The fifth disease, also referred to as epidemic Erythema infectiosum, is a viral condition characterized by a rash. This infection is mainly observed in children between 5 and 14 years old.
The main infectious agent responsible for this disease is parvovirus B19. Transmission of this virus occurs through the respiratory route, through direct contact with an infected person.
The disease is generally mild, but it can have more serious consequences in immunocompromised people or pregnant women.
Symptoms of Fifth Disease
Visible Signs of the Disease
- Rash:
- Begins with redness on the cheeks, giving a “slapped cheeks” appearance.
- Can spread to the arms, legs, and trunk.
- Lesions may be slightly raised with ragged edges.
- Typically symmetrical on the body.
- May be accompanied by a mild fever.
- Joint Pain (Arthralgia):
- Common in adults.
- Can last several weeks before disappearing.
Red Cheeks in Children
- Characteristic Symptom:
- Red spots on the cheeks are often one of the first visible symptoms.
- Usually associated with a slight fever.
- Followed by a ragged rash on the arms, legs, and trunk.
- The intensity of redness can vary from child to child.
- Important Note:
- Do not rely solely on red cheeks for diagnosis.
- Other conditions can also cause cheek redness in children.
- A healthcare professional should confirm the presence of the fifth disease through observation and possibly additional tests.
Symptoms in Adults
- Joint Pain (Arthralgia):
- Often reported.
- Affects multiple joints (wrists, knees, hand joints).
- Can last from a few days to several weeks.
- General Flu-like Symptoms:
- Mild fever.
- Fatigue.
- Asymptomatic Cases:
- Some adults infected with parvovirus B19 may not have any symptoms.
Diagnosis of Childhood Fifth Disease
The fifth disease diagnosis is confirmed based on the recognition of clinical symptoms, particularly the distinctive rash. However, additional testing may be necessary in specific situations.
For patients with chronic hemolytic anemia, paraclinical confirmation is warranted. Blood tests are usually reserved for children with a known blood disease or a compromised immune system.
These tests may include
- acute phase blood PCRÂ
- Serology to detect IgM (immunoglobulin M) specific to a foreign antigen.
However, it is generally not recommended to perform serology in immunocompetent patients.
In cases of suspected infection in an adult or contact with a pregnant woman, laboratory testing may be required.
In an epidemic context, no additional examination is necessary to make the diagnosis. The health professional primarily relies on the clinical signs observed.
Possible Complications of Fifth Disease
Although the fifth disease is usually benign, it can cause complications in some cases.
In people with chronic hemolysis, such as those with sickle cell disease, the fifth disease can lead to acute erythroblastopenic anemia. This condition is characterized by a sudden decrease in red blood cell production, which can be serious and requires medical attention.
In immunocompetent adults, parvovirus B19 infection can cause nonspecific polyarthralgia, which is joint pain not specific to any one area. This can be associated with skin lesions and, more rarely, with more severe complications such as liver, neurological, cardiac, or kidney issues.
Children with hemoglobin abnormalities or immune deficiencies are also at risk. Infection with parvovirus B19 in these children can lead to acute anemia, a significant drop in red blood cell count that can impact overall health.
It is essential to monitor these potential complications and consult a healthcare professional if any concerning symptoms occur.
Treatment of Fifth Disease
Treatment for childhood fifth disease is primarily aimed at relieving the symptoms of the disease, as there is no specific cure to eliminate the virus. This is generally an outpatient treatment which includes:
- The use of antipyretics such as paracetamol to reduce fever.
- Analgesics to relieve pain, particularly joint pain .
- Antihistamines can be used for itching.
- It is also recommended to avoid exposure to the sun to limit the intensity of the rash.
In certain high-risk cases, particularly in the presence of poorly tolerated acute anemia, a blood transfusion may be considered.
Treatment may also include fetal transfusion if seroconversion is identified in pregnant women. In all cases, the treatment must be adapted to each patient and requires medical monitoring.
What are the Causes of the Fifth Disease?
