Clinical features

The majority of patients with Parvovirus B19 infection are either asymptomatic or exhibit mild, nonspecific, cold like symptoms. Clinical conditions associated with the infection include (1):

• erythema infectiosum (also called fifth disease and slapped cheek syndrome)
  • most common clinical presentation of Parvovirus B19 infection (2)
  • seen in children between the ages of 6 to 14 years (3), a less-pronounced rash may be seen in adults (1)
  • after an incubation period of 13 to 18 days (2), a prodrome of mild fever with a sore throat, coryza, headache and gastrointestinal disturbance (nausea) may be observed which lasts for up to 4 days
  • during the first stage, erythema of the cheeks (“slapped-cheek” rash) can be seen with circumoral pallor
  • the second stage of the rash occurs after one to four days and presents as a maculopapular rash in the extremities and trunk
    • a lacy, reticular pattern may be seen caused by the central clearing of the rash (1)
    • by the second day, it usually has spread to involve the proximal arms and extensor surfaces of the legs
    • later, it may extend to the flexor surfaces and the trunk, and rarely, the palms and soles
  • exposure to sunlight and heat may cause the rash to fade and reappear (3)
  • it usually disappears within 7 – 10 days (3)
• arthropathy
  • may present as a complication of erythema infectiosum or as a primary presentation of the infection itself
  • more common in adolescents and adults (upto 60% of infected patients might be affected)
  • presentation of arthropathy differ in adults when compared to children
    • in adults – presents as symmetric and polyarticular arthropathy with involvement of the proximal interphalangeal and meta-carpophalangeal joints, knees, wrists, and ankles are affected less often, resolves within three weeks,
    • in children – it can be symmetric or asymmetric with knees (82% of patients) and ankles usually affected
• transient aplastic crisis
  • seen when people with iron deficiency anemia, human immunodeficiency virus (HIV), sickle cell disease, spherocytosis, or thalassemia are infected with parvovirus B19
  • there can be a transient aplastic crisis with cessation of erythrocyte production
  • can be life threatening but most recover fully within two weeks
  • the typical slapped cheek rash is seen rarely in these patients (3)
• chronic red cell aplasia
  • seen in immunocompromised patients in whom Parvovirus B19 infection may persist without antibodies
  • patients may have severe, prolonged, or recurrent fatigue and pallor caused by anemia
  • intravenous immuneglobulins may be needed in severe anaemia
• papular, purpuric eruptions on the hands and feet (“gloves and socks” syndrome)
  • typically seen in young adults who presents with symmetric, painful erythema and edema of the feet and hands (1) (in a “glove and stocking” distribution) with a clear demarcation at the wrists and ankles (3)
  • the rash is likely to appear before the antibodies appear and resolves in about a week (3)
• hydrops fetalis

Reference:

• (1) Servey JT, Reamy BV, Hodge J. Clinical presentations of parvovirus B19 infection. Am Fam Physician. 2007;75(3):373-6
• (2) Health Protection Agency (HPA) 2008. General information on parvovirus: parvovirus B19 (Slapped cheek syndrome, Fifth disease or Erythema infectiosum) – general information
• (3) Health Protection Agency (HPA) 2007. Investigation of red rash. QSOP 56. Issued by standards unit, evaluations and standards laboratory. Centre for infections