Fifth disease
Encyclopedia
Erythema infectiosum or fifth disease is one of several possible manifestations of infection by erythrovirus
, previously called parvovirus B19
. The disease is also referred to as slapped cheek syndrome, slapcheek, slap face or slapped face. In Japan
the disease is called 'apple
sickness' or 'ringo-byou' (りんご病）in reference to the symptom of facial redness. In Hungary it is called "butterfly pox" as the red cheeks look like the wings of a butterfly
.
s are a defining symptom of the infection in children (hence the name "slapped cheek disease"). Occasionally the rash
will extend over the bridge of the nose or around the mouth. In addition to red cheeks, children often develop a red, lacy rash on the rest of the body, with the upper arms and legs being the most common locations. The rash typically lasts a couple of days and may itch; some cases have been known to last for several weeks. Patients are usually no longer infectious once the rash has appeared.
Teenagers and adults may present with a self-limited arthritis
. It manifests in painful swelling
of the joint
s that feels similar to arthritis. Older children and adults with fifth disease may have difficulty in walking and in bending joints such as wrists, knees, ankles, fingers, and shoulders.
The disease
is usually mild, but in certain risk groups it can have serious consequences:
, mucus
, etc.) but can also be spread by contact with infected blood
. The incubation period (the time between the initial infection and the onset of symptoms) is usually between 4 and 21 days. Individuals with fifth disease are most infectious before the onset of symptoms. Typically, school children, day-care workers, teachers and mothers are most likely to be exposed to the virus. When symptoms are evident, there is little risk of transmission; therefore, symptomatic individuals need not be isolated.
s. Their classification is as follows:
It was first described by Robert Willan
in 1799 as "Rubeola, sine catarrho". It was better defined by Anton Tschamer in 1889 as a rubella
variant ("Ortliche Rotheln"), identified as a distinct condition in 1896 by T. Escherich, and given the name "erythema infectiosum" in 1899.
Erythrovirus
Erythrovirus is a genus of viruses in the family Parvoviridae.The type species is parvovirus B19.-Virology:Erythroviruses are small , non-enveloped icosahedral viruses...
, previously called parvovirus B19
Parvovirus B19
The B19 virus, generally referred to as parvovirus B19 or sometimes erythrovirus B19, was the first known human virus in the family of parvoviruses, genus erythrovirus...
. The disease is also referred to as slapped cheek syndrome, slapcheek, slap face or slapped face. In Japan
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
the disease is called 'apple
Apple
The apple is the pomaceous fruit of the apple tree, species Malus domestica in the rose family . It is one of the most widely cultivated tree fruits, and the most widely known of the many members of genus Malus that are used by humans. Apple grow on small, deciduous trees that blossom in the spring...
sickness' or 'ringo-byou' (りんご病）in reference to the symptom of facial redness. In Hungary it is called "butterfly pox" as the red cheeks look like the wings of a butterfly
Butterfly
A butterfly is a mainly day-flying insect of the order Lepidoptera, which includes the butterflies and moths. Like other holometabolous insects, the butterfly's life cycle consists of four parts: egg, larva, pupa and adult. Most species are diurnal. Butterflies have large, often brightly coloured...
.
Symptoms
Bright red cheekCheek
Cheeks constitute the area of the face below the eyes and between the nose and the left or right ear. They may also be referred to as jowls. "Buccal" means relating to the cheek. In humans, the region is innervated by the buccal nerve...
s are a defining symptom of the infection in children (hence the name "slapped cheek disease"). Occasionally the rash
Rash
A rash is a change of the skin which affects its color, appearance or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked or blistered, swell and may be painful. The causes, and...
will extend over the bridge of the nose or around the mouth. In addition to red cheeks, children often develop a red, lacy rash on the rest of the body, with the upper arms and legs being the most common locations. The rash typically lasts a couple of days and may itch; some cases have been known to last for several weeks. Patients are usually no longer infectious once the rash has appeared.
Teenagers and adults may present with a self-limited arthritis
Arthritis
Arthritis is a form of joint disorder that involves inflammation of one or more joints....
. It manifests in painful swelling
Swelling (medical)
In medical parlance, swelling is the transient enlargement or protuberance in the body and may include tumors. According to cause, it may be congenital, traumatic, inflammatory, neoplastic or miscellaneous....
of the joint
Joint
A joint is the location at which two or more bones make contact. They are constructed to allow movement and provide mechanical support, and are classified structurally and functionally.-Classification:...
s that feels similar to arthritis. Older children and adults with fifth disease may have difficulty in walking and in bending joints such as wrists, knees, ankles, fingers, and shoulders.
The disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
is usually mild, but in certain risk groups it can have serious consequences:
- In pregnant women, infection in the first trimester has been linked to hydrops fetalisHydrops fetalisHydrops fetalis is a condition in the fetus characterized by an accumulation of fluid, or edema, in at least two fetal compartments. By comparison, hydrops allantois or hydrops amnion are an accumulation of excessive fluid in the allantoic or amniotic space respectively.-Presentation:Locations can...
