Fifth disease

Definition

Fifth disease is a mild childhood illness caused by the human parvovirus B19 that causes flu-like symptoms and a rash. It is called fifth disease because it was fifth on a list of common childhood illnesses that are accompanied by a rash, including measles , rubella (or German measles), scarlet fever (or scarlatina), and scarlatinella, a variant of scarlet fever.

Description

The Latin name for fifth disease is erythema infectiosum, meaning infectious redness. It is also called the "slapped cheek disease" because, when the bright red rash first appears on the cheeks, it looks as if the face has been slapped. Anyone can get the disease, but it occurs more frequently in school-aged children. The disease is usually mild, and both children and adults usually recover quickly without complications. Some individuals exhibit no symptoms and never even feel ill.

Transmission

The virus that causes fifth disease lives in the nose, mouth, and throat of an infected person; therefore, the virus can be spread through the air by coughing and sneezing. It can also be spread through shared drinking glasses and eating utensils.

Demographics

Fifth disease is very common in children between the ages of five and 15. Studies show that although 40 percent to 60 percent of adults worldwide have laboratory evidence of a past parvovirus B19 infection, most of these adults cannot remember having had symptoms of fifth disease. This fact leads medical experts to believe that most people with parvovirus B19 infection have either very mild symptoms or no symptoms at all.

Fifth disease occurs everywhere in the world. Outbreaks of parvovirus tend to occur in the late winter and early spring, but there may also be sporadic cases of the disease any time throughout the year.

In households where a child has fifth disease, another family member who has not previously had fifth disease has about a 50 percent chance of also getting the infection, while classmates of a child with fifth disease have about a 60 percent chance of getting the disease.

Causes and symptoms

Fifth disease is caused by the human parvovirus B19, a member of the Parvoviridae family of viruses, that lives in the nose, mouth, and throat of an infected person. Because the virus needs a rapidly dividing cell in order to multiply, it attacks the red blood cells of the body. Once infected, a person is believed to be immune to reinfection.

Symptoms may appear four to 28 days after being exposed to the virus, with the average time to onset ranging from 16 to 17 days. Initial symptoms are flu-like and include headache , stuffy or runny nose, body ache, sore throat , a mild fever of 101°F (38.3°C), and chills. It is at this time, prior to the development of the rash, that individuals are contagious. These symptoms last for two to three days. Other symptoms that sometimes occur with fifth disease include swollen glands, red eyes, and diarrhea . In older teens and adults, fifth disease may be followed by joint swelling or pain in the hands, wrists, knees, and ankles, lasting from a few months to several years.

In children, especially those under the age of ten, a bright red rash that looks like a slap mark develops suddenly on the cheeks a few days after the original symptoms were experienced. The rash may be flat or raised and may or may not be itchy. Sometimes, the rash spreads to the arms, legs, and trunk, where it has a lace-like or net-like appearance as the centers of the blotches fade. By the time the rash appears, individuals are no longer infectious. On average, the rash lasts for ten to 11 days but may last for as long as five to six weeks. The rash may fade away and then reappear upon exposure to sunlight, hot baths, emotional distress, or vigorous exercise .

The virus causes the destruction of red blood cells and, therefore, a deficiency in the oxygen-carrying capacity of the blood (anemia) can result. In healthy children, the anemia is mild and only lasts a short while. In children with weakened immune systems, however, either because they have a chronic disease like AIDS or cancer (immunocompromised) or are receiving medication to suppress the immune system (immunosuppressed), such as organ transplant recipients, this anemia can be severe and last long after the infection has subsided. Symptoms of anemia include fatigue, lack of color, lack of energy, and shortness of breath. Some individuals with sickle cell anemia , iron deficiency, a number of different hereditary blood disorders, and those who have received bone marrow transplantations may be susceptible to developing a potentially life-threatening complication called a transient aplastic crisis in which the body is temporarily unable to form new red blood cells.

In very rare instances, the virus can cause inflammation of different areas of the body, including the brain (encephalitis ), the covering of the brain and spinal cord (meningitis ), the lungs (pneumonitis), the liver (hepatitis), and the heart muscle (myocarditis). The virus can also aggravate symptoms for people with an autoimmune disease called systemic lupus erythematosus.

Although no association with an increased number of birth defects has been demonstrated, there is concern that infection during the first three months of pregnancy may lead to a slight increase in the number of miscarriages due to the fetus developing severe anemia. There is also some concern that infection later in pregnancy may involve a very small risk of premature delivery or stillbirth. As a result, women who get fifth disease while they are pregnant should be monitored closely by a physician.