The Role of Parvovirus B19
Parvovirus B19 plays a key role in the emergence of childhood fifth disease. This human-specific virus replicates only in bone marrow cells that produce red blood cells. By infecting these cells, the virus causes a temporary interruption in the production of red blood cells, which can lead to anemia in affected individuals.
The first symptoms of parvovirus B19 infection are low-grade fever, headache, and runny nose. These non-specific symptoms are often confused with those of a common cold. It is during the second phase, occurring one to two weeks after the initial infection, that the fifth disease truly manifests itself, causing a rash characteristic of the disease.
Transmission of Parvovirus B19
- Respiratory Route:
- Transmitted mainly through sneezing, coughing, or close contact with an infected person.
- Epidemics often occur in closed environments such as schools or within the family circle.
- Bloodstream:
- Possible spread through the transfusion of infected blood.
- Maternal-Fetal Transmission:
- Can occur, posing risks to the fetus.
The virus is silent in its initial phase, meaning that the virus carrier is contagious before symptoms appear, during the invasion phase which precedes the rash.
Parvovirus B19 and Fifth Childhood Disease
Parvovirus B19, the infectious agent responsible for fifth childhood illness, was identified in 1983. This virus has a particular tropism for erythroblastic stem cells, which it infects and destroys, leading to a temporary interruption in the production of red blood cells. In a healthy person, this phenomenon often goes unnoticed. However, in patients with chronic hemolytic anemia, it may be responsible for acute anemia.
In addition to the characteristic skin symptoms, parvovirus B19 can cause other problems such as joint pain. In adults, it can cause nonspecific polyarthralgia associated with skin lesions and rarer pathologies (hepatic, neurological, cardiac, or nephrological).
Parvovirus B19 can also have serious consequences in the event of maternal-fetal transmission, leading to fetal hydrops and sometimes fetal death in utero.
Fifth Disease and Pregnancy: What Are the Risks?
Risks for Pregnant Women
Complications may occur if a woman who has never been infected with parvovirus B19 contracts the disease during pregnancy. The virus can be transmitted from mother to fetus via the placenta, potentially causing serious issues for the fetus.
Possible Complications Include,
- Fetal anasarca: Generalized swelling of the fetus due to fluid accumulation in the tissues.
- Severe fetal anemia: A drop in the number of red blood cells in the fetus’s blood, which can lead to heart failure.
- In utero death: In rare cases, infection can cause fetal death.
It is recommended that non-immune pregnant women avoid contact with people suffering from epidemic fifth disease.
Consequences for the Fetus
The fetus can be seriously impacted in the event of maternal infection. The risk of virus transmission from mother to fetus is approximately 33%.
Potential Consequences Include,
- Fetal hydrops: Abnormal accumulation of fluid in the fetus and placenta, with an incidence of 2.9%.
- Spontaneous abortions (Miscarriages): The disease can cause miscarriages, especially if the infection occurs during the first trimester of pregnancy.
- Fetal deaths in utero: Infection can lead to fetal deaths in utero.
- Birth defects: In extreme cases, the disease can cause birth defects.
Prevention of Fifth Disease
Prevention of fifth disease is mainly based on respecting basic hygiene measures to limit the spread of the virus.
- Hand washing: it is essential to wash your hands regularly after being in contact with a sick person or potentially contaminated objects.
- Cleaning of surfaces: the virus can proliferate and survive on objects or surfaces, it is therefore advisable to regularly disinfect objects and surfaces in frequent contact with children (toys, door handles)
- Avoid interactions: Non-immune people, especially pregnant women and individuals with chronic hemolysis, should avoid contact with people with epidemic Erythema infectiosum.
When Should You Visit a Doctor?
If you or your child exhibit symptoms of a fifth disease, such as a distinctive rash or joint pain, it is important to monitor the condition closely. While the fifth disease is generally mild and resolves on its own, there are situations where you should seek medical attention.
If symptoms worsen, if you or your child have a weakened immune system, haemoglobin abnormalities, or chronic hemolysis, or if you are pregnant and suspect exposure to the virus, it’s crucial to consult a healthcare professional.
For urgent care and expert advice, Integrum Urgent Care is here to help, ensuring you receive the necessary care and support for a swift recovery.