Fifth Disease

Fifth Disease

Fifth disease, or erythema infectiosum, is caused by a virus called the human parvovirus B19. It most often infects school aged children, and appearing most frequently in the winter and spring. It is also possible for adults to get the virus, and for it to occur anytime during the year.

The name fifth disease was given to the viral infection because it was one of the five most common illnesses of childhood in the past that the main characteristic was a rash. Fifth disease is also called slapped cheek syndrome or disease because of the characteristic rash that appears of the face.

What are the signs and symptoms of fifth disease?

Fifth disease is usually a mild infection. The first signs and symptoms of fifth disease are vague and nonspecific, including:

  • Fever
  • Chills
  • Headache
  • Runny nose
  • Sore throat
  • Upset stomach
  • Fatigue
  • Joint swelling and/or pain

After several days of the above cold/flu like symptoms the classic “slapped cheek” rash will appear. The rash is bright red, and is found on both cheeks. After about 4 days, the rash will spread to the trunk of the body (chest and abdomen), and then will continue onto the arms, legs and rest of the body. On the body the rash looks pink, with a lacy looking pattern and is slightly raised. Sometimes the rash is itchy, especially once it spreads to the feet. The rash can last several weeks, but most often it lasts about 7 to 10 days.

How is fifth disease spread?

Parvovirus B19 is easily spread from person to person through respiratory secretions like saliva, sputum, or nasal mucus. It is expelled into the air when an infected person breathes, coughs or sneezes. It can also be spread to nearby surfaces or hand-to-hand contact. A person can spread the infection before they have a rash, and is no longer infectious after the rash appears. At this point your child is able to return to school.

The virus can also be transmitted through blood, or through pregnancy. A pregnant woman can transmit the virus directly to her unborn baby.

How is fifth disease diagnosed?

When seeing your doctor or nurse practitioner they will examine your child looking for the above signs and symptoms, most importantly the characteristic “slapped cheek” rash on the face. They will perform a physical exam and take a history including information about possible exposure to someone who is infected with the fifth disease. A diagnosis can be determined often just by a clinical exam. The clinical diagnosis can be confirmed by performing a blood test, if necessary, to see if your child has the infection, was recently infected, or if they are immune to parvovirus B19. This test usually takes a couple days before results are confirmed.

Are there complications of fifth disease?

Fifth disease is usually a mild infection that resolves on its own with time in an otherwise healthy child or adult. The virus can cause severe complications in people with anemia, leukemia, cancer, HIV, organ transplants, those with weakened immune systems or pregnant women.

  • Pregnancy: If a pregnant women becomes infected with parvovirus B19 most often they will only contract a mild illness. However, in about 5% of cases it can cause severe anemia in the unborn baby, which could lead to miscarriage and/or death. The greatest risk is during the first 4-5 months of pregnancy. The best way to minimize this risk is to stay away from individuals who may be infected with fifth disease.
  • Anemia: When a person has anemia, they have a decreased number of red blood cells in their body. Red blood cells are responsible for carrying oxygen to all the organs and tissues throughout your body. Some people can have temporally or for a longer period of time like. If a person with anemia becomes infected with parvovirus B19, they may experience an anemic crisis, where their bone marrow will stop producing red blood cells. While this complication is very rare, it can be fatal.
  • Weak Immune System: Those with weakened immune systems are also at risk for an anemic crisis, or erythrocyte aplasia as mentioned above. A weakened immune system can be a result of leukemia, cancer, HIV and AIDS, cancer treatments, organ transplants, or certain medications.

If you think your child has fifth disease and has any of the above conditions, or if you are pregnant and think you may have been exposed to fifth disease, see your doctor or nurse practitioner.

Is there treatment for fifth disease?

Like most viral illness, fifth disease cannot be treated with antibiotics. As a parent you can help to manage your child’s symptoms and keep them comfortable. The following may be helpful for your child:

  • Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce the fever. Do NOT give your child aspirin!
  • Keep your child well hydrated with water (juice may over stimulate the salivary glands causing more pain and discomfort).

You can help to prevent the transmission of parvovirus B19 and risk of infecting others by:

  • Cover your mouth with a tissue when coughing or sneezing.
  • Practicing good hand hygiene.
  • Do not share drinks, utensils with others.
  • Keep areas clean, like toys, doorknobs, tables, etc.
  • Minimize close contact with other who are infected or if you are infected.
  • Keeping your child home when they are sick, before the rash appears since this is when they are contagious and can spread the infection to other children.

– Dr. Christina Cesareo and Dr. G Paul Dempsey

[Featured image by: Andrew Kerr]


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