When to call the doctor

Parents should call their child's doctor if their child develops a rash, especially if the rash is widespread over the child's body or if the rash is accompanied by other symptoms.

KEY TERMS

Anemia —A condition in which there is an abnormally low number of red blood cells in the bloodstream. It may be due to loss of blood, an increase in red blood cell destruction, or a decrease in red blood cell production. Major symptoms are paleness, shortness of breath, unusually fast or strong heart beats, and tiredness.

Antibody —A special protein made by the body's immune system as a defense against foreign material (bacteria, viruses, etc.) that enters the body. It is uniquely designed to attack and neutralize the specific antigen that triggered the immune response.

Immunocompromised —A state in which the immune system is suppressed or not functioning properly.

Immunosuppressed —A state in which the immune system is suppressed by medications during the treatment of other disorders, like cancer, or following an organ transplantation.

Reye's syndrome —A serious, life-threatening illness in children, usually developing after a bout of flu or chickenpox, and often associated with the use of aspirin. Symptoms include uncontrollable vomiting, often with lethargy, memory loss, disorientation, or delirium. Swelling of the brain may cause seizures, coma, and in severe cases, death.

Sickle cell anemia —An inherited disorder in which red blood cells contain an abnormal form of hemoglobin, a protein that carries oxygen. The abnormal form of hemoglobin causes the red cells to become sickle-shaped. The misshapen cells may clog blood vessels, preventing oxygen from reaching tissues and leading to pain, blood clots and other problems.

Diagnosis

Fifth disease is usually suspected based on a patient's symptoms, including the typical appearance of the bright red rash on the cheeks, patient history, age, and the time of year. The physician will also exclude other potential causes for the symptoms and rash, including rubella, infectious mononucleosis , bacterial infections such as Lyme disease , allergic reactions, and lupus.

In addition, there is a blood test for fifth disease, but it is generally used only for pregnant women and for people who have weakened immune systems or who suffer from blood disorders, such as sickle cell anemia. The test involves measuring for a particular antibody or protein that the body produces in response to infection with the human parvovirus B19. The test is 92–97 percent specific for this disease.

Because fifth disease can pose problems for an unborn fetus exposed to the disease through the mother, testing for the disease may be conducted while a fetus is still in the uterus. This test uses fluid collected from the sac around the fetus (amniotic fluid) instead of blood to detect the viral DNA.

Prognosis

Generally, fifth disease is mild, and patients tend to improve without any complications. In cases where the patient is either immunocompromised or immunosuppressed, a life-threatening aplastic crisis can occur. With prompt treatment, however, the prognosis is good. Mothers who develop the infection while pregnant can pass the infection on to their fetus and thus stand an increased risk of miscarriage and stillbirth. There are tests and treatments, however, that can be performed on the fetus while still in the uterus that can reduce the risk of anemia or other complications.

Prevention

As of 2004, there was no vaccine against fifth disease. Avoiding contact with persons who exhibit symptoms of a cold and maintaining good personal hygiene by regularly washing hands may minimize the chances of an infection. Pregnant women should avoid exposure to persons infected with the disease and notify their obstetricians immediately if they are exposed so that they can be tested and monitored closely.

Parental concerns

Generally parents should not be concerned if their child contracts fifth disease. However, if the mother is pregnant, she should contact her doctor.

Resources

BOOKS

Laskey, Elizabeth. Fifth Disease. It's Catching Series. Oxford, UK: Heinemann Library, 2003.

PM Medical Health News. 21st Century Complete Medical Guide to Fifth Disease, Parvovirus: Authoritative Government Documents, Clinical References, and Practical Information for Patients and Physicians. Washington, DC: Progressive Management, 2004.

WEB SITES

Eppes, Stephen. "Fifth Disease." KidsHealth, April 2004. Available online at <http://kidshealth.org/parent/infections/bacterial_viral/fifth.html/> (accessed November 18, 2004).

"Fifth Disease." Centers for Disease Control (CDC), September 7, 2004. Available online at <www.cdc.gov/ncidod/diseases/parvovirus/B19.htm> (accessed November 18, 2004).

Judith Sims, MS Lata Cherath, PhD

Fifth Disease

Definition

Fifth disease is a mild childhood illness caused by the human parvovirus B19 that causes flu-like symptoms and a rash. It is called fifth disease because it was fifth on a list of common childhood illnesses that are accompanied by a rash, including measles, rubella or German measles, scarlet fever (or scarlatina), and scarlatinella, a variant of scarlet fever.

