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Erythema infectiosum

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VOL: 100, ISSUE: 02, PAGE NO: 29




- Erythema infectiosum is a mild rash illness caused by infection with human parvovirus B19.



- It is sometimes known as slapped-cheek syndrome because of the rash it causes on the cheeks.



- It is also known as fifth disease, because it was historically numbered as the fifth of six rash-associated diseases of childhood (the others are measles, scarlet fever, rubella and roseola; the sixth, Duke’s disease, was never clearly distinguished).



- Erythema infectiosum is usually seen in children, but can occur in adults who were not infected in childhood and have no immunity.



- It occurs in epidemics about every four to five years (Communicable Disease Report, 2002).



- Diagnosis is made during a physical examination to assess symptoms.



- If there is a risk of complications, diagnosis can be confirmed by taking a blood test to look for antibodies to the parvovirus.



- Erythema infectiosum is often asymptomatic in its early stages, but may be accompanied by a mild fever or cold symptoms.



- Adults may develop joint pain, most commonly in the hands, wrists and knees. This usually resolves after one or two weeks, but can last several months (National Centers for Infectious Diseases, 2000).



- A rash appears about 15 days after infection, beginning with red patches on the face, which merge to give the appearance of hot, slapped cheeks.



- It then extends to the limbs and trunk, forming a lace-like pattern before fading spontaneously after about a week. The rash may reappear then fade again.



- The condition is contagious in the early stage, but by the time the rash appears the patient is not contagious.



- Parvovirus B19 has been found in the respiratory secretions of infected people, and is spread by exposure to airborne droplets, and possibly by sharing cups and utensils.



- People who are immunosuppressed or who have certain anaemias may be contagious for a longer period (New York State Department of Health, 2003).



- There is no specific treatment for the condition. Where necessary, treatment focuses on alleviating symptoms, for example with non-steroidal anti-inflammatory drugs to relieve joint pain and reduce fever.



- Adults with joint pain and swelling may need to rest.



- Patients in whom infection causes severe anaemia may require hospital admission for blood transfusion.



- Those with immune problems may need special medical care, including treatment with immunoglobulin.



- In people with sickle-cell disease or similar disorders, the condition may cause severe anaemia, which will resolve after recovery.



- In immunosuppressed patients, such as those with leukaemia or HIV infection, and organ transplant recipients, it may cause chronic anaemia.



- Infection during the first half of pregnancy can cause severe anaemia in the foetus in a minority of cases (less than five per cent), and can lead to miscarriage (National Centers for Infectious Diseases, 2000).



- Infection has been associated with arthritis in adults (NYSDoH, 2003).



- There is no vaccine against parvovirus B19.



- Frequent handwashing is the most effective method of prevention.







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