Fifth Disease

Overview

Fifth disease or erythema infectiosum is an infection of the respiratory system which begins to show itself as a red rash on the cheeks. It is commonly known as fifth disease because it was the fifth childhood disease with a similar rash to be discovered after scarlet fever measles rubella (German measles) and rubeolla. It is most common among elementary school-age children during outbreaks in the winter and spring months but anyone can become ill with it any time of the year. Fifth disease is usually mild but can be serious in those who have certain other medical problems.

Causes

The disease is caused by human parvovirus B19 and spreads from person to person in the same way as a cold virus often through respiratory secretions and hand-to-hand contact. A susceptible person usually becomes ill 4 to 14 days after being infected with the virus.

Symptoms

The infection tends to start with cold-like symptoms including headaches low-grade fevers muscle aches and tiredness. The symptoms are usually mild and last for a couple of days. It is before and during this period that the child is contagious. This is different than for many other rash illnesses such as measles for which the child is contagious while he or she has the rash.

In fifth disease the rash phase progresses through several stages:

Stage 1

Stage one is the red rash on the cheeks that gives rise to fifth disease's old street name "slap cheek" because it looks as if the child has been slapped on the face. It is most noticeable when someone moves from a cool environment into a warm one.

Stage 2

The second stage of the rash begins between 1 and 4 days later when a milder rash appears on the arms and legs buttocks and the truck of the body itself. The rash usually spreads in a downward direction. Near the end of this stage there is a blotchy clearing of the rash that appears as a lacy pattern.

Stage 3

The third stage of the rash usually lasts for a week or so sometimes even a month or more. The intensity of the rash will fluctuate during this period especially when the temperature changes. A child can appear to have completely recovered only to have the rash reappear when he or she takes a bath.

If your child develops what appear to be signs of fifth disease but you're not sure contact your doctor to see if there may be some other cause for the symptoms. Also contact your doctor if your child has a temperature greater than 102 F or if you have other concerns.

At least half of all adults have had fifth disease in childhood and will not get it again if exposed to a child with the infection. Those who have not built up immunity and do contract fifth disease will likely suffer fever and soreness in the joints of their hands wrists knees and ankles. This will last anywhere from a few days to several weeks.

Treatment

The best treatment is prevention. While there is no vaccine or medicine that protects against the infection frequent hand washing will decrease your chances of becoming infected.

Adults who do become infected will likely suffer pain and swelling in their joints and may need to rest restrict their activities and take aspirin or ibuprofen to relieve symptoms. You can give acetaminophen (i.e. Tylenol) to help reduce fever or discomfort in a child. However never give aspirin to children. It can trigger a rare but potentially fatal disorder known as Reye's syndrome.

The rash itself doesn't require treatment. You do not have to keep your sick child home from school or daycare as they will already be past the contagious period by the time you realize they have fifth disease. When you can see the rash they are no longer contagious.

Complications

If you are pregnant and you become infected with fifth disease particularly in the first half of your pregnancy there is a slight chance your fetus may develop serious complications such as severe anemia. But this occurs in less than five percent of pregnancies. Most pregnant women with fifth disease have normal healthy babies and parvovirus infection doesn't increase the risk of birth defects or mental retardation.

The parvovirus that causes fifth disease may also spark a serious illness in people with sickle-cell disease or similar types of chronic anemia and in those with a compromised immune system. If this is the case see your doctor.