parvovirus b19

Parvovirus B19

Parvovirus B19 infects only humans, sometimes called “Fifth disease”, “erythema infectiosum” or “slapped-cheek disease” because of the distinctive face rash that develops 1). Parvovirus B19 most commonly causes Fifth disease, a mild rash illness that usually affects children. But parvovirus B19 can cause different signs and symptoms, depending on your age and overall health. Many people infected with parvovirus B19 do not have any symptoms, or they have only mild, nonspecific rash illness, like the common cold.

Parvovirus B19 infection is a common and highly contagious childhood ailment. The human parvovirus B19 only infects humans and is different from the parvovirus seen in dogs and cats, so you can’t get the parvovirus B19 infection from a pet or vice versa. Parvovirus B19 is a non-enveloped, icosahedral virus, containing a single-stranded, linear DNA genome 2).

Parvovirus B19 infection occurs worldwide and is most common in school-aged children. The prevalence of parvovirus B19 in developed countries in children younger than five years is 2% to 10%, 40% to 60% in adults older than 20 years, and 85% or more in people 70 years and older. Infections with parvovirus B19 tend to occur more often in the late winter, spring, and early summer. Mini-outbreaks of parvovirus B19 infection occur about every three to four years.

In most children, parvovirus B19 infection is mild and requires little treatment. However, in some adults, the parvovirus B19 infection can be serious. Parvovirus B19 infection in some pregnant women can lead to serious health problems for the fetus. Parvovirus infection is also more serious for people with some kinds of anemia or who have a compromised immune system.

Patients are no longer infectious after other symptoms resolve (usually by day 7 of illness). Thus, children with a classic parvovirus B19 rash may return to school or daycare 3).

Parvovirus B19 causes

Human parvovirus infection is most common among elementary school-age children during outbreaks in the winter and spring months, but anyone can become ill with it anytime of the year. It spreads from person to person, just like a cold, often through respiratory secretions and hand-to-hand contact.

Parvovirus infection can also spread through blood. A pregnant woman who is infected can pass the virus to her baby.

The illness is contagious in the week before the rash appears. Once the rash appears, the person with the illness is no longer considered contagious and doesn’t need to be isolated.

Parvovirus B19 transmission

Parvovirus B19 which causes Fifth disease, spreads through respiratory secretions, such as saliva, sputum, or nasal mucus, when an infected person coughs or sneezes. You are most contagious when it seems like you have “just a fever and/or cold” and before you get the rash or joint pain and swelling. After you get the rash you are not likely to be contagious, so then it is usually safe for you or your child to go back to work or school. People with fifth disease who have weakened immune systems may be contagious for a longer amount of time.

Parvovirus B19 can also spread through blood or blood products. A pregnant woman who is infected with parvovirus B19 can pass the virus to her baby.

In parts of the world with changing seasons, people tend to get infected with parvovirus B19 more often in late winter, spring, and early summer. Mini-outbreaks of parvovirus B19 infection occur about every 3 to 4 years.

Since parvovirus B19 only infects humans, a person cannot get the virus from a dog or cat. Also, dogs and cats cannot get parvovirus B19 from an infected person.

Pet dogs and cats can get infected with other parvoviruses that do not infect humans. Pets can be vaccinated to protect them from parvovirus infection.

Once you recover from fifth disease, you develop immunity that generally protects you from parvovirus B19 infection in the future.

Parvovirus B19 prevention

There is no vaccine or medicine that can prevent parvovirus B19 infection. You can reduce your chance of being infected with parvovirus B19 or infecting others by

  • washing your hands often with soap and water
  • covering your mouth and nose when you cough or sneeze
  • not touching your eyes, nose, or mouth
  • avoiding close contact with people who are sick
  • staying home when you are sick

All healthcare providers and patients should strictly follow the infection control practices listed above to prevent parvovirus B19 from spreading.

Once you’ve become infected with parvovirus B19, you acquire lifelong immunity.

Parvovirus B19 symptoms

Most people with parvovirus B19 infection have no signs or symptoms. When symptoms do appear, they vary greatly depending on the age of the person who has the disease.

Parvovirus B19 most commonly causes Fifth disease, a mild rash illness that usually affects children. Adults can get infected with parvovirus B19, too.

