Fifth disease

• Alternative Names

  Parvovirus B19; Erythema infectiosum; Slapped cheek

• Causes, incidence, and risk factors

  Fifth disease is caused by human parvovirus B19. It often affects preschoolers or school-age children during the spring. The disease is spread by contact with respiratory secretions and usually return for 5 days. However, the rash associated with fifth disease may return for several weeks. Return of the rash may be brought on by sunlight, heat, exercise, fever, or emotional stress.

  The first sign of the disease is usually bright red cheeks, which look as though the child has been recently slapped on both sides of the face. Following this, a rash appears on the arms and legs and middle of the body. The rash fades from the center outwards, giving it a lacy appearance. Over a period of 1 to 2 weeks, the rash completely goes away.

  Fifth disease is also sometimes associated with fever.

  If a pregnant woman becomes infected with parvovirus B19, it can cause significant harm to her unborn baby. Any pregnant woman who believes that she may have been in contact with a person who has this virus should talk to her health care provider.

  Parvovirus B19 is also thought to cause other diseases, including an infectious form of arthritis.

  The majority of adults seem to have antibodies to parvovirus B19 in their bodies. This indicates that most people have been exposed to the virus, and also suggests that many infections go unnoticed.

• Symptoms
  • Rash
    • First appears on the cheeks, often looks like "slapped cheeks"
    • Spreads to the arms and legs about 1 day later, often has a "lacy" appearance
  • Fever
  • Joint pain
  • Temporary anemia -- this is only serious if the patient has a immune system problem and some other, existing form of anemia
• Signs and tests

  Fifth disease causes a very distinct rash. Your health care provider will examine the appearance and pattern of the rash. This is usually all that is needed to make a diagnosis.

  Blood tests that look for antibodies against parvovirus B19 may indicate infection. However, these tests are usually not needed, although they may be helpful in the diagnosis of aplastic crisis and persistent anemia.

  Testing may also be done when there is a question of whether a pregnant woman has been exposed to the virus.

• Treatment

  No treatment is usually required for fifth disease in children. If fever or joint discomfort is present then oral acetaminophen (such as Tylenol) may be given.

• Expectations (prognosis)

  Since this is a mild and generally benign viral infection, complete recovery can be expected.

• Complications

  There are generally no complications in normally healthy children.

• Calling your health care provider

  Call your health care provider if your child has symptoms of this disease. Other disorders can cause similar symptoms and should be ruled out.

Review Date: 8/2/2009

Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.