Erythema infectiosum B08.30

Author: Prof. Dr. med. Peter Altmeyer

Our authors

Last updated on: 29.10.2020

Dieser Artikel auf Deutsch

Synonym(s)

Fifth disease; Jar face; Large Spot Disease; Megalerythem; Megalerythema epidemicum; Megalerytheme infectiosum; Ringelröteln; Slap in the face disease; Slapped-Cheek-Disease; sticker disease

History
This section has been translated automatically.

Willan, 1798; Sticker, 1899; Cheinisse, 1905

Definition
This section has been translated automatically.

Moderately contagious, mild viral exanthema in childhood, caused by infection with parvovirus B19.

Pathogen
This section has been translated automatically.

Parvovirus B19 (single-stranded DNA virus), transmission by droplet infection, incubation period 13-17 days. Parvovirus B19 is the only parvovirus that infects humans. It was found by chance by Yvonne Cossart in 1975 and named after a series of tests (number 19 in series B). The virus multiplies in erythroblasts and binds to the blood group antigen P.

Occurrence/Epidemiology
This section has been translated automatically.

The prevalence of infection is 5-10% in pre-school age and 60-70% in adults.

Manifestation
This section has been translated automatically.

Occurs mainly in children under 14 years of age, mostly between the ages of 4 and 10. Seasonal accumulation from June to November.

Localization
This section has been translated automatically.

At first cheeks, spread mainly to the extensor sides of the arms, possibly legs and buttocks. No mucous membrane infestation, palms and soles of the feet are usually free.

Clinical features
This section has been translated automatically.

The incubation period is 4-14 days. Mostly mild, catarrhal heralds, intensive butterfly-shaped redness and swelling of the cheeks (in 75% of the patients: slapped cheek appearance), 1-4 days later typical lattice or garland-shaped erythema figures.

Morbilliform exanthema can also be caused by the parvovirus B19.

Duration of exanthema: 1-3 weeks.

Frequent lymph node swelling, possibly accompanied by arthritis (5-10% of children. The finger, foot and knee joints are particularly affected. Under symptomatic treatment the joint symptoms subside within 2-3 weeks.

Possible are petechial monopedal exanthema(glove-sock syndrome)

Histology
This section has been translated automatically.

Signs of inflammation, perifollicular infiltration, swelling of the connective tissue fibres.

Diagnosis
This section has been translated automatically.

Acute infection: detection of viral DNA; VP2-specific IgM (positive 14 days to about 5 months after infection) and VP1/VP2-specific IgG (21 days after infection, detectable for life).

Differential diagnosis
This section has been translated automatically.

  • Measles: (generally much more severe clinical picture than the erythema infectiosum; with catarrhal prodromal stage: fever up to 40 °C, rhinitis, conjunctivitis, photophobia, pharyngitis, tracheitis. Enanthema; Exantherm: Red, round or oval, first pale then dark red, possibly haemorrhagic spots first behind the ears, then on the neck and trunk, finally on the extremities. Enlargement and confluence of the spots).
  • Rubella: Hardly plays a role in differential diagnosis.
  • Scarlet: (Fever, headache, sore throat, vomiting. Pharyngotonsillitis. Swelling of the cervical lymph nodes. Exanthema, possibly delayed by days, typically on the flexion side - groin, thigh triangle, flexion sides of the arms). Characteristic is the perioral free zone).
  • Systemic lupus erythematosus: (skin lesions are present in 80% of cases. "Butterfly erythema": morbilliform, scarlatiniform, multiform, rosacea or livedo exanthema may also develop, especially in the upper back and chest; serology and immunohistology are diagnostic).
  • Erysipelas: (Highly febrile [chills: ask for more details!] and highly acute clinical picture with lymphadenopathy; mostly asymmetrically localized; leukocytosis, neutrophilia, CRP, ASL significantly increased).
  • Erythema exsudativum multiforme: (important DD in the case of anularly pronounced rubella; the exanthema is much more prominent than in the erythema infectiosum; an EEM usually shows succulent cocardium structures with a possibly blistery centre).
  • Erythema anulare rheumaticum (most important differential diagnosis, since morphologically very similar; important differentiation: fever attacks; chronicity; already initially massive joint infestation; serology with positive rheumatoid factor!)

Complication(s)
This section has been translated automatically.

In immunocompromised persons, infections with parvovirus B 19 may be complicated, usually persisting chronically with the appearance of

  • recurrent exanthema and continue to work with
  • chronic anaemia, reticulcytopenia, erythroblastopenia (PRCA = pure red cell aplasia)
  • Myocarditis
  • Percarditis
  • Meningitis and
  • Encephalitis.

To what extent the so-called juvenile spring eruption is associated with a parvovirus B-19 infection is still unclear.

Therapy
This section has been translated automatically.

Symptomatic, lotions.

A school or day-care centre exemption is unnecessary, because with the appearance of the exanthema there is no longer any infectiousness.

Progression/forecast
This section has been translated automatically.

Cheap. Lifetime immunity.

Note(s)
This section has been translated automatically.

Cave! in immunocompromised patients. Danger of chronic Anemia, arthritis, thrombocytopenia.

In case of infection during pregnancy danger of infection of the foetus:

  • in 1st trimester: abortion in 9% of cases
  • in the 2nd trimenon: 1-2 weeks after maternal disease: Hydrops fetalis (5-10% of cases) due to aplastic anemia with consecutive death of the foetus Prenatal diagnosis possible. An elevation of alpha-fetoprotein in the mother's blood may indicate an infection of the foetus even before the hydrops fetalis is detectable by ultrasound.

If an infection is detected, weekly ultrasound examinations are necessary.

Literature
This section has been translated automatically.

  1. Frank R et al (1996) Dermatologic symptoms of parvovirus B19 infections. Dermatologist 47: 365-368
  2. Cheinisse L (1905) Une cinquieme maladie eruptive: Le megal-erytheme epidemique. Semaine Med 25
  3. Cossart YE, Field AM, Cant B, Widdows D (1975) Parvovirus-like particles in human sera. Lancet 1: 72-73
  4. Frydenberg A, Starr M (2003) Slapped cheek disease. How it affects children and pregnant women. Aust Fam Physician 32: 589-592
  5. Catta R (2002) Parvovirus B19: a review. Dermatol Clin 20: 333-342
  6. Scott LA et al (2003) Viral exanthems. Dermatol Online J 9: 4
  7. Sticker G (1899) The new childhood disease in the Giese area (Erythema infectiosum). Z Practitioners 8
  8. Willan R (1798) On Cutaneous Diseases. vol 1 (London) J. Johnson, St Paul's Church-Yard

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

Authors

Last updated on: 29.10.2020