, causing spontaneous miscarriageMiscarriageMiscarriage or spontaneous abortion is the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving independently, generally defined in humans at prior to 20 weeks of gestation...
. - In people with sickle-cell diseaseSickle-cell diseaseSickle-cell disease , or sickle-cell anaemia or drepanocytosis, is an autosomal recessive genetic blood disorder with overdominance, characterized by red blood cells that assume an abnormal, rigid, sickle shape. Sickling decreases the cells' flexibility and results in a risk of various...
or other forms of chronic hemolytic anemiaHemolytic anemiaHemolytic anemia is a form of anemia due to hemolysis, the abnormal breakdown of red blood cells , either in the blood vessels or elsewhere in the human body . It has numerous possible causes, ranging from relatively harmless to life-threatening...
such as hereditary spherocytosisHereditary spherocytosisHereditary spherocytosis is a genetically-transmitted form of spherocytosis, an auto-hemolytic anemia characterized by the production of red blood cells that are sphere-shaped rather than bi-concave disk shaped , and therefore more prone to hemolysis.-Symptoms:As in non-hereditary spherocytosis,...
, infection can precipitate an aplastic crisisReticulocytopeniaReticulocytopenia, or "aplastic crisis", is the medical term for an abnormal decrease of reticulocytes in the body. Reticulocytopenia can originate from congenital hemolytic anemia, especially when exacerbated by Parvovirus B19 infection...
. - It should also be noted that those who are immuno-compromised (HIV/AIDS, ChemotherapyChemotherapyChemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
) may be at risk for complications if exposed.
Transmission
Fifth disease is transmitted primarily by respiratory secretions (salivaSaliva
Saliva , referred to in various contexts as spit, spittle, drivel, drool, or slobber, is the watery substance produced in the mouths of humans and most other animals. Saliva is a component of oral fluid. In mammals, saliva is produced in and secreted from the three pairs of major salivary glands,...
, mucus
Mucus
In vertebrates, mucus is a slippery secretion produced by, and covering, mucous membranes. Mucous fluid is typically produced from mucous cells found in mucous glands. Mucous cells secrete products that are rich in glycoproteins and water. Mucous fluid may also originate from mixed glands, which...
, etc.) but can also be spread by contact with infected blood
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
. The incubation period (the time between the initial infection and the onset of symptoms) is usually between 4 and 21 days. Individuals with fifth disease are most infectious before the onset of symptoms. Typically, school children, day-care workers, teachers and mothers are most likely to be exposed to the virus. When symptoms are evident, there is little risk of transmission; therefore, symptomatic individuals need not be isolated.
Epidemiology
Any age may be affected although it is most common in children aged five to fifteen years. By the time adulthood is reached about half the population will have become immune following infection at some time in their past. Outbreaks can arise especially in nursery schools, preschools, and elementary schools.History
The name "fifth disease" is not typically capitalized, since the name derives from its historical classification as the fifth of the classical childhood skin rashes or exanthemExanthem
An exanthem is a widespread rash usually occurring in children. Exanthems can be caused by toxins or drugs, microorganisms, or can result from autoimmune disease.It can be contrasted with an enanthem.-Types:...
s. Their classification is as follows:
- MeaslesMeaslesMeasles, also known as rubeola or morbilli, is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses...
- Scarlet feverScarlet feverScarlet fever is a disease caused by exotoxin released by Streptococcus pyogenes. Once a major cause of death, it is now effectively treated with antibiotics...
- RubellaRubellaRubella, commonly known as German measles, is a disease caused by the rubella virus. The name "rubella" is derived from the Latin, meaning little red. Rubella is also known as German measles because the disease was first described by German physicians in the mid-eighteenth century. This disease is...
- Duke's diseaseDuke's diseaseDukes' disease or fourth disease is an exanthem.It is named for Clement Dukes.Some of these eruptions are characteristic of the causative virus, but in most cases one must be satisfied with the diagnosis of viral rash....
- Fifth disease (erythema infectiosum)
- RoseolaRoseolaExanthema subitum , also referred to as roseola infantum , sixth disease and baby measles, or three-day fever, is a disease of children, generally under two years old, although it has been known to occur in eighteen year olds, whose manifestations...
It was first described by Robert Willan
Robert Willan
Robert Willan was an English physician and the founder of dermatology as a medical specialty. He received his MD at Edinburgh in 1780 and was elected a Fellow of the Royal Society in 1809...
in 1799 as "Rubeola, sine catarrho". It was better defined by Anton Tschamer in 1889 as a rubella
Rubella
Rubella, commonly known as German measles, is a disease caused by the rubella virus. The name "rubella" is derived from the Latin, meaning little red. Rubella is also known as German measles because the disease was first described by German physicians in the mid-eighteenth century. This disease is...
variant ("Ortliche Rotheln"), identified as a distinct condition in 1896 by T. Escherich, and given the name "erythema infectiosum" in 1899.
External links
- Parvovirus B19 at the Centers for Disease Control and PreventionCenters for Disease Control and PreventionThe Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...