Description

The Latin name for the disease is erythema infectiosum, meaning infectious redness. It is also called the "slapped cheek disease" because, when the bright red rash first appears on the cheeks, it looks as if the face has been slapped. Anyone can get the disease, but it occurs more frequently in school-aged children. The disease is usually mild, and both children and adults usually recover quickly without complications. In fact, some individuals exhibit no symptoms and never even feel ill. Outbreaks most often occur in the winter and spring.

Causes and symptoms

Fifth disease is caused by the human parvovirus B19, a member of the Parvoviridae family of viruses, that lives in the nose and throat of the infected person. The virus is spread through the air by coughing and sneezing. Because the virus needs a rapidly dividing cell in order to multiply, it attacks the red blood cells of the body. Once infected, a person is believed to be immune to reinfection.

Symptoms may appear four to 21 days after being exposed to the virus. Initial symptoms are flu-like and include headache, body ache, sore throat, a mild fever of 101 °F (38.3 °C), and chills. It is at this time, prior to the development of the rash, that individuals are contagious. These symptoms last for two to three days. In children, a bright red rash that looks like a slap mark develops suddenly on the cheeks. The rash may be flat or raised and may or may not be itchy. Sometimes, the rash spreads to the arms, legs, and trunk, where it has a lace-like or net-like appearance. The rash can also involve the palms of the hands and soles of the feet. By the time the rash appears, individuals are no longer infectious. On average, the rash lasts for 10-11 days, but may last for as long as five to six weeks. The rash may fade away and then reappear upon exposure to sunlight, hot baths, emotional distress, or vigorous exercise.

Adults generally do not develop a rash, but instead may have swollen and painful joints, especially in the hands and feet. In adults, symptoms such as sore throat, headache, muscle and joint pain, abdominal pain, diarrhea, and vomiting occur more frequently than in children and are usually more severe. The joint pain can be arthritis-like and last for several months, especially in women, but the disease does not appear to progress to rheumatoid arthritis.

The virus causes the destruction of red blood cells and, therefore, a deficiency in the oxygen-carrying capacity of the blood (anemia) can result. In healthy people, the anemia is mild and only lasts a short while. In people with weakened immune systems, however, either because they have a chronic disease like AIDS or cancer (immunocompromised), or are receiving medication to suppress the immune system (immunosuppressed), such as organ transplant recipients, this anemia can be severe and last long after the infection has subsided. Symptoms of anemia include fatigue, lack of color, lack of energy, and shortness of breath. Some individuals with sickle cell anemia, iron deficiency, a number of different hereditary blood disorders, and those who have received bone marrow transplantations may be susceptible to developing a potentially life-threatening complication called a transient aplastic crisis where the body is temporarily unable to form new red blood cells.

In very rare instances, the virus can cause inflammation of different areas of the body, including the brain (encephalitis ), the covering of the brain and spinal cord (meningitis ), the lungs (pneumonitis), the liver (hepatitis), and the heart muscle (myocarditis ). The virus can also aggravate symptoms for people with an autoimmune disease called systemic lupus erythematosus.

There is some concern about fifth disease in pregnant women. Although no association with an increased number of birth defects has been demonstrated, there is concern that infection during the first three months of pregnancy may lead to a slight increase in the number of miscarriages. There is also some concern that infection later in pregnancy may involve a very small risk of premature delivery or stillbirths. As a result, women who get fifth disease while they are pregnant should be monitored closely by a physician.

Diagnosis

Fifth disease is usually suspected based on a patient's symptoms, including the typical appearance of the bright red rash on the cheeks, patient history, age, and the time of year. The physician will also exclude other potential causes for the symptoms and rash, including rubella, infectious mononucleosis, bacterial infections like Lyme disease, allergic reactions, and lupus.

In addition, there is a blood test for fifth disease, but it is generally used only for pregnant women and for people who have weakened immune systems or who suffer from blood disorders, such as sickle cell anemia. The test involves measuring for a particular antibody or protein that the body produces in response to infection with the human parvovirus B19. The test is 92-97% specific for this disease.

Because fifth disease can pose problems for an unborn fetus exposed to the disease through the mother, testing may also be conducted while a fetus is still in the uterus. This test uses fluid collected from the sac around the fetus (amniotic fluid) instead of blood to detect the viral DNA.

Treatment

In general, no specific treatment for fifth disease is required. The symptoms can be treated using over-the counter medications, such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil). If the rash itches, calamine lotion can be applied. Aspirin is usually not given to children under the age of 18 to prevent the development of a serious illness called Reye's syndrome.

