Core Dermatology Diagnoses / CategoriesInfectious

Erythema infectiosum

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Publish date: Posted on
Last updated: February 17, 2024

Keywords #

parvovirus B19
human parvovirus B19
Erythroparvovirus
Fifth’s disease
slapped cheek
erythema infectiosum

Diagnosis #

Erythema infectiosum is one of five major syndromes associated with parvovirus B19 infection. It is self-limited and is generally a mild school-age illness.[1] It is characterized by classic erythematous, symmetric patches on the malar cheeks followed by erythematous, blanching, reticular patches and papules dispersed along the trunk and extremities.[2] Erythema infectiosum resolves spontaneously over weeks and does not require treatment, although symptomatic relief for fever and discomfort can be administered.[3]

Key Concepts #
  • Erythema infectiosum is the most common manifestation of parvovirus B19 infection.[4]
  • Erythema infectiosum is common in school-aged children.[1]
  • Prodromal, non-specific, flu-like symptoms during acute viremia are followed by a characteristic malar rash that disseminates.[2]
  • It is a self-limited and generally mild illness requiring no treatment aside from symptomatic relief.[3]
Epidemiology #

Parvovirus B19, typified by the genus Erythroparvovirus as it infects erythrocyte progenitor cells, causes five major recognized syndromes, of which erythema infectiosum is the most common.[4] Erythema infectiosum is most common in children of school age; outbreaks can occur within schools with 25-50% of children becoming infected.[5] It is referred to as “Fifth’s Disease” as it is one of the six most common rashes of childhood.[6] Parvovirus B19 is usually transmitted via respiratory droplets but can also be transmitted through physical contact and fomites.[2] Patients infected with parvovirus B19 are most contagious 5-10 days after exposure for approximately 5 days. Symptoms usually resolve within a few weeks but can last for months in some patients.[7]

Clinical Features #
  • Prodromal symptoms, including fever, coryza, headache, nausea, and diarrhea, occur during the acute viremic phase and are nonspecific. These generally resolve before cutaneous signs occur.[2]
  • Up to 5 days after prodromal symptoms, erythematous, symmetric patches occur on the malar cheeks with a “slapped cheek” appearance.[2]
  • Erythematous, blanching, reticular patches and papules subsequently develop along the trunk and extremities after the facial rash.[2]
  • This rash resolves completely within a month.[3]
Differential Diagnoses #
Diagnostic Workup #

In immunocompetent patients with malar rash presentation, the diagnosis can be made clinically based on history of preceding viral symptoms with subsequent characteristic rash.

In patients with atypical presentation or who are immunocompromised, serologic testing for IgM and IgG antibodies to Parvovirus B19 may be performed.[8]

Treatment #

Erythema infectiosum is self-limited and often very mild in children.[3] No treatment is indicated for the viral infection, but supportive care can be indicated for those with arthralgias, arthritis, or pruritus.[9]

Slide Viewer #
https://utahderm.med.utah.edu/image-viewer/
References #
  1. Anderson LJ. Role of Parvovirus B19 in Human Disease. Pediatric Infectious Disease Journal. 1987; 6:711.
  2. Anderson MJ, Higgins PG, Davis LR, et al. Experimental Parvoviral Infection in Humans. Journal of Infectious Disease. 1985; 152:257.
  3. Young NS, Brown KE. Parvovirus B19. New England Journal of Medicine. 2004; 350:586.
  4. Cotmore SF, Agbandje-McKenna M, Chiorini JA, et al. The Family Parvoviridae. Archives of Virology. 2014; 159:1239.
  5. Cohen BJ, Buckley MM. The Prevalence of Antibody to Human Parvovirus B19 in England and Wales. Journal of Medical Microbiology. 1988; 25:151.
  6. Cherry JD. Contemporary Infectious Exanthems. Clinical Infectious Diseases. 1993; 16:199.
  7. Lindblom A, Isa A, Norbeck O, et al. Slow Clearance of Human Parvovirus B19 Viremia Following Acute Infection. Clinical Infectious Disease. 2005; 41:1201.
  8. Jordan JA. Comparison of a Baculovirus-based VP2 Enzyme Immunoassay (EIA) to an Escherichia coli-based VP1 EIA for Detection of Human Parvovirus B19 Immunoglobulin M and Immunoglobulin G in Sera of Pregnant Women. Journal of Clinical Microbiology. 2000; 38:1472.
  9. Naides SJ, Scharosch LL, Foto F, Howard EJ. Rheumatologic Manifestations of Human Parvovirus B19 Infection in Adults. Initial Two-Year Clinical Experience. Arthritis and Rheumatology. 1990; 33:1297.
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