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Fifth Disease, scientifically known as Erythema Infectiosum (and a host of other names), is an infectious skin disorder that is caused by the virus ‘erythrovirus’ (previously called parvovirus B19). It usually affects very young children.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Apple Sickness
  • Erythema Contagiosum
  • Parvovirus B19 Infection

What is Fifth Disease? (Definition/Background Information)

  • Fifth Disease, scientifically known as Erythema Infectiosum (and a host of other names), is an infectious skin disorder that is caused by the virus ‘erythrovirus’ (previously called parvovirus B19). It usually affects very young children
  • Bright red rash spots appear on both cheeks of the infected children, resembling a ‘slapped cheek’; hence, it is also called as Slapped Cheek Disease. The other signs include red rashes (in a wavy-like form) on the upper torso or chest
  • Other symptoms of the condition in teenagers and adults, may include acute joint pain (like arthritis) and difficulties in walking/flexing the joints
  • Fifth Disease is a generally mild disease that is transmitted by respiratory secretions (during coughing, sneezing, talking). But, it has the potential to pose a serious threat to pregnant women, individuals with anemia, and in individuals who have a weak immune system (immunocompromised host)

Who gets Fifth Disease? (Age and Sex Distribution)

  • Fifth Disease usually occurs during early childhood phase (between the ages 2-6 years). It can affect older children and even adults
  • Both male and female sexes are equally affected
  • No particular racial, ethnic, or geographical preference is observed

What are the Risk Factors for Fifth Disease? (Predisposing Factors)

The risk factors for Fifth Disease include:

  • It is a viral infection that spreads through air (airborne infection). The virus is contained in nasal fluids or mucus present in the respiratory tract, which is expelled when an infected person sneezes or coughs
  • The disease can also be transmitted through blood, during blood transfusions (transfusion-related infection)
  • A pregnant woman can transmit the infection to the baby in the womb (called vertical transplacental transmission of infection). This could lead to a dangerous condition affecting the unborn baby
  • School-going children, school teachers, mothers, and childcare workers, have the highest risk of contracting Fifth Disease. There may be disease outbreaks at these (schools, daycare centers) locations. It is important to recognize the signs and symptoms at school, so that appropriate measures can be taken to decrease the number of individuals affected, in such locations

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Fifth Disease? (Etiology)

Erythrovirus (parvovirus B19) is a virus that is responsible for Fifth Disease. The virus spreads mostly through air (respiratory secretions) and blood.

What are the Signs and Symptoms of Fifth Disease?

Around 20% of those infected by the virus remain asymptomatic. In others, the signs and symptoms of Fifth Disease include:

  • A distinctive ‘slapped cheek’ appearance in children, defined by bright red cheeks on either side of the face. Sometimes, this is seen around the mouth and on the nose-bridge
  • Lace-like red rashes on the upper trunk, hands, and legs, may also be seen. The rashes may be itchy, and such a rash can usually last a few days (in some cases they may stay for several weeks)
  • Before the onset of the rashes, a child may experience mild fever, headache, and runny nose
  • In teenagers and adults; arthritis-like joint inflammation and pain at the wrists, knees, and ankles, are felt. These subside spontaneously, within a week to a month’s time. It may be difficult to walk, move, and flex oneself, during this period
  • Rashes are rare in adults, but common in children. Once the rashes appear, the affected individuals are in their least contagious phase (unless the individuals are in the immunocompromised category). Contagious period is a time, during which the infection can spread from one person to another
  • The signs and symptoms of Fifth Disease appear within 4-21 days of first infection. The most infectious phase of the disease is during the incubation period, when there are no visible signs (such as the red cheeks). Incubation period is the time duration between whichan individual is infected with the virus, and when they start showing signs and symptoms of the disease

How is Fifth Disease Diagnosed?

Diagnostic tests that may be performed for Fifth Disease include:

  • Physical exam with evaluation of medical history; the slapped cheek rash, is a classic sign of this infection
  • Blood test for the presence of virus, or antibodies to the virus
  • Further tests may be required depending on the individual’s health circumstances

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Fifth Disease?

Complications of Fifth Disease are normally associated with:

  • Pregnant women: It can harm the child in the womb; especially in the 1st trimester, causing fatal fluid accumulation, or even leading to a miscarriage
  • Individuals with anemia: It may cause a red blood cell disorder, leading to anemia with an increased severity, thereby necessitating blood transfusions. The virus infects the bone marrow cells, causing failure of production of properly functioning red cells that are needed by the body to carry oxygen from lungs, to the rest of the body
  • Individuals on chemotherapy, those suffering from AIDS/HIV infections, or having undergone recent organ transplants, have an increased risk of greater complications, due to the infection

How is Fifth Disease Treated?

Most cases of Fifth Disease are self-limiting, implying that a healthy individual or child usually recovers from the condition, once the infection cycle is complete. The treatment measures involve:

  • Symptomatic treatment of the disease, such as the use of medication for fever and body aches
  • There is no specific medicine or drug to treat Fifth Disease viral infection
  • If there are any complications present, then the healthcare provider gives specific treatment based on the patient’s specific signs and symptoms

How can Fifth Disease be Prevented?

