ERYTHEMA INFECTIOSUM

ERYTHEMA INFECTIOSUM Also known as 5th disease/ slapped cheek syndromeEtiology : causes by human parvovirus B19, a single stranded DNA virus, producing a benign viral exanthem In healthy children.

Incubation period : typically 4-14 days & rarely may last for 21 days. Clinical ManifestationParvovirus B19 infects Erythroblastoid red cell (precursor in the bone marrow)

Causes range of clinical syndromes

asymptomatic infection Eryhtema infectiosum Aplastic crisis Fetal disease 1. Asymptomatic infection Common in those who have build antibodies - pre-schooler : 5-10%- adults : 65%2. Erythema infectiosum Most common illness With viraemic phases of :-fever, malaise, headache and myalgia followed by characteristic rash 7-10 days later.

Initial stage slapped cheek rash with circumoral pallorlater stage lacy, reticulated rash lasts for 2-40days (mean 11 days). Rash may be pruritic , does not desquamate and may recur with exercise, bathing, rubbing or stress.

3. Aplastic crisis Most serious consequences of parvovirus infection Occurs in children with: chronic hemolytic anemia, where there is an increase in cell turnover (eg: thalassemia, sickle cell diseaseImmunodeficient children (eg: malignancy) who are unable to produce antibody 4. Fetal disease Vertical transmission of maternal parvovirus infection may lead to hydrop fetalis and death due to severe anemia. Associated complications Parvovirus B19 Is not teratogenic, but in utero infection of fetal erythroid cells may result in - Fetal heart failure-hydrops fetalis -fetal deathFatalities associated with transient aplastic crisis is rare. Management

There is no specific therapyRoutine supportive care includes maintaining adequate hydration and antipyreticsIn transient aplastic crisis blood transfusion is requiredIntrauterine transfusion has been performed for hydrops fetalis associated with fetal parvovirus B19 infection.Intravenous immunoglobulin may be used for immunocompromised persons with severe anemia or chronic infection

Preventive measuresEffective control measures are limited. Exclusion of affected children from school is not recommended, because children generally are not infectious by the time rash is present. Good hand washing and hygiene are practical measures that should help reduce transmission.