What causes erythema infectiosum (fifth disease)?

Updated: Mar 06, 2020
  • Author: Glenn L Zellman, MD; Chief Editor: Dirk M Elston, MD  more...
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Erythema infectiosum is caused by infection with PV-B19, a member of the Parvoviridae family that dates back 7000 years in human dental and skeletal genomic studies. [20]  PV-B19, the virus with the smallest DNA known to cause illness in humans, consists of a single-stranded DNA core surrounded by an unenveloped icosahedral capsid. PV-B19 requires mitotically active cells and a globoside cellular receptor for propagation, thus making erythroid cell lines a prime target. Erythroid cell line suppression usually lasts up to 2 weeks, although in some cases it is chronic, lasting months to years. [21]

The tropism for human erythroid progenitor cells and other rare sites of the globoside receptor (eg, endothelial cells, placental cells) is responsible for the more serious complications associated with the viral infection. [22, 23]

Transmission of human PV-B19 occurs through respiratory secretions, possibly through fomites, and parenterally via vertical transmission from mother to fetus and by transfusion of blood or blood products.

PV-B19 and HIV

In a Taiwanese study of the transmission of PV-B19 in men infected with HIV-1/AIDS, Lee et al found that HIV-1 ̶ seropositive men who were injection drug users (IDUs) were significantly more likely to be infected with PV-B19 than were seropositive men who had sex with men (MSM). Using serum samples from 553 male IDUs and 231 MSM, a portion of whom had HIV-1/AIDS, the investigators found PV-B19 infection in 35.4% of the HIV-1 ̶ positive members of the MSM group and in 78.8% of the HIV-1 ̶ positive members of the IDU group. [24]

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