Fifth disease is a mild rash illness caused by parvovirus B19. A person usually gets sick with Fifth disease within four to 14 days after getting infected with parvovirus B19. This disease, also called erythema infectiosum, got its name because it was fifth in a list of historical classifications of common skin rash illnesses in children.

Other much less common symptoms of parvovirus B19 infection include painful or swollen joints (polyarthropathy syndrome), which is more common in adults, and severe anemia (a condition in which the body doesn’t have enough healthy red blood cells). In rare cases, some of these symptoms can persist for a long time.

Parvovirus B19 Fifth disease signs and symptoms

The symptoms of fifth disease are usually mild and may include

  • fever
  • runny nose
  • headache
  • rash

You can get a rash on your face and body

You may get a red rash on your face called “slapped cheek” rash. This rash is the most recognized feature of Fifth disease. It is more common in children than adults.

Some people may get a second rash a few days later on their chest, back, buttocks, or arms and legs. The rash may be itchy, especially on the soles of the feet. It can vary in intensity and usually goes away in seven to 10 days, but it can come and go for several weeks. As it starts to go away, it may look lacy.

You may also have painful or swollen joints

People with Fifth disease can also develop pain and swelling in their joints. This is called polyarthropathy syndrome. It is more common in adults, especially women. Some adults with fifth disease may only have painful joints, usually in the hands, feet, or knees, and no other symptoms. The joint pain usually lasts 1 to 3 weeks, but it can last for months or longer. It usually goes away without any long-term problems.

Fifth disease complications

Fifth disease is usually mild for children and adults who are otherwise healthy. But for some people fifth disease can cause serious health complications, such as chronic anemia that requires medical treatment.

You may be at risk for serious complications from fifth disease if you have a weakened immune system caused by leukemia, cancer, organ transplants, or HIV infection.

Pregnancy and Parvovirus B19

Fifth disease is a mild rash illness caused by parvovirus B19. This disease is usually not a problem for pregnant women and their babies. About half of pregnant women are immune to parvovirus B19, so they and their babies are usually protected from getting the virus and fifth disease. Pregnant women who are not immune usually have only mild illness if they are exposed to fifth disease. Also, their babies usually do not have any problems.

Parvovirus infection during pregnancy sometimes affects red blood cells in the fetus. Although uncommon, this may cause severe anemia that could lead to hydrops fetalis, miscarriage or stillbirth. Fetal risk appears greatest during the first half of the pregnancy (before 20 weeks gestation).

Hydrops fetalis is not itself a disease, but an ultrasound marker of other fetal complications. Hydrops fetalis is defined as an abnormal collection of fluid in at least two different fetal organ spaces, including ascites, pleural effusion, pericardial effusion, and skin edema. Most fetal losses occur in the second trimester. However, the overall risk of fetal loss while pregnant is 2% to 6% 4). The parvovirus B19 is not usually tested for in pre-conception or antenatal screenings. Most babies born to mothers with the infection are born asymptomatic and full term.

Rarely, a baby will develop severe anemia caused by its mother’s infection with fifth disease, and the woman may have a miscarriage. But this is not common. It happens less than 5% of the time among all pregnant women with parvovirus B19 infection, and it happens more commonly during the first half of pregnancy.

Parvovirus B19 and Other Illnesses

Parvovirus B19 infection can cause painful or swollen joints (polyarthropathy syndrome), which is more common in adults. It can also cause the body to temporarily stop making new red blood cells. This can lead to severe anemia and other complications, but these are not very common. They usually affect people who have:

  • sickle cell disease or similar types of long-lasting anemia or problems producing red blood cells, or
  • weakened immune systems caused by leukemia, cancer, organ transplants, or HIV infection.

If you have severe anemia or other chronic illnesses caused by parvovirus B19 infection, you can potentially spread the virus to others.

You may want to talk to your healthcare provider if you have a weakened immune system, sickle cell disease or a similar long-lasting anemia and you:

  • have been exposed to someone with fifth disease or
  • have an illness that might be caused by parvovirus B19.

Your healthcare provider may want to test your blood to see if you have parvovirus B19 infection.

Parvovirus B19 complications

Parvovirus B19 infection can cause serious complications for people with anemia, a condition in which red blood cells, which carry oxygen to all the parts of your body, are used up faster than your bone marrow can replace them. Aplastic crisis may occur in those with pre-existing conditions such as decreased red cell production (iron deficiency anemia and thalassemias) or increased red cell destruction (sickle cell anemia, hereditary spherocytosis, pyruvate kinase deficiency, glucose-6-phosphate dehydrogenase deficiency), as well as recipients of allogeneic hematopoietic stem cell or solid organ transplants and patients with HIV infection.

