Diseases

Around 5% of children and about half of adults with fifth disease experience joint aches and pains. This arthritis or arthropathy is more common in females than males, is usually temporary, lasts days to weeks, and may become a long-term problem for months. People with arthritis from fifth disease usually have stiffness in the morning, with redness and swelling of the same joints on both sides of the body ("symmetrical" arthritis). The joints most commonly involved are the knees, fingers, and wrists.

Parvovirus B19 is usually spread by droplets. The virus can be spread whenever an infected person coughs or sneezes. However, once the rash is present, that person is usually no longer contagious and need not be isolated.

Similar to most viral illnesses, the best way to prevent the spread of the disease is by proper hand washing, by covering your mouth and nose when you sneeze or cough, and by staying home when you become sick.

Fifth disease generally occurs in children between 4-10 years of age, but it can affect any age group. Fifth disease most commonly occurs during the winter and spring. The illness classically begins with a low-grade fever, headache, runny nose, and malaise (a sense of not feeling well). Of course, these symptoms mimic any other viral illness, so it is impossible to determine the cause early in the illness. After about a week, initial symptoms are followed by a characteristic bright red rash on the cheeks (the so-called "slapped cheeks"). Finally, after three to four days, a fine, red, lacelike rash can develop over the rest of the body. This rash may last for five to seven days and occasionally comes and goes for up to three weeks. The other symptoms are usually gone by the time the rash appears. Patients with the rash are usually not contagious. Unfortunately, as with many other viral illnesses, the features and timing of the different stages of illness are often unpredictable. Unlike other viral infections that usually cause "hand, foot, and mouth disease" (namely coxsackievirus A16 and enterovirus 71), fifth disease does not involve the palms and soles.

Rarely, these patients develop erythrocyte aplasia, meaning the bone marrow stops forming a normal number of red blood cells. This complication is rare and usually transient, but can be fatal. Patients who are immunocompromised (by disease or treatment) are at high risk of this complication. Pregnant women (who have not previously had the illness) should avoid contact with patients who have fifth disease. The fifth disease virus can infect the fetus prior to birth. Although no birth defects have been reported as a result of fifth disease, for 2%-10% of B19-infected pregnant women, fifth disease can cause severe anemia and even the death of the unborn fetus (by hydrops fetalis).

Fifth disease is a viral illness caused by parvovirus B19. Fifth disease has also been known as erythema infectiosum and "slapped cheek disease." The clinical illness was described in 1896 and named fifth disease because of its fifth position in the numerical classification of six childhood illnesses associated with rashes (exanthems). Other numbered viral exanthems included measles (rubeola or first disease), rubella (German measles or third disease), and roseola infantum (sixth disease). Scarlet fever was called "second disease" and is due to the bacterium Streptococcus pyogenes. Fourth disease is no longer classified as a clinical entity. These did not get renamed until the molecular era, when it became possible to isolate viruses and bacteria. Fifth disease is a very common infection. Almost 50% of adults have been infected with parvovirus B19 but often do not remember having it because this infection frequently does not cause symptoms.

The only available treatment is supportive. Fluids, acetaminophen (Tylenol), and rest provide relief. Antibiotics are useless against fifth disease, because it is a viral illness. For those with persistent arthritis, anti-inflammatory medications such as ibuprofen (Advil) or naproxen (Aleve) can be used.