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What

Fifth disease is a viral illness that commonly affects children and is characterized by a skin rash that has 3 phases. The rash initially appears on the face with a “slapped cheek” appearance and then progresses to the extremities. A “blotchy”, lacy pattern develops in the final phase and is classic. The name Fifth disease comes from the description of four other classical rash-associated infections of childhood during the pre-vaccination era.

Who

Fifth Disease primarily affects children aged 3-15 years, but it can occur at any age. Peak incidence occurs in winter and early spring. Males and females are affected equally however females tend to have more joint symptoms. Fifth disease can affect children from all ethnic backgrounds, and it has been shown to occur worldwide.

Signs and Symptoms

Children with Fifth Disease have the following symptoms:

• Red rash on the cheeks that make the child look as though they have been slapped on both sides of the face (this is the first sign of the disease)
  
• Red rash with a lace-like pattern on the arms, legs, and trunk (this appears after the rash on the face)
  
• Occasional itching with the rash
• Fever
  
• Malaise (a general feeling of discomfort, uneasiness, or an “out of sorts” feeling)
  
• Joint Pain (this occurs in adults with Fifth disease more than children)
  
• Mild cold symptoms may appear a few days before the rash on the cheeks

Possible Causes

Fifth disease is caused by infection with a virus called the human parvovirus B19. This virus is contagious and can be spread from person to person by way of saliva, sputum and nasal secretions in the same way that a common cold is spread. A child infected with parvovirus B19 is contagious during the early part of the illness, before the rash appears. During this time the child may appear to just have a cold. By the time a child has the characteristic “slapped cheek” rash they are usually no longer contagious and may return to school or to their child care center.

Diagnosis

A diagnosis of Fifths Disease is usually made based on the physical symptoms alone, specifically the characteristic “slapped cheek” face rash. In cases in which it is important to confirm the diagnosis, a blood test may be done to look for antibodies to the human parvovirus B19. Antibodies are proteins produced by the immune system in response to parvovirus B19 and other germs. If the antibody to parvovirus B19 is detected, the test result suggests that the child has had a recent infection.

Treatment

No treatment is usually required for Fifth disease in children. Treatment of the symptoms such as fever, pain and itching is most important. Oral pain and fever reducers may be given to treat the symptoms. There is no vaccine or medicine that prevents the human parvovirus B19 infection. Frequent handwashing is recommended as a practical and effective method to decrease the chance of becoming infected, especially during the winter and spring seasons when outbreaks are more likely to occur.

Prognosis

The prognosis is excellent for typical childhood cases. Fifth disease is usually a mild illness that resolves on its own in children who are otherwise healthy. The cold-like symptoms of Fifths Disease generally resolve within about a week and the rash may persist for a few weeks. However, in children with sickle-cell disease or similar types of chronic anemia, compromised immune systems, cancer, and organ transplants, parvovirus 19 infection can lead to a condition known as aplastic crisis. During such a crisis, the bone marrow is unable to produce new blood cells and children become severely anemic, often requiring blood transfusion.

Connect with other parents

In the spirit of community and support, Madisons Foundation offers the unique service of connecting parents of children with rare diseases. If you would like to be connected to other parents of children with this disease, please fill out this brief form.

Weblinks

Baby Center
Parent Friendly website with great information on Fifths Disease

Center for Disease Control
Excellent website with information on Fifths Disease

Google Search for Fifth Disease

References and Sources

1. www.emedicinehealth.com/articles/15841-1.asp 2. Kwon, K. (2001) Pediatrics, Fifth Disease or Erythema Infectiosum www.emedicine.com/emerg/topic378.htm 3. Zellman, G. (2002) Erythema Infectiosum (Fifth Disease) www.emedicine.com/derm/topic136.htm