What is the pathophysiology of erythema infectiosum (fifth disease)?

Answer

Human PV-B19, a member of the family Parvoviridae, is a heat-stable, single-stranded DNA virus^[10]; it is the only parvovirus known to cause disease in humans.

The development of erythema infectiosum in children is a normal response to infection by PV-B19. Acute infection in a host who is immunocompetent leads to a Th-1–mediated cellular immune response, with the production of specific immunoglobulin M (IgM) antibodies and subsequent formation of immune complexes. Clinical signs and symptoms of erythema infectiosum probably result from the deposition of the immune complexes in the skin and joints of individuals with this condition and not from the circulating virus.^[11]The incubation period is usually 7-10 days, but it can be 4-21 days. Extremely high viral loads are noted in patients with aplastic crisis, but low-level persistent polymerase chain reaction positivity in tissues is also common among adults in a variety of tissues.^{[12, 13]}

Did this answer your question?

Yes No

Additional feedback? (Optional)

Thank you for your feedback!

Magro CM, Dawood MR, Crowson AN. The cutaneous manifestations of human parvovirus B19 infection. Hum Pathol. 2000 Apr. 31(4):488-97. [Medline].
Drago F, Ciccarese G, Broccolo F, Javor S, Parodi A. Atypical exanthems associated with Parvovirus B19 (B19V) infection in children and adults. J Med Virol. 2015 Nov. 87 (11):1981-4. [Medline].
Macri A, Crane JS. Parvoviruses. 2018 Jan. [Medline]. [Full Text].
Servey JT, Reamy BV, Hodge J. Clinical presentations of parvovirus B19 infection. Am Fam Physician. 2007 Feb 1. 75(3):373-6. [Medline].
Yamada Y, Itoh M, Yoshida M. Sensitive and rapid diagnosis of human parvovirus B19 infection by loop-mediated isothermal amplification. Br J Dermatol. 2006. 155:50-5. [Medline].
Corcoran A, Doyle S. Advances in the biology, diagnosis and host-pathogen interactions of parvovirus B19. J Med Microbiol. 2004 Jun. 53(Pt 6):459-75. [Medline].
American Academy of Pediatrics. Red Book: 2006 Report on the Committee of Infectious Diseases. 2006. 484-487.
Revilla Grande AI, Carro Garcia T, Sanchez de Dios M, Galan Calvo MJ, Nebreda Mayoral T. [Outbreak of infectious erythema at a urban health center]. Aten Primaria. Jul-Aug 2000. 26(3):172-5. [Medline].
Veraldi S, Rizzitelli G. Erythematous exanthem associated with primary infection by human parvovirus B19. Int J Dermatol. 1995 Feb. 34(2):119. [Medline].
Cossart YE, Field AM, Cant B, Widdows D. Parvovirus-like particles in human sera. Lancet. 1975 Jan 11. 1(7898):72-3. [Medline].
Anderson MJ, Higgins PG, Davis LR, Willman JS, Jones SE, Kidd IM, et al. Experimental parvoviral infection in humans. J Infect Dis. 1985 Aug. 152(2):257-65. [Medline].
Ishikawa A, Yoto Y, Tsugawa T, Tsutsumi H. Quantitation of human parvovirus B19 DNA in erythema infectiosum and aplastic crisis. J Med Virol. 2014 Jun 24. [Medline].
Aravindh R, Saikia UN, Mishra B, et al. Persistence of human parvovirus B19 in tissues from adult individuals: a comparison with serostatus and its clinical utility. Arch Virol. 2014 Sep. 159(9):2371-6. [Medline].
Fattet S, Cassinotti P, Popovic MB. Persistent human parvovirus B19 infection in children under maintenance chemotherapy for acute lymphocytic leukemia. J Pediatr Hematol Oncol. 2004. 26:497-503. [Medline].
Watt AP, Brown M, Pathiraja M, Anbazhagan A, Coyle PV. The lack of routine surveillance of Parvovirus B19 infection in pregnancy prevents an accurate understanding of this regular cause of fetal loss and the risks posed by occupational exposure. J Med Microbiol. 2013 Jan. 62:86-92. [Medline].