Patients who are receiving medications to suppress the immune system in the treatment of some other condition may be allowed to temporarily decrease the medications in order to allow the immune system to combat the infection and recover from the anemia. Those with weakened (not suppressed) immune systems, such as AIDS patients, may be given immunoglobulin intravenously to help the immune system fight the infection. People with severe anemia or who experience an aplastic crisis may require hospitalization and blood transfusions.

Prognosis

Generally, fifth disease is mild, and patients tend to improve without any complications. In cases where the patient is either immunocompromised or immunosuppressed, a life-threatening aplastic crisis can occur. With prompt treatment, however, the prognosis is good. Mothers who develop the infection while pregnant can pass the infection on to their fetus, and as such, stand an increased risk of miscarriage and stillbirth. There are tests and treatments, however, that can be performed on the fetus while still in the uterus that can reduce the risk of anemia or other complications.

Prevention

Currently, there is no vaccine against fifth disease. Avoiding contact with persons who exhibit symptoms of a cold and maintaining good personal hygiene by regularly washing hands may minimize the chances of an infection. Pregnant women should avoid exposure to persons infected with the disease and notify their obstetrician immediately if they are exposed so that they can be tested and monitored closely.

Resources

BOOKS

Berktow, Robert, et al., editors. Merck Manual of Diagnosis and Therapy. Rahway, NJ: Merck Research Laboratories, 2004.

KEY TERMS

Anemia— A congenital or acquired deficiency in the iron-carrying capacity of the blood.

Antibody— A specific protein produced by the immune system in response to a specific foreign protein or particle called an antigen.

Immunocompromised— A state in which the immune system is weakened or is not functioning properly due to chronic disease.

Immunosuppressed— A state in which the immune system is suppressed by medications during the treatment of other disorders, like cancer, or following an organ transplantation.

Reye's syndrome— A very serious, rare disease, most common in children, that involves an upper respiratory tract infection followed by brain and liver damage.

Sickle cell anemia— A hereditary blood disorder in which the red blood cells are misshapen into crescent or sickle shapes resulting in the reduced oxygen-carrying capacity of the lungs.

Fifth Disease

What Is Fifth Disease?

How Common Is Fifth Disease?

What Happens When People Get Fifth Disease?

Can Fifth Disease Be Prevented?

Resources

Fifth disease, also known as erythema infectiosum (air-uh-THEE-muh in-fek-she-O-sum), is a common viral infection of infants and young children that causes a characteristic “slapped cheek” rash.

KEYWORDS

for searching the Internet and other reference sources

Erythema infectiosum

Parvovirus

Slapped-cheek rash

Viral infections

What Is Fifth Disease?

Fifth disease, sometimes called slapped-cheek disease, is an infection caused by a virus called human parvovirus B19. Its most characteristic feature is a bright red rash that begins on the face, making the cheeks look as if they have been slapped. After a few days, the rash may spread down the body and onto the arms and legs. As it spreads, the rash takes on a pink, lacy appearance.

Most people with fifth disease have mild symptoms and do not become seriously ill; some may not have any symptoms at all. However, the disease can be serious for people with certain blood disorders, such as sickle-cell disease*, because parvovirus B19 can temporarily cause or worsen existing anemia*. For most people, temporary anemia is not a problem, but for those who already have anemia, the condition can become severe, causing paleness, fatigue, and a fast pulse. People with weakened immune systems, such as those who have AIDS*, cancer, or who have had an organ transplant, can also develop severe anemia as a result of fifth disease.

*sickle-cell disease

is a hereditary condition in which the red blood cells, which are usually round, take on an abnormal crescent shape and have a decreased ability to carry oxygen throughout the body.

*anemia

(uh-NEE-me-uh) is a blood condition in which there is a decreased amount of oxygen-carrying hemoglobin in the blood and, usually, fewer than normal numbers of red blood cells.

*AIDS ,

or acquired immunodeficiency (ih-myoo-no-dih-FIH-shen-see) syndrome, is an infection that severely weakens the immune system; it is caused by the human immunodeficiency virus (HIV).

Parvoviruses can infect animals, but these are not the same strains* that affect humans. Therefore, a person cannot catch fifth disease from a dog or cat, and a pet cannot catch it from an infected person.

*strains

are various subtypes of organisms, such as viruses or bacteria.

How Common Is Fifth Disease?

Fifth disease occurs most commonly in children between the ages of 5 and 15 years, but adults can get it too. It often occurs in outbreaks (for example, among classmates at school or children in a child-care center) in the winter and spring, but people can get it throughout the year.

Fifth disease spreads quickly. At home, up to half of family members exposed to someone with fifth disease will become infected. If an outbreak occurs in school, up to 60 percent of students may get the virus.

