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Fifth disease

Updated : August 30, 2023





Background

The fifth disease, also known as erythema infectiosum, is a mild viral illness caused by parvovirus B19. It is most commonly seen in children but can affect people of any age. The name “fifth disease” comes from its historical classification as the fifth of six childhood diseases characterized by a rash. The virus is spread through respiratory secretions such as coughing or sneezing and can also be transmitted through contact with infected blood. The incubation period is usually 4-14 days, and symptoms may appear within this time frame.

The fifth disease is generally a mild illness with symptoms similar to those of a common cold, including fever, headache, and sore throat. However, the characteristic rash that appears on the face and body is the most distinguishing feature of the disease. The rash begins as red, raised areas on the cheeks that give the appearance of slapped cheeks. This is followed by a lacy, red rash on the arms, legs, and trunk, which may be itchy. In most cases, the fifth disease resolves on its own within a few weeks without any specific treatment.

However, in rare cases, the virus can cause complications, particularly in individuals with weakened immune systems or pregnant women. These complications may include anemia, arthritis, and fetal loss in pregnant women. Prevention of the fifth disease involves practicing good hygiene, such as washing hands frequently and avoiding close contact with infected individuals. It is also important to stay home from work or school when experiencing symptoms of illness to avoid spreading the virus to others.

Epidemiology

The fifth disease is a common viral illness that occurs worldwide. It is most common in children between the ages of 5 and 15 years but can affect people of any age. The virus is highly contagious and can be easily spread through respiratory secretions such as coughing or sneezing. It can also be spread through contact with infected blood, although this is less common.

The fifth disease is most commonly seen in the late winter and early spring but can occur at any time of the year. Outbreaks of the disease may occur in schools, daycares, and other crowded settings. Although the fifth disease can affect people of any age, it is more common in children because they have not yet developed immunity to the virus. Once a person has been infected with the virus, they typically develop lifelong immunity.

While the fifth disease is generally a mild illness, it can cause complications in certain populations. These include individuals with weakened immune systems and pregnant women. In pregnant women, the virus can cause fetal loss or other complications, particularly during the first half of pregnancy. Overall, the fifth disease is a common viral illness with a high rate of transmission. While it is generally a mild illness, it is important to take precautions to prevent its spread and to seek medical attention if complications are suspected.

Anatomy

Pathophysiology

The fifth disease is caused by parvovirus B19, which is a single-stranded DNA virus that primarily infects human erythroid progenitor cells in the bone marrow. The virus enters the body through the respiratory tract and spreads to other parts of the body through the bloodstream. Once the virus enters the erythroid progenitor cells, it replicates and causes cell lysis, leading to a decrease in red blood cell production. This can result in anemia, particularly in individuals with pre-existing conditions that affect red blood cell production, such as sickle cell disease or thalassemia.

In addition to the effects on the bone marrow, the virus can also cause inflammation and damage to blood vessels, particularly in the skin. This can result in the characteristic rash seen in the fifth disease, which begins as red, raised areas on the cheeks that give the appearance of “slapped cheeks.” This is followed by a lacy, red rash on the arms, legs, and trunk, which may be itchy. In most cases, the symptoms of the fifth disease resolve on their own within a few weeks without any specific treatment.

However, in rare cases, the virus can cause complications, particularly in individuals with weakened immune systems or pregnant women. These complications may include anemia, arthritis, and fetal loss in pregnant women. Overall, the fifth disease is a relatively mild viral illness that primarily affects the bone marrow and blood vessels, resulting in anemia and a characteristic rash. While it is generally a self-limited illness, it is important to be aware of the potential complications and to seek medical attention if they are suspected.

Etiology

The fifth disease is caused by a virus called parvovirus B19. This virus is a small, single-stranded DNA virus that is highly contagious and can be easily transmitted through respiratory secretions such as coughing or sneezing. Parvovirus B19 is most commonly transmitted in school or daycare settings, where it can easily spread from child to child through close contact.

It can also be spread through blood transfusions or exposure to contaminated blood products. Once a person is infected with the virus, it takes between 4 and 14 days for symptoms to appear. During this time, the person is contagious and can spread the virus to others. While the fifth disease is generally a mild illness, it can cause complications in certain populations.

These include individuals with weakened immune systems, pregnant women, and individuals with pre-existing conditions that affect red blood cell production, such as sickle cell disease or thalassemia. In these populations, the virus can cause more severe symptoms and may require medical treatment.

Genetics

Prognostic Factors

The prognosis for most individuals with the fifth disease is excellent. The illness is generally mild and self-limited, and most people recover fully without any complications. Symptoms typically last for one to three weeks and gradually improve over time. However, in rare cases, the fifth disease can cause more severe symptoms, particularly in individuals with weakened immune systems or pregnant women.

