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

• Erythrovirus B19 Lymphadenitis
• Human Erythroparvovirus Lymphadenopathy
• Parvovirus B19 causing Enlarged Lymph Nodes

What is Parvovirus B19 Lymphadenopathy? (Definition/Background Information)

• Parvovirus B19 Lymphadenopathy is the inflammation and enlargement of lymph nodes due to underlying Parvovirus B19 infection
• Parvovirus B19 infection (or Fifth Disease or Erythema Infectiosum) is an infectious skin condition that is caused by parvovirus B19 (the virus spreads through cough and sneeze). The infection usually affects very young children
• In addition to swollen lymph nodes due to Parvovirus B19 Lymphadenopathy, Parvovirus B19 infection causes bright red rash spots on both cheeks of the infected children
• The other signs include red rashes on the upper torso or chest; and acute joint pain and difficulties in walking/flexing the joints, in teenagers and adults
• Parvovirus B19 infection is a generally mild disease that is transmitted by respiratory secretions (during coughing, sneezing, or 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
• The treatment measures of Parvovirus B19 Lymphadenopathy include treating the underlying infection symptomatically and addressing any complications that may develop
• The prognosis of Parvovirus B19 Lymphadenopathy generally depends upon the severity of the underlying signs and symptoms due to the infection. In general, the prognosis is excellent

Who gets Parvovirus B19 Lymphadenopathy? (Age and Sex Distribution)

• Parvovirus B19 Lymphadenopathy occurs due to underlying Parvovirus B19 infection that usually occurs during early childhood phase (between the ages 2-6 years)
• It can affect older children and even adults
• Both male and female genders can be affected
• No particular racial, ethnic, or geographical preference is observed

What are the Risk Factors for Parvovirus B19 Lymphadenopathy? (Predisposing Factors)

The main risk factor for Parvovirus B19 Lymphadenopathy is the underlying Parvovirus B19 infection. The risk factors for this infectious condition include:

• Airborne infection: It is a viral infection that spreads through air. The virus is contained in nasal fluids or mucus present in the respiratory tract, which is expelled when an infected individual 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. This is a dangerous condition affecting the unborn child
• School-going children, school teachers, mothers, and childcare workers have the highest risk of contracting Parvovirus B19 infection. There may be disease outbreaks at schools and daycare centers

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones 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 Parvovirus B19 Lymphadenopathy? (Etiology)

Parvovirus B19 Lymphadenopathy is caused by a viral infection that results in swollen lymph nodes and other related signs and symptoms. The virus spreads mostly through air (respiratory secretions) and blood.

What are the Signs and Symptoms of Parvovirus B19 Lymphadenopathy?

The signs and symptoms of Parvovirus B19 Lymphadenopathy may include:

• Lymphadenopathy or enlarged lymph nodes that may involve lymph nodes all over the body
• The swollen lymph nodes are generally painless

Around 20% of those infected by the virus remain asymptomatic. In others, the underlying Parvovirus B19 infection signs and symptoms 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 nasal bridge
• Lace-like red rashes on the upper trunk, hands, and legs, may also be seen after the rash on the cheeks resolves. The rashes may be itchy and can usually last a few days
• 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 they are immunocompromised)

The signs and symptoms of the infection 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. Incubation period is the time duration between which an individual is infected with the virus, and when they start showing signs and symptoms of the disease.

How is Parvovirus B19 Lymphadenopathy Diagnosed?

Diagnostic tests that may be performed for Parvovirus B19 Lymphadenopathy and underlying infection may 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

In majority of the cases, a lymph node biopsy is not performed for Parvovirus B19 Lymphadenopathy. However, if the signs and symptoms persist despite suitable treatment and passage of time during observation, then a biopsy may be undertaken to rule-out other causes of swollen lymph nodes (such as a lymphoma).

In case of a lymph node biopsy, the following information may be noted:

• Lymph node biopsy: A lymph node biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. The pathologist may use special techniques, such as immunohistochemistry stains, to help reveal the presence of the pathogen
• The lymph node biopsy may be performed through any of the following procedures:
  • Fine needle aspiration biopsy (FNAB): A device called a cannula is used to extract tissue or fluid from the lymph nodes
  • Lymph node core biopsy of the enlarged lymph node
  • Lymph node open biopsy of the enlarged lymph node

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 Parvovirus B19 Lymphadenopathy?

Complications of Parvovirus B19 Infection causing Lymphadenopathy are normally associated with individuals belonging to the following category:

• 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 with AIDS/HIV infection, or those who have undergone recent organ transplants have an increased risk of greater complications

How is Parvovirus B19 Lymphadenopathy Treated?

The management of Parvovirus B19 Lymphadenopathy may include undertaking treatment of the underlying Parvovirus B19 infection. This may involve the following measures:

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

Most cases of Parvovirus B19 infection are self-limiting, implying that a healthy individual or child usually recovers from the condition, once the infection cycle is complete. 

How can Parvovirus B19 Lymphadenopathy be Prevented?

Parvovirus B19 infection is a viral infection that may not be prevented. However, one may consider certain precautions to prevent transmission of the infection and thus avoid Parvovirus B19 Lymphadenopathy. The measures may include:

• Avoid contact with those who are ill; stay home if 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 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
• Wearing an appropriate face mask can decrease the distance and volume of virus-containing fluids spread by coughing and sneezing
• Parents of a child must practice/enforce the above habits to prevent and control the spread of 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 Parvovirus B19 Lymphadenopathy? (Outcomes/Resolutions)

The prognosis of Parvovirus B19 Lymphadenopathy is based on the severity of the underlying Parvovirus B19 infection.

• In a majority of the individuals, the infection is mild. 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 the severity of their signs and symptoms
• Pregnant women, those who are anemic, and individuals with weak immune system, have to be additionally careful, since certain serious medical complications can develop due to the infection

Additional and Relevant Useful Information for Parvovirus B19 Lymphadenopathy:

General information on lymph nodes:

The lymph nodes are part of one’s immune system. The lymph nodes are present throughout the body, usually in groups. In normal healthy adults, one cannot feel (see or touch) the lymph nodes readily. However, if they are enlarged, they can be felt either by the individual himself/herself or by the healthcare provider.

Enlarged lymph nodes can occur in both benign and malignant conditions. Hence, the cause of enlarged lymph nodes should be evaluated. If no obvious cause for enlargement of lymph nodes is found, then the possibility of a lymph node malignancy should be ruled out.

In a majority of individuals, a lymph node swelling is caused by a benign process such as an inflammation or infection. In many cases, swollen lymph nodes are part of other signs and symptoms. This can help a healthcare provider arrive at a list of follow-up tests and ensure an accurate diagnosis. Superficial enlarged lymph nodes can be felt by the healthcare provider through palpation. Enlarged lymph nodes deep in the body are often detected by radiological studies such as X-rays, ultrasound scan, CT and MRI scans.

Some enlarged lymph nodes can be painful, while others may be painless. Depending upon the underlying cause, enlarged lymph nodes can be localized to a particular area of the body, or they can be generalized, meaning that they are present throughout the body.