Parvovirus B19 can also cause anemia and related complications in:

  • The unborn children of women infected with parvovirus during pregnancy
  • People who have weakened immune systems

Papular purpuric gloves and socks syndrome

Papular purpuric gloves and socks syndrome usually occurs in young adults but can occur at any age. On exam, one will find petechiae and purpura with a sharp demarcation at the wrists and ankles. There also will be symmetric edema and erythema of the palms and soles that may extend onto the dorsal surfaces and patients may complain of burning or pruritus. Some sources have documented cases involving intertriginous areas of the body as well. Unlike erythema infectiosum, patients are contagious when they have the rash. Erosions and petechiae may occur in the mouth involving the palate, pharynx, and tongue.

Parvovirus B19 diagnosis

Healthcare providers can often diagnose fifth disease just by seeing “slapped cheek” rash on a patient’s face. Your healthcare provider can do a blood test checking a serum anti-B19 IgM antibody to determine if you are susceptible or immune to parvovirus B19 infection or if you were recently infected. This is not a routine test but can be performed in special circumstances. Talk to your healthcare provider. The blood test may be particularly helpful for pregnant women who may have been exposed to parvovirus B19 and are suspected to have Fifth disease.

If a serum anti-B19 IgM antibody is positive, it indicates infection within the previous two to four months. The IgG antibody will be positive after one week. Polymerase chain reaction (PCR) testing from the serum or tissue can also be used.

Parvovirus B19 treatment

Fifth disease is usually mild and will go away on its own. Children and adults who are otherwise healthy usually recover completely. Treatment usually involves relieving symptoms, such as fever, itching, and joint pain and swelling.

People who have complications from fifth disease should see their healthcare provider for medical treatment. People with severe anemia may need to be hospitalized and receive blood transfusions. Those with weakened immune systems may receive antibodies, via intravenous immunoglobulin (IVIG) injections, to treat the infection. Intravenous immunoglobulin (IVIG) has been used with good results for patients suffering pure red cell aplasia 5). Patients should be monitored for relapsed viremia 6).

Patients in aplastic crisis require packed red blood cell transfusions 7). In some studies, more than 80% of patients with sickle cell disease in transient aplastic crisis have required transfusion 8). Intravenous immunoglobulin (IVIG) is not recommended for transient aplastic crisis.

In patients receiving immunosuppressive agents, temporarily decreasing the dose of immunosuppressive agents usually enables the immune system to produce sufficient immunoglobulin G (IgG) to eradicate the infection and confer lifelong protection. In some individuals with human immunodeficiency virus (HIV) infection, highly active antiretroviral therapy restores immune function, enabling resolution of chronic parvovirus B19 infection 9).

Although its use is controversial and carries many risks, intrauterine blood transfusions may be helpful in cases of hydrops fetalis 10).

Home remedies

Self-care treatment is aimed primarily at relieving signs and symptoms and easing any discomfort. Make sure you or your child gets plenty of rest and drinks lots of fluids. Acetaminophen (Tylenol, others) may help to relieve temperatures of more than 102 °F (39 °C) or minor aches and pains.

Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 3, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye’s syndrome, a rare but potentially life-threatening condition, in such children.

It’s impractical and unnecessary to isolate your sick child. You won’t know your child has parvovirus infection until the rash appears, and by that time, your child is no longer contagious.

Parvovirus B19 infection during pregnancy

If you are pregnant, you may want to talk with your healthcare provider if you:

  • have been exposed to someone with Fifth disease,
  • have an illness that might be caused by parvovirus B19 infection, or
  • were recently infected with parvovirus B19.

There is no single recommended way to monitor pregnant women with parvovirus B19 infection. Your healthcare provider may recommend additional prenatal visits, blood tests, and ultrasounds.

Parvovirus B19 prognosis

Erythema infectiosum is usually mild for those that are healthy. However, it can cause serious complications in immunocompromised patients. In some people parvovirus B19 can cause chronic anemia requiring treatment. After a person becomes infected with erythema infectiousum, immunity is obtained that protects one from infection in the future. Most of the time papular purpuric gloves and socks syndrome resolves on its own without any complications.

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