Zajkowska A, Garkowski A, Czupryna P, Moniuszko A, Król ME, Szamatowicz J, et al. Seroprevalence of parvovirus B19 antibodies among young pregnant women or planning pregnancy, tested for toxoplasmosis. Przegl Epidemiol. 2015. 69 (3):479-82, 597-600. [Medline].
Lamont RF, Sobel JD, Vaisbuch E, Kusanovic JP, Mazaki-Tovi S, Kim SK, et al. Parvovirus B19 infection in human pregnancy. BJOG. 2011 Jan. 118 (2):175-86. [Medline].
Palermo CI, Costanzo CM, Franchina C, Castiglione G, Giuliano L, Russo R, et al. Focal epilepsy as a long term sequela of Parvovirus B19 encephalitis. J Clin Virol. 2016 Apr 14. 80:20-23. [Medline].
Kechaou I, Cherif E, Boukhris I, Azzabi S, Kaouech Z. Pseudo-erysipelas: A new atypical cutaneous manifestation of parvovirus B19 primary infection. Med Mal Infect. 2016 Mar. 46 (2):107-8. [Medline].
Mühlemann B, Margaryan A, Damgaard PB, Allentoft ME, Vinner L, Weber A, et al. Ancient human parvovirus B19 in Eurasia reveals its long-term association with humans. Proc Natl Acad Sci U S A. 2018 Jul 17. 115 (29):7557-7562. [Medline].
Quattrocchi S, Ruprecht N, Bönsch C, Bieli S, Zürcher C, Boller K, et al. Characterization of the early steps of human parvovirus B19 infection. J Virol. 2012 Sep. 86(17):9274-84. [Medline]. [Full Text].
Broliden K, Tolfvenstam T, Norbeck O. Clinical aspects of parvovirus B19 infection. J Intern Med. 2006. 260:285-304. [Medline].
Servant-Delmas A, Morinet F. Update of the human parvovirus B19 biology. Transfus Clin Biol. 2016 Feb. 23 (1):5-12. [Medline].
Lee YM, Chuang SY, Wang SF, Lin YT, Chen YM. Epidemiology of human herpesvirus type 8 and parvovirus B19 infections and their association with HIV-1 among men who have sex with men and injection drug users in Taiwan. J Microbiol Immunol Infect. 2013 Mar 3. [Medline].
Romero Starke K, Kofahl M, Freiberg A, Schubert M, Groß ML, Schmauder S, et al. Are Daycare Workers at a Higher Risk of Parvovirus B19 Infection? A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2019 Apr 17. 16 (8):[Medline].
Cubel Garcia RC, Pereira RF, Azevedo KM, Castro TX, Mello FC, Setubal S, et al. Molecular diversity of human parvovirus B19 during two outbreaks of erythema infectiosum in Brazil. Braz J Infect Dis. 2017 Jan - Feb. 21 (1):102-106. [Medline].
Young NS, Brown KE. Parvovirus B19. N Engl J Med. 2004 Feb 5. 350(6):586-97. [Medline].
van Rijckevorsel GG, Sonder GJ, Schim van der Loeff MF, van den Hoek JA. Population-based study on the seroprevalence of parvovirus B19 in Amsterdam. J Med Virol. 2009 Jul. 81(7):1305-9. [Medline].
Nicolay N, Cotter S. Clinical and epidemiological aspects of parvovirus B19 infections in Ireland, January 1996-June 2008. Euro Surveill. 2009 Jun 25. 14(25):[Medline].
Exindari M, Chatzidimitriou D, Melidou A, Gioula G, Ziogou L, Diza E. Epidemiological and clinical characteristics of human parvovirus B19 infections during 2006-2009 in Northern Greece. Hippokratia. 2011 Apr. 15(2):157-60. [Medline]. [Full Text].
Frydenberg A, Starr M. Slapped cheek disease. How it affects children and pregnant women. Aust Fam Physician. 2003. 32:589-92. [Medline].
McCarter-Spaulding D. Parvovirus B19 in pregnancy. J Obstet Gynecol Neonatal Nurs. 2002 Jan-Feb. 31(1):107-12. [Medline].
Keeler ML. Human parvovirus B-19: not just a pediatric problem. J Emerg Med. 1992 Jan-Feb. 10(1):39-44. [Medline].