In these cases, complications can include anemia, miscarriage, stillbirth in pregnant women or chronic joint pain in adults. It is important to seek medical attention if these complications are suspected. Overall, the prognosis for the fifth disease is good, and most people recover fully without any long-term effects. Good hygiene practices and avoidance of contact with others can help prevent the spread of the virus and reduce the risk of complications.

Clinical History

Clinical history

The clinical history of the fifth disease typically includes the following:

  • Incubation period: The incubation period of parvovirus B19 is between 4 and 14 days, during which time the person is contagious and can spread the virus to others.
  • Initial symptoms: The initial symptoms of the fifth disease can be mild and flu-like, including fever, headache, and runny nose. Some people may also experience sore throat, fatigue, or gastrointestinal symptoms.
  • Slapped cheek appearance: After a few days, the characteristic “slapped cheek” appearance develops, with red, raised areas on both cheeks. This can last for several days and may be accompanied by a fever or other symptoms.
  • Lacy rash: A few days after the onset of the “slapped cheek” appearance, a lacy, red rash may appear on the arms, legs, and trunk. This rash may be itchy and can come and go for several weeks.
  • Joint pain: In some cases, the fifth disease can cause joint pain, particularly in adults. This pain may last for several weeks or months and can be severe.

Most people with the fifth disease recover without any complications, although joint pain may persist for some time. However, in rare cases, the virus can cause more severe symptoms, particularly in individuals with weakened immune systems or pregnant women. It is important to seek medical attention if these complications are suspected.

Physical Examination

Physical examination

During a physical examination for the fifth disease, a healthcare provider will typically look for the characteristic “slapped cheek” appearance and the lacy, red rash on the arms, legs, and trunk. They may also look for signs of joint pain or swelling. The healthcare provider may also take the patient’s temperature, blood pressure, and other vital signs.

They may ask about other symptoms, such as sore throat, fatigue, or gastrointestinal symptoms, and may perform additional tests or blood work to help confirm a diagnosis. In some cases, a healthcare provider may also recommend additional testing or monitoring for individuals who are at higher risk of complications, such as pregnant women or individuals with weakened immune systems.

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Differential diagnosis

The characteristic “slapped cheek” appearance of the fifth disease is often distinctive, but other viral exanthems can also cause similar rashes, including:

  • Measles: A viral infection that can cause fever, cough, and a characteristic rash that typically starts on the face and spreads to other parts of the body.
  • Rubella: A viral infection that can cause fever, rash, and swollen lymph nodes. The rash typically starts on the face and spreads to other parts of the body.
  • Roseola: A viral infection that can cause high fever, followed by a rash that typically starts on the trunk and spreads to the face and limbs.
  • Hand, foot, and mouth disease: A viral infection that can cause fever, sore throat, and rash or blisters on the hands, feet, and mouth.
  • Scarlet fever: A bacterial infection that can cause a rash that typically starts on the chest and spreads to other parts of the body. It is often accompanied by a sore throat and fever.
  • Kawasaki disease: A rare but serious condition that can cause fever, rash, and other symptoms, including redness and swelling of the hands and feet.

Other conditions that can cause a rash include drug reactions, allergic reactions, and autoimmune disorders. A healthcare provider will take a detailed medical history, perform a physical examination, and may order laboratory tests to help make a diagnosis.

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

There is no specific treatment for the fifth disease, as it is caused by a viral infection that typically resolves on its own. However, there are a few steps that can be taken to help manage symptoms and prevent the spread of the virus:

  • Rest and hydration: It is important for individuals with the fifth disease to rest and stay hydrated. Drinking plenty of fluids can help alleviate symptoms and prevent dehydration.
  • Pain relief: Over-the-counter pain relievers such as acetaminophen or ibuprofen can help alleviate fever, joint pain, and other symptoms.
  • Avoidance of triggers: Individuals with joint pain should avoid activities that exacerbate their symptoms, such as high-impact exercise or heavy lifting.
  • Prevention of spread: Individuals with the fifth disease should avoid contact with others, particularly pregnant women and individuals with weakened immune systems until symptoms have resolved. Good hand hygiene and respiratory etiquette, such as covering the mouth and nose when coughing or sneezing, can also help prevent the spread of the virus.
  • In rare cases, the fifth disease can cause more severe symptoms, particularly in individuals with weakened immune systems or pregnant women. These individuals may require additional monitoring or treatment to prevent complications. It is important to seek medical attention if these complications are suspected.