A person with fifth disease can spread the infection in the early part of the illness, before the rash develops. By the time the rash appears (about a week after being exposed to the virus), a person likely is no longer contagious. Once someone is infected with parvovirus B19, that person develops immunity* to it and will not usually become infected again.

*immunity

(ih-MYOON-uh-tee) is the condition of being protected against an infectious disease. Immunity often develops after a germ has entered the body. One type of immunity occurs when the body makes special protein molecules called antibodies to fight the disease-causing germ. The next time that germ enters the body, the antibodies quickly attack it, usually preventing the germ from causing disease.

A few days after infection with the virus that causes fifth disease, the telltale “slapped cheek” rash appears on the face. Custom Medical Stock Photo, Inc.

Parvovirus B19 passes from one person to another through nose and mouth fluids, such as saliva and mucus. Any direct contact with the fluids of an infected person, whether through a cough or sneeze or by sharing drinking glasses or utensils, can spread the infection.

Fifth disease can also be passed from pregnant women to their unborn babies. Most of the time, the baby is not harmed. Occasionally the infection can cause severe anemia in the baby and lead to miscarriage*, especially if the baby was infected in the first half of pregnancy.

*miscarriage

is the ending of a pregnancy through the death of the embryo or fetus before birth.

What Happens When People Get Fifth Disease?

Signs and symptoms

The first symptoms of fifth disease are similar to those of a common cold and include low fever, a runny or stuffy nose, sore throat, cough, headache, diarrhea, and fatigue. It is during this early period that fifth disease is most contagious. After a few days, especially in children, the slapped-cheek rash usually first appears on the face, and it soon begins to involve the rest of the body in a pink, lacy-looking pattern. Not everyone with fifth disease develops this rash; it is much more likely to appear in children under 10 years of age. For some people it will fade and reappear if triggered by heat, exercise, stress, or exposure to the sun. Sometimes the rash may itch, and adults in particular may experience pain and swelling of the joints in the hands, or the wrists, knees, or ankles.

Diagnosis

In children, doctors can usually diagnose fifth disease simply by looking for the telltale rash on the face and body. In cases where there is no rash, blood tests can confirm the presence of parvovirus B19.

Treatment

Most people with fifth disease do not require treatment. Antibiotics will not help because the illness is caused by a virus. Symptoms

Naming a Disease

Fifth disease was named in the late 1800s. It was the fifth classic childhood rash-associated disease to be named, following measles (first disease), scarlet fever (second disease), rubella or German measles (third disease), and a fourth condition with a rash that is unknown to doctors today (fourth disease). The name fifth disease probably stuck because it is a lot easier to say than erythema infectiosum.

such as fever or joint pain may be treated with acetaminophen (uh-see-teh-MIH-noh-fen), a medication commonly used to reduce fever and relieve pain.

The rash clears up on its own, often within 1 to 3 weeks. Joint pain and swelling can take longer to go away, sometimes up to several months. People with joint pain may need to rest and restrict their activities until they feel better.

People with blood disorders or immune deficiencies who develop severe anemia as a result of fifth disease may require blood transfusions* and other specialized medical care.

*blood transfusions

(trans-FYOO-zhunz) are procedures in which blood or certain parts of blood (such as specific cells) are given to a person who needs them because of illness or blood loss.

Complications

The vast majority of people who are infected with parvovirus B19 recover completely without any complications. Severe anemia, the complication most often associated with fifth disease, usually affects people with weakened immune systems or blood disorders and, rarely, unborn babies that were infected during the first half of pregnancy.

In healthy people, parvovirus B19 infection can sometimes affect the ability of the bone marrow (the soft tissue inside bones where blood cells are made) to make new red blood cells, but this effect is usually temporary and does not cause significant anemia or other problems.

Can Fifth Disease Be Prevented?

There is no vaccine to prevent fifth disease. The best way to prevent the spread of infection is to practice good hygiene, including frequent hand washing and not sharing drinking glasses and eating utensils. Because the disease is most contagious before the telltale rash appears, it is difficult to keep the infection from spreading among family members or young children in school or day care. By the time the rash appears and the illness is diagnosed, the person is usually no longer contagious.

See also

Measles (Rubeola)

Rubella (German Measles)

Resources

Organization

U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30333. The CDC provides fact sheets about fifth disease at its website.

Telephone 800-311-3435 http://www.cdc.gov

Website

KidsHealth.org. KidsHealth is a website created by the medical experts of the Nemours Foundation and is devoted to issues of children’s health. It contains articles on a variety of health topics, including fifth disease.

http://www.KidsHealth.org

fifth disease (fifth) n. see erythema (infectiosum).

fifth disease see parvovirus .