FIFTHS DISEASE

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OTHER NAMES: Erythema Infectiosum

WHAT IS IT? Fifths disease is a viral infection. The time from contact to first symptoms ranges from 4 to 28 days (average 7-10 days). Most people have this illness in the school years (70% of cases occur in the school years), while some get to adulthood without having had it (40%), which means that adults can get it too. When the patient is first infected, they may get mild muscle aches, joint aches, feel bad or get a headache. 15 to 30% of those who get it get a fever of up to 103 to 105 degrees F. The fever lasts for 3 to 5 days, then stops on its own. After the fever subsides a characteristic rash appears in most patients. There are 2 parts to the rash. First, some get a "slapped cheek" appearance or a mottling on the face (see second picture). Second, and most common, there is a lacey reticular rash on the body (see first picture, the picture is more bright than most patient's rashes appear). The rash can last from 7 to 21 days and may reappear months later with other viral infections, sunlight, stress, heat, or a hot bath. The rash may itch, but usually doesn't. The biggest confusion about fifths disease is this: the child is only contagious before the rash appears, but we don't know its fifths disease until the characteristic rash appears.  The child is not contagious after the rash appears. If you have more than one child and one of the kids gets fifths disease, there is only a 15-30% chance that the other child or parent will get it from the first child. The virus is mainly spread by respiratory droplets. When adults get the illness, they are more prone to itching if they get the rash, they are less prone to getting the rash and are more prone to get the joint aches and general bad feeling.

Characteristic lacey rash (if you can't see well, reset your display settings to the maximum color: START / SETTINGS / CONTROL PANEL / DISPLAY / SETTINGS / COLOR PALETTE)

Characteristic "slapped cheek" appearance.

 WHAT CAUSES IT? The virus that causes Fifths disease is called Parvovirus B19. This virus is not related to any viruses that infect animals.

 WHAT ARE THE COMPLICATIONS? Those who are not pregnant or have complex blood disorders, rarely have any complications. In my first 13 years of experience, I have not seen a single patient get any of these severe complications unless they had one of the conditions listed below and we get calls about this illness almost daily. Arthralgia: The most common complication is temporary joint pain resembling arthritis. This usually lasts only a few weeks, responds to ibuprofen (Motrin) and should not get severe. Blood problem: Parvovirus destroys developing red blood cells and this gives the more severe complications. Healthy, non-pregnant patients rarely have any problem with this part of the illness. Those who have problems manufacturing red blood cells to begin with (Sickle cell, thalassemia, hereditary spherocytosis, pyruvate kinase deficiency, immune deficiencies) may go into an aplastic crisis or severe anemia. If you child gets extremely pale (not just mildly pale like they always get when sick), has elevated heart rate, is breathing fast or is extremely tired, then call the doctor right away. Pregnancy: Fetuses also are very sensitive to destruction of developing red blood cells. Depending on the stage of pregnancy, a infection can cause anything from nothing to miscarriage (2-6%). Since most adults have had this illness in childhood, there is little chance of a pregnant woman getting the illness and having a problem. In my first 13 years of experience, I have seen 3 women have miscarriages. If your child has fifths disease and has contacted anyone who may be pregnant, have that woman call her OBGYN and inform them of the exposure. The OBGYN will usually order a test to see if the woman is immune to Parvovirus already (60% chance) and will discuss what to watch for. There is no medicine to take to prevent infection or the complications.

 HOW CAN I MAKE MY CHILD FEEL BETTER? Most children don't have any symptoms bad enough to warrant any treatment. There is no cure for the infection itself, you simply have to let it run its course. Of course if any of the symptoms are bad enough, you should treat the symptoms. If the child has a bad itch, then give Benedryl (if that isn't strong enough call and ask about Atarax). If the child has joint aches, then give ibuprofen (Motrin).

Medication

8 lbs

16 lbs

24 lbs

32 lbs

48 lbs

64 lbs

>80 lbs

Motrin Drops 40mg/cc

0.4 cc

0.8 cc

1.2 cc

1.6 cc

2.2 cc

3.2 cc

3.2 cc

Motrin Elixir 100mg/tsp

1/3 tsp

1/2 tsp

3/4 tsp

1 tsp

1.5 tsp

2 tsp

2 tsp

Motrin 50mg chewable

 

 

1

2

3

4

4

Motrin 100mg chewable

 

 

 

1

1.5

2

2

Benedryl Liquid 12.5mg/tsp

tsp

tsp

1 tsp

1.5 tsp

2 tsp

2-3 tsp

2-4 tsp

2006, Joe Matusic, MD, FAAP

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