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| |    Fifth Disease (Slapped Cheek): Overview by Lynn Cates, M.D., F.A.A.P. reviewed by Laura Jana, M.D., F.A.A.P. Fifth disease is one of the most common infections in childhood. It is noteworthy for its distinctive rash, but it causes only mild illness in the vast majority of people. Classically, a child develops a flushed face that looks as if she has been slapped across both cheeks, giving rise to the common term "slapped-cheek disease." What causes fifth disease? Fifth disease is caused by a virus known as human parvovirus B19. The name simply comes from the fact that it was the fifth of six common children's rash-causing diseases listed in a particular classification scheme (the other five are measles, scarlet fever, rubella, roseola, and a variant of scarlet fever that is no longer recognized). In addition to the names fifth disease and slapped-cheek disease, it also is known as erythema infectiosum and parvovirus B19 infection. Who gets it? Fifth disease can spread in schools or anyplace where people are exposed to others' respiratory secretions (the result of coughing or sneezing), or blood or blood products. It also can be transmitted from an infected mother to her fetus. While it is most commonly seen in children between the ages of 5 and 15, it can occur at any age. About 90 percent of all people eventually become infected, but few become seriously ill. How to recognize it Your child probably has fifth disease if he has a mild respiratory illness followed about a week to 10 days later by bright red cheeks. The initial symptoms generally are very mild and consist mainly of tiredness, poor appetite, headache, sore throat, stuffy nose, and--in up to about a third of children--a low-grade fever. The rash on the face typically lasts one to three days; at the same time as, or just following, the facial rash, a fine lacelike rash develops on most of the rest of the body (especially the upper limbs and trunk). The rash may flare up again and again with various stimuli, such as exercise, stress, or sun exposure, but it usually goes away completely within about three weeks. Joint symptoms--such as pain, tenderness, swelling, and stiffness--occasionally occur in young children with parvovirus infections, but they are much more common in teenagers and adults. Usually parvovirus affects the hands, wrists, ankles, and knees, although other joints also may be involved. Joint symptoms usually go away in two to four weeks but may last longer. Permanent joint damage is very unusual. The healthcare provider's role The main role of healthcare professionals in fifth disease is evaluating the risk when pregnant women or individuals with underlying medical conditions such as sickle cell disease are exposed to this infection and in treating complications should those people become infected. Making the diagnosis In most cases, the diagnosis is made based on the characteristic rash. Unless there is a concern that someone at risk for serious disease is infected or has been exposed, no laboratory tests need to be performed. When it is important to confirm the diagnosis of parvovirus B19 infection, it is possible to perform antibody tests on the blood or to look for evidence of the virus itself in various specimens, such as a blood sample. Although the virus has been cultivated in research laboratories, viral cultures are not available for routine diagnosis. Treatment Most children with fifth disease do not need any treatment because their symptoms are so mild. Individuals who develop joint pain benefit from pain medication such as acetaminophen (as is found in Tylenol) or ibuprofen (as is found in Advil or Motrin). Pregnant women who become infected need to be followed very closely with ultrasound imaging to see if the fetus is affected. Individuals with sickle cell disease or other underlying problems that make them susceptible to severe anemia from parvovirus infection may require blood transfusions or other treatment such as intravenous (IV) immunoglobulin.
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