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Media Gallary

References

https://my.clevelandclinic.org/health/diseases/15774-fifth-disease

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Fifth disease

Updated : August 30, 2023




The fifth disease, also known as erythema infectiosum, is a mild viral illness caused by parvovirus B19. It is most commonly seen in children but can affect people of any age. The name “fifth disease” comes from its historical classification as the fifth of six childhood diseases characterized by a rash. The virus is spread through respiratory secretions such as coughing or sneezing and can also be transmitted through contact with infected blood. The incubation period is usually 4-14 days, and symptoms may appear within this time frame.

The fifth disease is generally a mild illness with symptoms similar to those of a common cold, including fever, headache, and sore throat. However, the characteristic rash that appears on the face and body is the most distinguishing feature of the disease. The rash begins as red, raised areas on the cheeks that give the appearance of slapped cheeks. This is followed by a lacy, red rash on the arms, legs, and trunk, which may be itchy. In most cases, the fifth disease resolves on its own within a few weeks without any specific treatment.

However, in rare cases, the virus can cause complications, particularly in individuals with weakened immune systems or pregnant women. These complications may include anemia, arthritis, and fetal loss in pregnant women. Prevention of the fifth disease involves practicing good hygiene, such as washing hands frequently and avoiding close contact with infected individuals. It is also important to stay home from work or school when experiencing symptoms of illness to avoid spreading the virus to others.

The fifth disease is a common viral illness that occurs worldwide. It is most common in children between the ages of 5 and 15 years but can affect people of any age. The virus is highly contagious and can be easily spread through respiratory secretions such as coughing or sneezing. It can also be spread through contact with infected blood, although this is less common.

The fifth disease is most commonly seen in the late winter and early spring but can occur at any time of the year. Outbreaks of the disease may occur in schools, daycares, and other crowded settings. Although the fifth disease can affect people of any age, it is more common in children because they have not yet developed immunity to the virus. Once a person has been infected with the virus, they typically develop lifelong immunity.

While the fifth disease is generally a mild illness, it can cause complications in certain populations. These include individuals with weakened immune systems and pregnant women. In pregnant women, the virus can cause fetal loss or other complications, particularly during the first half of pregnancy. Overall, the fifth disease is a common viral illness with a high rate of transmission. While it is generally a mild illness, it is important to take precautions to prevent its spread and to seek medical attention if complications are suspected.

The fifth disease is caused by parvovirus B19, which is a single-stranded DNA virus that primarily infects human erythroid progenitor cells in the bone marrow. The virus enters the body through the respiratory tract and spreads to other parts of the body through the bloodstream. Once the virus enters the erythroid progenitor cells, it replicates and causes cell lysis, leading to a decrease in red blood cell production. This can result in anemia, particularly in individuals with pre-existing conditions that affect red blood cell production, such as sickle cell disease or thalassemia.

In addition to the effects on the bone marrow, the virus can also cause inflammation and damage to blood vessels, particularly in the skin. This can result in the characteristic rash seen in the fifth disease, which begins as red, raised areas on the cheeks that give the appearance of “slapped cheeks.” This is followed by a lacy, red rash on the arms, legs, and trunk, which may be itchy. In most cases, the symptoms of the fifth disease resolve on their own within a few weeks without any specific treatment.

However, in rare cases, the virus can cause complications, particularly in individuals with weakened immune systems or pregnant women. These complications may include anemia, arthritis, and fetal loss in pregnant women. Overall, the fifth disease is a relatively mild viral illness that primarily affects the bone marrow and blood vessels, resulting in anemia and a characteristic rash. While it is generally a self-limited illness, it is important to be aware of the potential complications and to seek medical attention if they are suspected.

The fifth disease is caused by a virus called parvovirus B19. This virus is a small, single-stranded DNA virus that is highly contagious and can be easily transmitted through respiratory secretions such as coughing or sneezing. Parvovirus B19 is most commonly transmitted in school or daycare settings, where it can easily spread from child to child through close contact.

It can also be spread through blood transfusions or exposure to contaminated blood products. Once a person is infected with the virus, it takes between 4 and 14 days for symptoms to appear. During this time, the person is contagious and can spread the virus to others. While the fifth disease is generally a mild illness, it can cause complications in certain populations.

These include individuals with weakened immune systems, pregnant women, and individuals with pre-existing conditions that affect red blood cell production, such as sickle cell disease or thalassemia. In these populations, the virus can cause more severe symptoms and may require medical treatment.

The prognosis for most individuals with the fifth disease is excellent. The illness is generally mild and self-limited, and most people recover fully without any complications. Symptoms typically last for one to three weeks and gradually improve over time. However, in rare cases, the fifth disease can cause more severe symptoms, particularly in individuals with weakened immune systems or pregnant women.

