Fifth disease

Fifth disease is one of several possible manifestations of infection by parvovirus B19. The disease is also referred to as erythema infectiosum (meaning infectious redness) and as slapped cheek syndrome, slapcheek, slap face or slapped face. The name "fifth disease" derives from its historical classification as the fifth of the classical childhood skin rashes or exanthems.

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Symptoms

The bright red cheeks are a defining symptom of the infection in children (hence the name "slapped cheek disease"). Occasionally the rash will extend over the bridge of the nose or around the mouth. In addition to the red cheeks, children often develop a red, lacy rash on the rest of the body, with the upper arms and legs being the most common locations. The rash can last a couple of weeks (some cases lasting for several months) and may itch. Patients are usually no longer infectious once the rash has appeared.

Teenagers and adults may present with a self-limited arthritis.

The disease is usually mild, but in certain risk groups it can have serious consequences:

• In pregnant women, infection in the first trimester has been linked to hydrops fetalis, causing spontaneous abortion
• In people with Sickle-cell disease or other forms of chronic hemolytic anemia, infection can precipitate an aplastic crisis.

Epidemiology

Any age may be affected although it is most common in children aged five to fourteen years. By the time adulthood is reached about half the population will have become immune following infection at some time in their past. Outbreaks can arise especially in nurseries and schools.