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Infectious Diseases

Fifth Disease



My child developed a bad cold recently while we were skiing abroad and his face became very red -- I assumed from the wind and from the cold. I then noticed that I was getting a rash on my skin. I didn't make a connection until another parent told me that my child could have something called "fifth disease" and that I may have contracted it as well, but in a different form. How can I know? How contagious is this? I have an immuno-compromised relative. Do I need to be especially concerned about exposing her to my child?


Obviously, since I have only a limited history and have never seen your child, I cannot give you any specific advice as to whether he or she even had "Fifth Disease," but I can give you some general information about the condition.

"Fifth Disease" or, erythema infectiosum, is caused by Parvovirus B19, and is a common childhood viral illness. It is manifested by a low-grade fever, followed by a "slapped-cheek" facial rash. This can be followed by a rash on the arms or legs, but it is usually not found on the trunk, palms or soles. Some children may complain of a mild headache, sore throat or abdominal pain but the majority of children have few symptoms other than rash. It commonly occurs in the spring and early summer and usually is seen in children between the ages of 5 and 14 years, although adults can be affected too. Aduts with acute Parvovirus B19 infection may also notice swollen lymph nodes, arthritis (knees and wrists primarily) and fatigue. Complications from the acute illness, such as pneumonia or encephalitis, are rare but have been reported. Approximately 60% of adults show evidence of prior infection at some point in their lives based on antibody studies.

Infection with Parvovirus B19 can cause aplastic crisis (failure of the bone marrow to make blood cells) in patients with chronic hemolytic anemias. The most common example is found in patients with sickle cell anemia, but it has also been reported to occur in patients with hereditary spherocytosis, pyruvate kinase deficiency and beta-thalassameia intermedia. Acute infection with Parvovirus B19 during pregnancy may also cause spontaneous abortions and/or a condition known as hydrops fetalis.

Diagnosis of Parvovirus B19 infection can be done via blood tests (antibody and antigen tests). Since the acute infection is usually mild, no specific treatment is necessary. For the more severe complication of aplastic anemia in patients with chronic hemolytic anemias, blood transfusions are required. There is no specific anti-viral drug available for Parvorirus B19, nor is there an effective vaccine. Most of this information was found in Madell/Douglas/Bennett's Principles and Practices of Infectious Diseases text book.

If you have concerns that your child may have this or another illness, I would suggest speaking with your child's Pediatrician. He or she could also then give you a more specific answer about whether your child poses any risk to other persons who are in some way immunosuppressed.

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Response by:

Kenneth   Skahan, MD Kenneth Skahan, MD
Assistant Professor in Infectious Diseases
College of Medicine
University of Cincinnati