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The following text is from an archived Red Book® edition and may not reflect current recommendations or information. To view the current edition, click here.
Section 3. Summaries of Infectious Diseases
Parvovirus B19
(Erythema Infectiosum, Fifth Disease)Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: Infection with parvovirus B19 is recognized most often as erythema infectiosum (EI), which is characterized by mild systemic symptoms, fever in 15% to 30% of patients, and commonly, a distinctive rash. The facial rash is intensely red with a "slapped cheek" appearance that often is accompanied by circumoral pallor. A symmetric, maculopapular, lace-like, and often pruritic rash also occurs on the trunk, moving peripherally to involve the arms, buttocks, and thighs. The rash can fluctuate in intensity and recur with environmental changes, such as temperature and exposure to sunlight, for weeks to months. A brief, mild, nonspecific illness consisting of fever, malaise, myalgias, and headache often precedes the characteristic exanthema by approximately 7 to 10 days. Arthralgia and arthritis occur rarely among infected children but commonly among adults, especially women.
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Human parvovirus B19 also can cause other manifestations (Table 3.39, p 460), including asymptomatic infection, a mild respiratory tract illness with no rash, a rash atypical for EI that may be rubelliform or petechial, polyarthropathy syndrome (arthralgia and arthritis in adults in the absence of other manifestations of EI), chronic erythroid hypoplasia in immunodeficient patients, and transient aplastic crisis lasting 7 to 10 days in patients with hemolytic anemias (eg, sickle cell disease and autoimmune hemolytic anemia) and other conditions associated with low hemoglobin concentrations, including hemorrhage, severe anemia, and thalassemia. Chronic parvovirus B19 infection may cause severe anemia in patients infected with human immunodeficiency virus (HIV). In addition, parvovirus B19 infection sometimes has been associated with thrombocytopenia and neutropenia. Patients with aplastic crisis may have a prodromal illness with fever, malaise, and myalgia, but rash usually
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