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Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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:


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