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Parvovirus B19 infection (Clinical presentation (Asymptomatic, Facial…
Parvovirus B19
infection
Definition
Infection with virus parvovirus B19,
typically causing a facial rash
(slapped cheek syndrome)
Epidemiology
School-age children (6-10y)
Most people exposed at some
point in their lives
Pathophysiology
Agent
Virus parovovirus B19 (erythrovirus)
Transmission
Droplet spread from respiratory secretions
Rarely vertical via placenta from mother-child, or blood transfusion
Mechanism
Incubation period 2-3weeks
Virus targets erythroid progenitor cells in BM, fetal liver, umbilical cord and peripheral blood
Slapped cheek syndrome/erythema infectiosum/fifth disease
Often a biphasic illness
Lifelong immunity afterwards
Clinical
presentation
Asymptomatic
Facial rash
Diffuse malar erythema one/both cheeks; 'slapped cheek' appearance
Spreads to trunk, back, limbs as maculopapular rash; fades to lace-like pattern
Gloves and socks appearance in adults
Fades after 1-2w
Fever
(low grade)
Coryza
Headache
Nausea
Diarrhoea
Diagnosis
Examination
ENT examination
NAD
Dermatological examination
Florid erythema on cheeks, maculopapular
rash on chest/abdo and limbs
Investigations
Bedside
Obs (low grade fever)
Bloods
Indication: pregnancy, immunocompromised
E.g. parvovirus B19 IgM, DNA, IgG; rubella infection; FBC
History
DH
Current meds, allergies
FH
Ill contacts
PMH
Milstones and development
Vaccinations
Known conditions
SH
Living arrangements, work/school
PC/HPC
Rash: initially facial, then trunk/limbs
(may not have facial stage in adults)
Additional symptoms: prodromal coryza, fever, fatigue, nausea, diarrhoea; symmetrical polyarthropathy in adults (hand PIP/MCP)
Management
Conservative
Information, advice, support
If pregnant or immunocompromised, seek local ID advice (will likely need urgent bloods, then fetal monitoring)
Self care (rest, fluids, analgesia, don't need to stay off school/work but should inform them)
Medical
Analgesia
Indication: pain, fever
E.g. paracetamol, ibuprofen
Complications
Pregnancy
Maternal
Pre-eclampsia-like syndrome (mirror syndrome,
rare, occurs in late pregnancy)
Foetal
Non-immune hydrops
Foetal death (often second trimester)
Congenital abnormality (rare, ~1%)
Immunocompromised
Transient aplastic anaemia
Pure red cell aplasia
Neurological (encephalitis, meningitis,
peripheral neuropathy, stroke)
Other (myocarditis, nephritic syndrome, hepatitis, vasculitis)
Prognosis
Usually mild and self limiting
Children may get a recurrent erythematous rash
after sunlight/exercise/stress
Adults may have a persistent polyarthropathy
for a few months after infection
In pregnant women, foetus most vulnerable during second trimester, with 10% fatality in <20w gestation; but most babies are born with no problems secondary to infection
Immunocompromised persons at increased risk
of developing complications
Differentials
Infection
Viral: rubella, measles, roseola infantum,
enterovirus, adenovirus, CMV, HIV, tropical viruses
Bacteria: scarlett fever, brucellosis, glandular fever, syphilis
Parasites: toxoplasmosis
Autoimmune
Kawasaki disease
RA (adults)
Drugs
Reactions e.g. AEDs
