Erythema Infectiosum - The Parvovirus B19 Infection

What Is Erythema Infectiosum?

Erythema infectiosum, also called "slapped cheek disease," can occur between the ages of 5 and 15. You'll know it when you see it. Your child's cheeks turn bright red as someone slaps them. The rash spreads to their body and limbs, too. It is caused by parvovirus B19, which spreads super easily when an infected child coughs or sneezes around others. Adults rarely get it, but it's common in school-aged children. Don't worry, though; it usually clears up on its own. It is also called the fifth disease.

What Are the Causes of Erythema Infectiosum?

Erythema infectiosum is caused by a DNA (deoxyribonucleic acid) virus that goes by the name parvovirus B19. When your child catches this virus, you will typically see the telltale red rash appear anywhere from 4 to 14 days later. Now, parvovirus B19 is a single-stranded, non-enveloped virus. It belongs to the Parvoviridae family.

What Are the Symptoms of Erythema Infectiosum?

If you have heard of erythema infectiosum, you probably know it by its more common nickname, the "slapped cheek" rash. When you first catch this virus, you will start feeling unwell within about five to ten days, and the virus stays active in your body for around five days. The two big signs are a bright red facial rash and joint pain. But sometimes you won't see any symptoms at all until you go out in the sun or a rash develops out of nowhere.

Early symptoms:

• Fever.

• Diarrhea and muscle aches.

• Vomiting and not wanting to eat.

Then comes that famous rash:

• Your cheeks turn bright red, as if someone had slapped them.

• The skin might feel itchy (this happens more in kids), but you're not contagious at this point.

• The area around your cheeks looks red and inflamed, while the center appears pale.

• Usually, you won't have that maddening itch that comes with other rashes.

As the rash fades:

• It develops a lacy, net-like pattern.

• You'll see it mostly on your arms and legs, but not on your palms or the soles of your feet.

If you are an adult (especially if you are female):

• Your joints might hurt, particularly your hands, wrists, knees, and feet.

• You will feel stiff when you try to move.

Some people experience blood-related issues:

• Your neutrophil count (a type of white blood cell) might drop.

• You could develop low platelet levels.

• In rare cases, your bone marrow might temporarily stop working properly.

How is Erythema Infectiosum Diagnosed?

When it comes to diagnosing erythema infectiosum, doctors usually spot it right away in your child, who shows up with that telltale "slapped cheek" appearance and the distinctive lacy rash. But if you want to be absolutely sure, blood tests can confirm what is going on.

What doctors typically check:

• Parvovirus Serology: Your doctor will look for IgG (immunoglobulin G) and IgM antibodies, and you will get results back in about a week.

• Parvovirus PCR (Polymerase Chain Reaction): This test is more sensitive and provides results faster, usually within 3 days.

• Tissue Testing: Sometimes your doctor will use in situ hybridization or immunohistochemistry on biopsy samples.

The thing is, doctors mainly rely on what they see and what your blood work shows. Since erythema infectiosum tends to be mild, the infection typically runs its course in about 7 to 10 days.

What Is the Differential Diagnosis of Erythema Infectiosum?

When your child is dealing with erythema infectiosum, it is easy to mix it up with other conditions since the symptoms can look similar. That is why it is important to compare what you are seeing with other possibilities; it helps you figure out what is actually going on and avoid getting it wrong.

Conditions that can look like erythema infectiosum:

• Measles (a viral infection that presents with maculopapular rash).

• Roseola (viral infection with a rash and fever).

• Rubella infection (viral infection with a rash and a fever).

• Scarlet fever (bacterial infection with a rash).

• Arthralgia (joint pain and stiffness).

• Drug hypersensitivity reaction (an adverse reaction to drugs that is similar to a rash).

• Rheumatoid arthritis (joint inflammation).

What Is the Treatment of Erythema Infectiosum?

Erythema infectiosum usually is not something you need to worry too much about. While there is no magic cure for it, here is what you can do to feel better:

• If your child is dealing with fever, joint pain, or headaches, Acetaminophen and NSAIDs, or non-steroidal anti-inflammatory drugs (like Ibuprofen) can help take the edge off.

• When your child's anemia gets severe, they might need a red blood cell transfusion to get their levels back up.

• If your baby develops hydrops fetalis (abnormal fluid accumulation in the abdomen, heart, skin, or lungs) due to a parvovirus infection, doctors can perform an intrauterine transfusion to help.

• Those burning hot cheeks can be really uncomfortable; you can try applying an ice-cold washcloth to your face, and you will feel relief almost instantly.

What Are the Complications of Erythema Infectiosum?

The complications of erythema infectiosum are mentioned below.

• Polyarthropathy (joint inflammation affecting more than 5 joints).

• Aplastic crisis (when your bone marrow stops making red blood cells).

• Intrauterine deaths or hydrops fetalis.

• Chronic parvovirus infection (a virus that can give you a rash or joint pain).

• Proteinuria (protein in your urine).

• Encephalitis (brain inflammation due to the viral infection).

• Hepatitis infection (liver inflammation).

• Myositis (inflammation of your muscles).

• Heart disease.

Is It Possible to Avoid Erythema Infectiosum?

There is no vaccine yet to protect you from erythema infectiosum. Since this virus loves to spread through tiny droplets when people cough or sneeze, your best defense is to keep things clean and be smart about it.

How Can You Keep Your Family Safer?

• Make sure you wash your hands often and keep them clean.

• When you need to cough or sneeze, catch it in your elbow instead of your hands.

• Try to keep your distance from anyone who is already sick.

Conclusion

If you have noticed your child's cheeks looking bright red, as if they had been slapped, you might be dealing with erythema infectiosum. This common childhood illness is caused by parvovirus B19 and typically presents with a distinctive "slapped cheek" rash and mild joint pain. It affects children aged between 5 and 15 years. Your child’s specialist can confirm the diagnosis with a simple blood test, and most cases clear up on their own within about 10 days. However, if you are pregnant or have a weakened immune system, you will need closer monitoring since complications can occur.

Key Takeaways

• Erythema infectiosum is characterized by bright red "slapped cheeks" followed by a lacy rash on the body. This disease is caused by human parvovirus B19.

• Your child is actually most contagious when they just seem to have a regular fever, but by the time you see that telltale red-cheeked rash, they are usually not spreading it anymore.

• If you are pregnant, have blood disorders, or your immune system is not working properly, you have to contact your doctor.