Fifth Disease is a viral infection that cannot be prevented. One can however be careful and consider certain practices, which may lower the risk for contracting the disease, or its spread to others. The steps include:

  • Avoiding (too much) contact with those who are sick. Staying home while you are unwell
  • Wash hands regularly; avoid touching your eyes, mouth, or nose, with hands that are unclean
  • While sneezing or coughing, cover your mouth
  • If you think that you may have the disease, then stay indoors and avoid contact with others, until after the rashes appear. This will help in preventing the spread of infection
  • Parents of a child must practice/enforce these (above) habits, in order to prevent and control the spread of any infection
  • Individuals who fall in the high risk group (teachers, school children) have to be made aware of the disease and its contagious nature. Sometimes, school teachers may be among the first ones, to recognize signs of the disease in their students
  • The high risk group (individuals on chemotherapy, those suffering from AIDS/HIV infections, or having undergone recent organ transplants) in whom certain serious complications can develop, have to be additionally watchful

What is the Prognosis of Fifth Disease? (Outcomes/Resolutions)

  • Fifth Disease, in a majority of the individuals is a mild infection. Most individuals affected by the disease, recover completely after the full course of the disease (usually within a week to a month)
  • A few individuals may require symptomatic treatment based on their condition and intensity of the signs (like fever, joint pain)
  • Pregnant women, those who are anemic, and individuals with weak immune system, have to be additionally careful, since certain serious medical complications could develop from the infection

Additional and Relevant Useful Information for Fifth Disease:

In the early historical classification of childhood skin conditions; the list of skin diseases was six. Erythema Infectiosum was fifth on the list; hence, it came to be known as the Fifth Disease.

What are some Useful Resources for Additional Information?

Centers for Disease Control and Prevention (CDC)
1600 Clifton Rd. Atlanta, GA 30333, USA
Phone: (404) 639-3534
Toll-Free: 800-CDC-INFO (800-232-4636)
TTY: (888) 232-6348
Email: cdcinfo@cdc.gov
Website: http://www.cdc.gov

American Academy of Pediatrics (AAP)
141 Northwest Point Blvd. Elk Grove Village, IL 60007
Phone: (847) 434-4000
Toll-Free: (800) 433-9016
Fax: (847) 434-8000
Website: http://www.aap.org

National Institutes of Health (NIH)
9000 Rockville Pike Bethesda, MD 20892
Phone: (301) 496-4000
TTY: (301) 402-9612
Email: NIHinfo@od.nih.gov
Website: http://www.nih.gov

References and Information Sources used for the Article:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001972/ (accessed on 11/24/12)

http://kidshealth.org/parent/infections/skin/fifth.html (accessed on 11/24/12)

http://www.cdc.gov/parvovirusB19/fifth-disease.html (accessed on 11/24/12)

Helpful Peer-Reviewed Medical Articles:

Joseph, P. R. (2005). Incubation period for fifth disease. Pediatr Infect Dis J, 24(2), 191-192.

Mandel, E. D. (2009). Erythema infectiosum: recognizing the many faces of fifth disease. JAAPA, 22(6), 42-46.

Mankuta, D., Bar-Oz, B., & Koren, G. (1999). Erythema infectiosum (Fifth disease) and pregnancy. Can Fam Physician, 45, 603-605.

Staroselsky, A., Klieger-Grossmann, C., Garcia-Bournissen, F., & Koren, G. (2009). Exposure to fifth disease in pregnancy. Can Fam Physician, 55(12), 1195-1198.

Weir, E. (2005). Parvovirus B19 infection: fifth disease and more. CMAJ, 172(6), 743. doi: 10.1503/cmaj.045293

Feder, H. M., & Anderson, I. (1989). Fifth disease: a brief review of infections in childhood, in adulthood, and in pregnancy. Archives of internal medicine, 149(10), 2176-2178.

Mortimer, P. P. (1984). The 80th year of fifth disease. British medical journal (Clinical research ed.), 289(6441), 338.

de Miranda, M. F., Linhares, A. C., & Shirley, J. A. (1989). Fifth disease in children living in Belém, Brazil. Revista do Instituto de Medicina Tropical de São Paulo, 31(5), 359-362.

Staroselsky, A., Klieger-Grossmann, C., Garcia-Bournissen, F., & Koren, G. (2009). Exposure to fifth disease in pregnancy. Canadian Family Physician, 55(12), 1195-1198.

Andrews, M., Martin, R. W., Duff, A. R., Greig, H. D., & Frost, S. A. (1984). Fifth disease: report of an outbreak. The Journal of the Royal College of General Practitioners, 34(267), 573.

BALFOUR, H. H. (1976). Fifth disease: full fathom five. American Journal of Diseases of Children, 130(3), 239-240.

Morens, D. M. (1982). Fifth disease: still hazy after all these years. JAMA, 248(5), 553-554.

Bosman, A., Wallinga, J., & Kroes, A. M. C. (2002). Fifth disease every four years: parvovirus B19. Infectieziekten Bulletin, 13, 215-219.