et. al. Saunders, 1992. | |
| Textbook of Pediatric Infectious Disease, Second edition, by Feigin, Cherry, et. al. |  |
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