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Dr. Fred Piaser

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FIFTH DISEASE  Fifth disease (also called erythema infectiosum) is caused by parvovirus B19. The incubation period (the time between infection and the onset of symptoms) for fifth disease ranges from 4 to 28 days, with the average being 16 to 17 days. Especially common in children between the ages of 5 and 15, fifth disease begins with a low-grade fever, malaise, muscle aches, headache, and mild cold-like symptoms (a stuffy or runny nose). These symptoms pass, and the illness seems to be gone until a rash appears a few days later. The bright red rash typically begins on the face, producing a distinctive red rash on the face that makes the child appear to have a slapped cheek. Several days later, the rash spreads and red blotches (usually lighter in color) extend down to the trunk, arms, and legs. The rash usually spares the palms of the hands and soles of the feet. As the centers of the blotches begin to clear, the rash takes on a lacy net-like appearance. Children younger than 10 years of age are most likely to get the rash. Older children and adults sometimes complain that the rash itches.

It may take 1 to 3 weeks for the rash to completely clear, and during that time it may seem to worsen until it finally fades away entirely. Other symptoms that sometimes occur with fifth disease include swollen glands, red eyes, sore throat, diarrhea, and unusual rashes that look like blisters or bruises. Joint swelling or pain, often in the hands, wrists, knees, or ankles is rare in children but commonly among adults, especially women. The rash can fluctuate in intensity and can be reactivated by environmental changes, such as temperature, exposure to sunlight or with exercise.

Despite being called a "disease," fifth disease is actually just a viral illness that the majority of children will recover from - with no complications - in a short period of time. Most people with a B19 infection have either very mild symptoms or no symptoms at all. Outbreaks of parvovirus tend to happen in the late winter and early spring, but there may also be sporadic cases of the disease any time throughout the year.

A person with parvovirus infection is most contagious before the rash appears - either during the incubation period (the time between infection and the onset of symptoms) or during the time when he or she has only mild respiratory symptoms. Because the rash of fifth disease is an immune reaction (a defense response launched by the body against foreign substances like germs) that occurs after the infection has passed, a child is usually not contagious once the rash appears.

Parvovirus B19 spreads easily from person to person in fluids from the nose, mouth, and throat of someone with the infection, especially through large droplets from coughs and sneezes. It can also be spread through shared drinking glasses and utensils. In households where a child has fifth disease, another family member who hasn't previously had parvovirus B19 has about a 50% chance of also getting the infection. Classmates of children with fifth disease have about a 60% chance of getting the virus. Once someone is infected with parvovirus B19, they develop immunity to it and won't usually become infected again.

The name "fifth Disease" comes from the fact that this infection was counted amoung the five classical rash-associated infections of childhood. The other four were measles, scarlet fever, rubella (German Measles), and a rash-producing infection that's unknown to doctors today and is simply referred to as "fourth disease."

Parvovirus B19 infection during pregnancy may cause problems for the fetus. Some fetuses may develop severe anemia if the mother is infected while pregnant - especially if the infection occurs during the first half of the pregnancy. In some cases, this anemia is so severe that the fetus doesn't survive. Fortunately, about half of all pregnant women are immune because of a previous infection with parvovirus. Serious problems occur in less than 5% of women who become infected during pregnancy.

There is no vaccine for fifth disease, and no real way to prevent the spread of the virus. Isolating someone with a fifth disease rash won't prevent spread of the infection because the person usually isn't contagious by that time. Practicing good hygiene, especially frequent hand washing, is always a good idea since it can help prevent the spread of many infections. A virus causes fifth disease, and is therefore not treated with antibiotics. Although antiviral medicines do exist, there are currently none available that will treat fifth disease. In most cases, this is such a mild illness that no medicine is necessary. Acetaminophen can be given for fever or joint pain. Antihistamines may help relieve the itching from the rash.

Feel free to call my office for additional information.

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