Erythema infectiosum is a contagious viral infection. In children, it causes a blotchy or raised red rash on the body and a "slapped-cheek" red rash on the face along with mild illness. In a fetus, it may be fatal.
Erythema infectiosum is caused by a virus.
Symptoms include a mild fever, "slapped-cheek" red rash on the face, and a lacy rash on the arms, legs, and trunk.
The diagnosis is based on the characteristic rash.
Treatment is aimed at relieving symptoms.
Erythema infectiosum, often referred to as fifth disease, is caused by human parvovirus B19. The name "fifth disease" is used because it is the fifth in the list of six historically numbered infections that commonly cause rashes in children. (Measles, scarlet fever, rubella, and roseola infantum are four of the others.) Erythema infectiosum is also sometimes called slapped-cheek disease.
Outbreaks of erythema infectiosum typically occur in the late winter and early spring. The infection can occur in adults. People who work in day care centers or who are in close contact with children are also at greater risk of infection.
This infection is spread mainly by breathing in small droplets that have been breathed out by an infected person, so infection tends to spread within a household. Some people can be infected but have no symptoms. People are contagious from before the start of the rash until the rash appears.
The infection can also be transmitted from mother to fetus during pregnancy, rarely resulting in miscarriage, stillbirth, or severe anemia and excess fluid and swelling (edema) in the fetus (hydrops fetalis).
The infection can be spread via contaminated blood or blood products (for example, platelets or plasma) donated by a person who is infected and has the virus in their blood at the time of blood donation.
Symptoms of Erythema Infectiosum
Erythema infectiosum symptoms begin about 4 to 14 days after infection. Many children have no symptoms. However, some children have a low fever and feel mildly ill with a headache and a runny nose for a few days.
Several days later, children develop red cheeks that often look like they have been slapped (“slapped-cheek” appearance) as well as a rash, especially on the arms, legs, and trunk but not usually on the palms or soles. The rash can be itchy and consists of raised, blotchy, red areas and lacy patterns, particularly on areas of the body that are not covered by clothing.
This photo shows the "slapped-cheek" appearance of the rash on the cheeks caused by erythema infectiosum (fifth disease).
This photo shows the "slapped-cheek" appearance of the rash on the cheeks caused by erythema infectiosum (fifth disease
John Kaprielian/SCIENCE PHOTO LIBRARY
This photo shows a red, lacy rash on the face ("slapped-cheek" appearance) of a child with erythema infectiosum.
This photo shows a red, lacy rash on the face ("slapped-cheek" appearance) of a child with erythema infectiosum.
Photo courtesy of Karen McKoy, MD.
This photo shows a red, lacy rash on the arm of a person with erythema infectiosum.
This photo shows a red, lacy rash on the arm of a person with erythema infectiosum.
Photo courtesy of Karen McKoy, MD.
This photo shows the "slapped-cheek" appearance of the rash on the cheeks caused by erythema infectiosum (fifth disease).
This photo shows the "slapped-cheek" appearance of the rash on the cheeks caused by erythema infectiosum (fifth disease
John Kaprielian/SCIENCE PHOTO LIBRARY
This photo shows a red, lacy rash on the face ("slapped-cheek" appearance) of a child with erythema infectiosum.
This photo shows a red, lacy rash on the face ("slapped-cheek" appearance) of a child with erythema infectiosum.
Photo courtesy of Karen McKoy, MD.
This photo shows a red, lacy rash on the arm of a person with erythema infectiosum.
This photo shows a red, lacy rash on the arm of a person with erythema infectiosum.
Photo courtesy of Karen McKoy, MD.
The rash and the entire illness usually last 5 to 10 days. Over the next several weeks, the rash may temporarily reappear and worsen because of sunlight, exercise, heat, fever, or emotional stress.
In some adults, mild joint pain and swelling may remain or come and go for weeks to months.
Erythema infectiosum can also manifest in a different way, particularly in children or sometimes in adults who have sickle cell disease or other disorders of the red blood cells, or a condition that impairs the immune system's ability to fight infection (such as those who were born with immune system problems, those receiving chemotherapy, or those with advanced human immunodeficiency virus (HIV) infection [also called acquired immunodeficiency syndrome or AIDS]). In these people, erythema infectiosum can affect the bone marrow and cause severe anemia (low blood count). Parvovirus B19 can also cause myocarditis, which is inflammation of the heart that sometimes causes heart failure in children.
Diagnosis of Erythema Infectiosum
A doctor's evaluation
Sometimes blood tests
For pregnant people, blood tests and ultrasound of the fetus
A doctor bases the diagnosis of erythema infectiosum on the characteristic appearance of the rash.
Blood tests are done only in children who have bone marrow problems or in adults who have joint pain.
If infection occurs during pregnancy, blood tests are done in pregnant people to measure antibodies. The presence of certain antibodies tells doctors whether the pregnant person has been infected before or is currently or was recently infected. Pregnant people who may have been recently infected have an ultrasound to assess the fetus.
Treatment of Erythema Infectiosum
Relief of symptoms
Erythema infectiosum goes away on its own, so treatment is aimed at relieving the symptoms.
People may be given pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve fever, achiness, headache, and joint pain and other medications to relieve itching if it is severe.
People who have anemia or a weakened immune system caused by erythema infectiosum are sometimes given a medication called immune globulin (also called intravenous immunoglobulin or IVIG).
