Fifth Disease

Fifth disease, also known as erythema infectiosum, is a contagious viral infection commonly found in school-age children. It usually peaks during late winter, spring, and early summer. Interestingly, around 50% of adults are immune to fifth disease because they had it during childhood, often without realizing it. Unlike some other childhood illnesses, there isn’t a vaccine available for fifth disease.

The name “fifth disease” originated when it was classified as the fifth on a list of six recognized childhood rash-forming illnesses, the others being rubella, measles, scarlet fever, chickenpox, and roseola infantum.

Symptoms of Fifth Disease

In children, fifth disease typically starts with symptoms resembling a common cold. Within 7 to 10 days, a distinctive rash usually develops. Common signs and symptoms of fifth disease include:

• Mild fever
• Congested or runny nose
• Headache
• Bright red cheeks
• A flat or raised red rash, usually appearing on the arms and legs. This rash can last from 2 to 39 days and might be itchy. It often fades from the center outwards, giving it a lace-like appearance. Additionally, the rash may reappear with activities like exercise, warm baths, or emotional stress.

While the hallmark sign of fifth disease is the red rash on the cheeks, not all children infected with the virus will develop this rash. Less commonly, some children may experience:

• Sore throat
• Joint pain
• Swollen glands
• Red eyes
• Diarrhea
• Rash resembling bruises or blisters

Fifth disease is rare in infants and adults. Adults who contract the virus typically don’t develop the characteristic rash but may experience more severe flu-like symptoms.

Causes of Fifth Disease

erythema infectiosum is caused by a virus called parvovirus B19, which exclusively infects humans. It’s worth noting that other forms of parvovirus can affect animals like dogs and cats.

Transmission of Fifth Disease

The virus responsible for fifth disease spreads through respiratory droplets and blood. This means it can be transmitted when an infected person coughs or sneezes. Adults who work closely with young children, such as teachers or healthcare workers, are at higher risk of exposure.

Once the rash appears, children are typically no longer contagious and can safely attend school or daycare. The incubation period for fifth disease ranges from 4 to 14 days, though it can extend up to 21 days.

Prevention of Fifth Disease

To prevent the spread of fifth disease among children, especially in daycare or school settings, several measures can be taken:

• Frequent handwashing, particularly after nose wiping or blowing and before meals.
• Avoiding sharing food, pacifiers, or utensils.
• Regular cleaning and disinfection of toys, especially if they are frequently mouthed by children.
• Discouraging kissing on the mouth.
• Encouraging outdoor play to minimize close contact indoors.
• Ensuring adequate spacing between children, especially during naptime.
• Teaching children to cough or sneeze into a tissue or their elbow and away from others.

In most cases, children with fifth disease do not need to be kept home from daycare once the rash appears and a diagnosis is confirmed.

Diagnosis and Treatment

Fifth disease is usually diagnosed based on its characteristic symptoms. While a blood test can confirm the presence of the virus, it’s often unnecessary for individuals with healthy immune systems. Pregnant individuals who suspect exposure to erythema infectiosum may undergo a blood test to determine their immunity status.

Treatment for fifth disease primarily focuses on symptom management to alleviate discomfort. This may include:

• Acetaminophen to reduce fever
• Ibuprofen for joint or muscle pain
• Antihistamines for rash-related itching

In cases where the individual has sickle cell anemia, chronic anemia, or a weakened immune system, immunoglobulin therapy or blood transfusions may be necessary.

Complications and When to Seek Medical Attention

Fifth disease typically poses little risk to healthy children and adults. However, in some cases, it can lead to chronic anemia, requiring hospitalization and blood transfusion. Those with compromised immune systems are at higher risk of severe complications.

Pregnant individuals should contact their doctor if they suspect exposure to the fifth disease, as it can lead to severe complications for the fetus. While rare, fetal infection can result in severe anemia, heart failure, miscarriage, or stillbirth.

If any concerning symptoms arise, such as purple, painful, or blistered rash, prolonged rash duration, or severe illness, medical attention should be sought promptly.

In conclusion, while fifth disease is usually a mild illness, it’s essential to take preventive measures to limit its spread, especially among vulnerable populations like pregnant individuals and those with weakened immune systems. Additionally, prompt medical evaluation is crucial for any concerning symptoms or complications.