In these cases, complications can include anemia, miscarriage, stillbirth in pregnant women or chronic joint pain in adults. It is important to seek medical attention if these complications are suspected. Overall, the prognosis for the fifth disease is good, and most people recover fully without any long-term effects. Good hygiene practices and avoidance of contact with others can help prevent the spread of the virus and reduce the risk of complications.

Clinical history

The clinical history of the fifth disease typically includes the following:

  • Incubation period: The incubation period of parvovirus B19 is between 4 and 14 days, during which time the person is contagious and can spread the virus to others.
  • Initial symptoms: The initial symptoms of the fifth disease can be mild and flu-like, including fever, headache, and runny nose. Some people may also experience sore throat, fatigue, or gastrointestinal symptoms.
  • Slapped cheek appearance: After a few days, the characteristic “slapped cheek” appearance develops, with red, raised areas on both cheeks. This can last for several days and may be accompanied by a fever or other symptoms.
  • Lacy rash: A few days after the onset of the “slapped cheek” appearance, a lacy, red rash may appear on the arms, legs, and trunk. This rash may be itchy and can come and go for several weeks.
  • Joint pain: In some cases, the fifth disease can cause joint pain, particularly in adults. This pain may last for several weeks or months and can be severe.

Most people with the fifth disease recover without any complications, although joint pain may persist for some time. However, in rare cases, the virus can cause more severe symptoms, particularly in individuals with weakened immune systems or pregnant women. It is important to seek medical attention if these complications are suspected.

Physical examination

During a physical examination for the fifth disease, a healthcare provider will typically look for the characteristic “slapped cheek” appearance and the lacy, red rash on the arms, legs, and trunk. They may also look for signs of joint pain or swelling. The healthcare provider may also take the patient’s temperature, blood pressure, and other vital signs.

They may ask about other symptoms, such as sore throat, fatigue, or gastrointestinal symptoms, and may perform additional tests or blood work to help confirm a diagnosis. In some cases, a healthcare provider may also recommend additional testing or monitoring for individuals who are at higher risk of complications, such as pregnant women or individuals with weakened immune systems.

Differential diagnosis

The characteristic “slapped cheek” appearance of the fifth disease is often distinctive, but other viral exanthems can also cause similar rashes, including:

  • Measles: A viral infection that can cause fever, cough, and a characteristic rash that typically starts on the face and spreads to other parts of the body.
  • Rubella: A viral infection that can cause fever, rash, and swollen lymph nodes. The rash typically starts on the face and spreads to other parts of the body.
  • Roseola: A viral infection that can cause high fever, followed by a rash that typically starts on the trunk and spreads to the face and limbs.
  • Hand, foot, and mouth disease: A viral infection that can cause fever, sore throat, and rash or blisters on the hands, feet, and mouth.
  • Scarlet fever: A bacterial infection that can cause a rash that typically starts on the chest and spreads to other parts of the body. It is often accompanied by a sore throat and fever.
  • Kawasaki disease: A rare but serious condition that can cause fever, rash, and other symptoms, including redness and swelling of the hands and feet.

Other conditions that can cause a rash include drug reactions, allergic reactions, and autoimmune disorders. A healthcare provider will take a detailed medical history, perform a physical examination, and may order laboratory tests to help make a diagnosis.

There is no specific treatment for the fifth disease, as it is caused by a viral infection that typically resolves on its own. However, there are a few steps that can be taken to help manage symptoms and prevent the spread of the virus:

  • Rest and hydration: It is important for individuals with the fifth disease to rest and stay hydrated. Drinking plenty of fluids can help alleviate symptoms and prevent dehydration.
  • Pain relief: Over-the-counter pain relievers such as acetaminophen or ibuprofen can help alleviate fever, joint pain, and other symptoms.
  • Avoidance of triggers: Individuals with joint pain should avoid activities that exacerbate their symptoms, such as high-impact exercise or heavy lifting.
  • Prevention of spread: Individuals with the fifth disease should avoid contact with others, particularly pregnant women and individuals with weakened immune systems until symptoms have resolved. Good hand hygiene and respiratory etiquette, such as covering the mouth and nose when coughing or sneezing, can also help prevent the spread of the virus.
  • In rare cases, the fifth disease can cause more severe symptoms, particularly in individuals with weakened immune systems or pregnant women. These individuals may require additional monitoring or treatment to prevent complications. It is important to seek medical attention if these complications are suspected.

https://my.clevelandclinic.org/health/diseases/15774-fifth-disease

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