Erythema Infectiosum - The Parvovirus B19 Infection

Introduction

Erythema infectiosum is also referred to by other names like fifth disease, parvovirus B19, and slapped cheek syndrome. Erythema infectiosum is a virus that is widely seen in children and is the sixth most commonly infecting virus. Adults are rarely affected by erythema infectiosum. The spring and summer months favor the incidence of erythema infectiosum. The virus is transmitted primarily via secretions from the respiratory and oral tracts. Blood transmission is also possible in rare cases. The treatment is based on supportive management to reduce the symptoms. Conditions like erythema infectiosum in pregnancy may lead to severe complications like aplastic crisis and hydrops fetalis; immediate hospitalization is needed in such patients.

What Is Erythema Infectiosum?

Erythema infectiosum is a viral infectious skin disease characterized by an erythematous malar rash on the trunk and limbs. The classic symptom of erythema infectiosum is the" slapped cheek rash." Erythema infectiosum is most commonly present in children between 5 to 15 years of age and rarely in adults. The other conditions commonly associated with the erythema infectiosum are aplastic anemia, hydrops fetalis, and polyarthropathy. The people at risk of developing erythema infectiosum are pregnant women, sickle cell anemia, and hemolytic disease. The erythema infectiosum is a self-limiting condition, and the mild symptoms are managed with symptomatic relief treatment.

What Are the Causes of Erythema Infectiosum?

The erythema infectiosum is caused by a DNA (deoxyribonucleic acid) virus called parvovirus B19. Parvovirus is a single-stranded non-enveloped virus belonging to the family Parvoviridae. The erythema infectiosum is expected in the spring and summer months.

What Are the Symptoms of Erythema Infectiosum?

The erythema infectiosum has classic skin symptoms called " slapped cheek rash." The viraemic symptoms appear within five to ten days, and the viremia lasts five days. The hallmark symptoms of erythema infectiosum include facial rash and arthralgia. Sometimes the erythema infectiosum shows no signs triggered by sun exposure and rash. The various symptoms of erythema infectiosum are mentioned below.

• The initial systemic symptoms include fever, malaise, diarrhea, and myalgias.

• Vomiting and loss of appetite are present.

• Facial rash and the rash in erythema infectiosum are typically present with itching, frequent in children, and non-infectious.

• The skin around the cheeks is red, erythematous, and appears pale.

• Pruritus is absent.

• The rash resolved with a lace or reticular-like appearance.

• The reticular rash is most typically present on the skin's external surface except in the palmar aspect of the hands and soles.

• Arthralgia occurs in adults, and females are more susceptible to arthralgia than men.

• Joint stiffness is present.

• The joint symptoms are observed in the hands, wrists, knees, and feet.

• Erythema infectiosum has no sign of physical destruction of joints.

• Neutropenia (a disproportionately low concentration of neutrophils (a kind of white blood cell) in the blood).

• Thrombocytopenia (a blood disorder characterized by unusually low amounts of platelets, also known as thrombocytes).

• Complete bone marrow suppression.

What Is the Diagnosis of Erythema Infectiosum?

The diagnosis is based on the clinical symptoms and blood examination. The signs and symptoms of erythema infectiosum are mild and usually asymptomatic; the acute infection is present for seven to ten days. The various diagnostic tools for the diagnosis of erythema infectiosum are given below.

• History of transmission.

• Clinical examination includes the sign of slapped cheek rash and joint symptoms.

• Blood examination.

• Antibody detection test, parvovirus B19 IgM, and IgG antibodies are present after viral infection.

• Antibody detection tests are the confirmed diagnosis in the case of aplastic anemia with erythema infectiosum.

• Hemoglobin level and hematocrit are examined.

• Ultrasound testing is done for infected pregnant women.

• Prenatal testing is done to detect congenital disabilities during pregnancy.

• Immunohistochemistry.

• In situ hybridization.

• Polymerase chain reaction, PCR.

What Is the Differential Diagnosis of Erythema Infectiosum?

The signs and symptoms of erythema infectiosum are similar to other infectious and non-infectious conditions. Therefore, the comparison of symptoms is helpful in differential diagnosis and avoids misdiagnosis. Some of the differential diagnoses of erythema infectiosum are given below.

• Measles.

• Roseola.

• Rubella infection.

• Scarlet fever.

• Arthralgia.

• Influenza virus.

• Infectious mononucleosis.

• Drug hypersensitivity reaction.

• Rheumatoid arthritis.

• Arthritis.

• Juvenile idiopathic arthritis.

What Is the Treatment of Erythema Infectiosum?

Symptomatic relief refers to the treatment of a mild form of erythema infectiosum. The mild symptoms are usually asymptomatic, and the symptoms will be resolved independently. The various treatment modes for treating erythema infectiosum are given below.

• Acetaminophen and non-steroidal anti-inflammatory drugs control fever, joint pain, and headache.

• Red blood transfusion is done in severe anemic conditions.

• In the case of erythema infectiosum in pregnancy, the pregnant women are closely monitored to avoid the risk of fetal complications and hydrops fetalis.

• Ice-cold flannel is done to relieve discomfort.

• Immunoglobulin therapy.

• Intrauterine transfusion.

What Are the Complications of Erythema Infectiosum?

Erythema infectiosum is a mild viral condition observed primarily in children. The symptoms are usually resolved independently, but in severe conditions, it may lead to many complications. The complications of erythema infectiosum are mentioned below.

• Polyarthropathy.

• Aplastic crisis.

• Spontaneous abortion.

• Intrauterine deaths or hydrops fetalis.

• Chronic parvovirus infection.

• Erythropoietin-resistant anemia.

• Proteinuria.

• Glomerulosclerosis.

• Encephalitis.

• Hepatitis infection.

• Non occlusive bowel infarction.

• Amegakaryocytic thrombocytopenia.

• Myositis.

• Heart disease.

Is It Possible to Avoid Erythema Infectiosum?

There is no vaccination available to prevent the fifth disease. Because the virus spreads easily by nose and mouth droplets, the best method to prevent the sickness is to practice excellent hygiene. One can lower the family's risk of illness by doing the following:

• Hand washing should be done regularly and thoroughly.

• Sneezing or coughing into the elbow crook.

• Avoiding close touch with infected individuals.

Conclusion

Erythema infectiosum or fifth disease, parvovirus B19, and slapped cheek syndrome is the viral skin condition caused by parvovirus B19 characterized by mild skin symptoms like erythematous malar rash and arthralgias. The hallmark sign of erythema infectiosum is the slapped cheek rash. Erythema infectiosum is primarily observed in children and rarely in adults. Conditions associated with erythema infectiosum are sickle cell anemia and hemolytic conditions. The diagnosis of erythema infectiosum is confirmed with parvovirus serology, and the treatment is done to reduce the symptoms. The mild symptoms of erythema infectiosum will last for ten days and are resolved independently. In a severe form of erythema infectiosum in pregnancy and immunosuppressive conditions, the patient is monitored in the hospital. However, the prognosis of erythema infectiosum is excellent for people with a sound immune system.