Lamont RF, Sobel JD, Vaisbuch E, Kusanovic JP, Mazaki-Tovi S, Kim SK, et al. Parvovirus B19 infection in human pregnancy. BJOG. 2011 Jan. 118(2):175-86. [Medline]. [Full Text].
Aractingi S, Bakhos D, Flageul B, Vérola O, Brunet M, Dubertret L, et al. Immunohistochemical and virological study of skin in the papular- purpuric gloves and socks syndrome. Br J Dermatol. 1996 Oct. 135(4):599-602. [Medline].
Harms M, Feldmann R, Saurat JH. Papular-purpuric "gloves and socks" syndrome. J Am Acad Dermatol. 1990 Nov. 23(5 Pt 1):850-4. [Medline].
Hashimoto H, Yuno T. Parvovirus B19-associated purpuric-petechial eruption. J Clin Virol. 2011 Nov. 52(3):269-71. [Medline].
McNeely M, Friedman J, Pope E. Generalized petechial eruption induced by parvovirus B19 infection. J Am Acad Dermatol. 2005 May. 52(5 Suppl 1):S109-13. [Medline].
Colmegna I, Alberts-Grill N. Parvovirus B19: its role in chronic arthritis. Rheum Dis Clin North Am. 2009 Feb. 35(1):95-110. [Medline].
Magro CM, Wusirika R, Frambach GE, Nuovo GJ, Ferri C, Ross P. Autoimmune-like pulmonary disease in association with parvovirus B19: a clinical, morphologic, and molecular study of 12 cases. Appl Immunohistochem Mol Morphol. Jun. 14:208-16. [Medline].
Douvoyiannis M, Litman N, Goldman DL. Neurologic manifestations associated with parvovirus B19 infection. Clin Infect Dis. 2009 Jun 15. 48(12):1713-23. [Medline].
Furukawa M, Kaji K, Masuda H, Ozaki K, Asada S, Koizumi A, et al. Severe Aplastic Anemia following Parvovirus B19-Associated Acute Hepatitis. Case Reports Hepatol. 2017. 2017:1359486. [Medline].
Barah F, Vallely PJ, Cleator GM, Kerr JR. Neurologic manifestations of human parvovirus B19 infection. Rev Med Virol. 2003. 13:185-99. [Medline].
Hsu D, Sandborg C, Hahn JS. Frontal lobe seizures and uveitis associated with acute human parvovirus B19 infection. J Child Neurol. 2004. 19:304-6. [Medline].
Ogunsile FJ, Currie KL, Rodeghier M, Kassim A, DeBaun MR, Sharma D. History of parvovirus B19 infection is associated with silent cerebral infarcts. Pediatr Blood Cancer. 2018 Jan. 65 (1):[Medline].
Hara S, Hirata M, Ito K, Mizushima I, Fujii H, Yamada K, et al. Post-infectious acute glomerulonephritis with podocytopathy induced by parvovirus B19 infection. Pathol Int. 2018 Mar. 68 (3):190-195. [Medline].
Ugai S, Aizawa Y, Kanayama T, Saitoh A. Parvovirus B19: A Cause of Sepsislike Syndrome in an Infant. Pediatrics. 2018 Jun. 141 (6):[Medline].
Yoshii S, Uda K, Miyairi I, Nakao H, Kono N, Kubota M, et al. Multiple Bullae Associated with Human Parvovirus B19. J Pediatr. 2018 Nov. 202:327-327.e1. [Medline].
Takeda S, Takaeda C, Takazakura E, Haratake J. Renal involvement induced by human parvovirus B19 infection. Nephron. 2001 Nov. 89(3):280-5. [Medline].
Bodewes R, Kerkhof J, Cremer J, Gijselaar DB, Voordouw BCG, Veldhuijzen IK, et al. Oral fluid: Non-invasive alternative for parvovirus B19 diagnosis?. J Clin Virol. 2019 Aug. 117:5-10. [Medline].
Peter G. School policies for children with erythema infectiosum. Pediatr Infect Dis J. 1989. 8 (1):64.

Media Gallery

Classic slapped-cheek appearance of fifth disease.
Pathognomonic reticulated, lacy-appearing eruption of fifth disease.

of 2

Author

Glenn L Zellman, MD Consulting Staff, Department of Internal Medicine, University Hospital, Tamarac, Florida

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Megan Boysen, MD Resident Physician, Department of Emergency Medicine, University of California Irvine Medical Center

Megan Boysen, MD, is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine