Erythema infectiosum

Willan 1798, Sticker 1899, Cheinisse 1905.

Ringel rubella, fifth disease, megalerythema, megalerythema infectiosum, megalerythema epidemicum, sticker disease, slapped cheek disease.

• Moderately contagious viral infectious childhood disease caused by parvovirus B19.
• Historical note:
• Parvovirus B19 is the only parvovirus that can infect humans. It was discovered in 1975 by Yvonne Cossart and is named after the series of studies (number 19 in series B).

• Seasonally more frequent in the winter and spring months.
• Girls are more frequently affected than boys.
• Occurs mainly between 4 and 10 years of age.
• Infestation rate: 5-10% at pre-school age, up to 70% in adults.
• 300-500 abortions per year are associated with parvovirus B19.
• Contagiousness occurs before the appearance of exanthema. If skin changes are visible, infection is no longer possible.

• Transmission occurs through droplet infection, skin contact or infected blood products. The incubation period is between 4-14 days.
• Trigger is the single-stranded DNA virus Parvovirus B19 (Parvoviridae), the smallest human pathogenic virus.

• Mainly asymptomatic.
• Sometimes subfebrile temperatures and symmetrical arthritis of the small joints.
• Affected localizations: cheeks, in the course of extension of the arms, legs and buttocks.
• In up to 20% an exanthema occurs: butterfly-shaped exanthema on the face, sometimes also diffuse or figured erythema and swelling of the cheeks (slap face), 1-3 days later there is a garland-shaped or reticular elephantized erythema on the trunk as well as on the inner sides of the extremities.
• Characteristic is the recurrent flare up and fading away again, which can be induced by external factors (hot bath, sun, stress).
• The general condition is mostly good.
• In the case of pregnant women, further serological examinations are indicated if a parvovirus B19 infection is suspected. If the diagnosis is confirmed, weekly sonographic checks are essential.

• Clinical features.
• Blood count (Leukopenia, Eosinophilia (relative)).
• Serological detection (IgM and IgG), DNA detection by PCR.
• VP2-specific IgM (positive 14d - 5 months after infection) and IgG (21d to life-long detectable).

Perifollicular infiltration, enlargement of connective tissue fibers.

• Aplastic anaemia (the target cells of the B19 parvovirus include haematopoietic stem cells)
• Aplastic crises, especially in patients with pre-existing haematological diseases.
• Hydrops fetalis (in pregnancy due to anemia or myocarditis). The risk is highest between the 4th and 5th month of pregnancy (up to 15% of fetuses die).
• Encephalitis/meningitis
• Myocarditis/pericarditis
• Necrotizing vasculitis

• Mostly regression within 14 days.
• School ban for 10 days.
• Lifelong immunity.
• There is no vaccine available.

1. Carlsen, K.M. and A. Hornsleth, [The fifth disease--erythema infectiosum. Parvovirus infection in a family group]. Ugeskr Laeger, 1990. 152(19): p. 1383-4.
2. Chorba, T., et al., The role of parvovirus B19 in aplastic crisis and erythema infectiosum (fifth disease). J Infect Dis, 1986. 154(3): p. 383-93.
3. Nunoue, T., et al., Human parvovirus (B19) and erythema infectiosum. J Pediatr, 1985. 107(1): p. 38-40.
4. Lefrere, J.J., et al., Aplastic crisis and erythema infectiosum (fifth disease) revealing a hereditary spherocytosis in a familial human parvovirus infection. Nouv Rev Fr Hematol, 1986. 28(1): p. 7-9.
5. Mankuta, D., B. Bar-Oz, and G. Koren, Erythema infectiosum (Fifth disease) and pregnancy. Can Fam Physician, 1999. 45: p. 603-5.
6. Schwarz, T.F., [Erythema infectiosum infection can cause intrauterine fetal death. Possibilities of diagnosis and treatment]. Fortschr Med, 1992. 110(15): p. 289.
7. Hornsleth, A. and K.M. Carlsen, [Parvovirus B19 infections. The cause of fifth disease-erythema infectiosum--can also cause aplastic crises, fetal damage and polyarthritis]. Ugeskr Laeger, 1990. 152(19): p. 1354-7.
8. Takahashi, T., et al., [Five cases of erythema infectiosum in adults]. Kansenshogaku Zasshi, 2001. 75(6): p. 469-72.