Fifth disease or “slapped cheek syndrome”
What is Fifth disease?
This is an infection caused by a virus, called parvovirus B19. It is also called erythema infectiosum, and it is one of the childhood diseases – infections. This virus is transmitted from human to human and not from pets (cats or dogs).
When does Fifth disease usually occur?
This viral disease is more common in the preschool and primary school ages, i.e. between the ages of 3 and 10 years, but it may also occur in other age groups – younger children, or even in adults.
How frequent is the disease?
It occurs very frequently. Most adults (about 6 out of 10) within the general population have antibodies against this virus, which means that they have had the disease at some time in their lives.
Most incidents occur at the end of the winter and during the spring.
How is it transmitted, and how long after contact?
It is transmitted by the saliva of the person carrying the virus, through the respiratory system or the hands, and through infected objects. The person carrying the virus is contagious mainly while he has a fever and aching of the body. Transmission occurs mainly through saliva, and during the 2 weeks preceding the appearance of the rash.
The first symptoms appear within 4 to 14 days after the day that the virus was transmitted (long incubation time).
How is it manifested, and what are the symptoms?
Most people catch the virus and develop antibodies without suffering, meaning that they get through the infection asymptomatically.
Sometimes the symptoms are so mild, that many people don’t even recognize the disease as a virus, and recover quickly.
When there are symptoms, these could be fever, headache, pain in the abdomen, and pain in the muscles and joints initially, i.e. symptoms that are similar to simple influenza.
The classic form of the virus, which provides the name of the disease, is the rapid development of a vivid red rash, which is very intense on the cheeks (as if the child has been slapped). This rash is called erythema, i.e. simple redness of the skin without underlying pimples or other lesions.
Often, only this rash on the cheeks is present. Sometimes, a rash coexists on other parts of the child’s body, for example, the back, the chest, the legs, and the arms (proximal, not on the palms or the soles). In these areas, the rash is blotchy. The rash is more prominent on the extended areas of the arms and legs, not at the joints.
These rashes appear and disappear, relapsing and recurring maybe for days or weeks. They may deteriorate in areas exposed to the sun or to heat, also, they may deteriorate after psychological stress or physical exertion, for example, after exercise.
What is the outcome of the disease?
Erythema infectiosum is not a serious disease, it is not life-threatening, and complications rarely occur. Most children do not require any treatment, apart from the conservative treatment of a virus: as much rest as they want, a healthy diet with vitamin intake, paracetamol in case of significant fever.
How is Fifth disease treated?
Antibiotics don’t have any effect on erythema infectiosum, because it is a virus; on the contrary, unnecessary use may harm the child.
When can my child return to school?
Children stop transmitting the infection when the rash appears on the face. Therefore, keep the child at home and away from other children during the period that they have a temperature, and they can return to school or nursery when they no longer have a temperature.
Does the Fifth disease have complications?
Complications are few, and relate in particular to three categories of children: girls of an older age, or teenage girls with the infection, who sometimes develop a form of arthralgia and arthritis, with pain and swelling in the joints of the arms and legs. This arthritis may last for weeks, but does not have long-term effects, neither does it become chronic, i.e. it is self-restrictive to a month at most. Treatment with anti-inflammatory medications prescribed by the paediatrician may be necessary.
The second category of children is children with hemolytic disease, like thalassemia or sickle cell anemia, in which cases this virus may lead to aplastic anemia, i.e. to interruption of the production of red blood cells.
The third category regards children who have been taking cortisone for a long period of time, or are immunosuppressed, or are undergoing chemotherapy, in which cases the virus can become more serious and dangerous.
Finally, a forth group of people who need to be cautious about this virus is pregnant women, who should avoid contact with people suffering from erythema infectiosum. If a pregnant woman has come into contact with a child with erythema infectiosum, she should have a blood test to ascertain if she has antibodies against the virus from previous illness. If she doesn’t, then there is a risk that the baby will be born with anemia. In addition, despite the fact that most pregnancies after infection with parvovirus continue until term without problems, there is a possibility of hydrops fetalis and stillbirth. The most sensitive period for a first infection with this virus appears to be the second trimester of pregnancy. Anemia in newborns is rarely severe and usually subsides by itself, and simply requires frequent monitoring of the infant by the paediatrician.
Stelios Papaventsis MRCPCH DCH IBCLC 2012