Erythema infectiosum

Willan 1798, Sticker 1899, Cheinisse 1905.

Ringella, 5th infectious disease, megalerythem, megalerythema infectiosum, megalerythema epidemicum, Stickers disease, ringworm, slapface disease, slapped-cheek disease.

• Medium Contagious, viral, infectious disease of childhood caused by parvovirus B19.
• Historical note:
• Parvovirus B19 is the only parvovirus that can infect humans. It was discovered in 1975 by Yvonne Cossart and is named after the series of investigations (number 19 in series B).

• Seasonally clustered in the winter and spring months.
• Girls are more frequently affected than boys.
• Very common between 4 and 10 years of age.
• Infection rate: 5-10% in preschoolers, up to 70% in adults.
• 300-500 abortions per year are associated with parvovirus B19.
• Contagiousness exists before the appearance of an exanthema. Provided skin lesions are visible, infection is no longer possible.

• Transmission occurs through droplet infection, skin contact or infected blood products. The incubation period is between 4-14 days.
• The trigger is the single-stranded DNA virus parvovirus B19 (Parvoviridae), the smallest human pathogenic virus.

• Mainly asymptomatic.
• Sometimes subfebrile temperatures and symmetrical arthritides of the small joints.
• Locations affected: Cheeks, in the course extensor sides of the arms, legs and the buttocks.
• In up to 20%, exanthema occurs: butterfly-shaped exanthema on the face, in part also diffuse or figured erythema and swelling of the cheeks (slap face), 1-3 days later there is the appearance of garland-shaped or reticular, elevated erythema on the trunk as well as on the inner sides of the extremities.
• Characteristic is the recurrent flare-up and fading away, which can be induced by external factors (hot bath, sun, stress).
• The general condition is mostly good.
• In pregnant women, further serological examinations are indicated if parvovirus B19 infection is suspected. If the diagnosis is confirmed, weekly sonographic controls are essential.

• Clinical.
• BB (leukopenia, eosinophilia (relative)).
• Serological detection (IgM and IgG), DNA detection by PCR.
• VP2-specific IgM (positive 14d - 5 months after infection) and IgG (detectable 21d to lifelong).

Perifollicular infiltration, enlargement of connective tissue fibres.

• Aplastic anaemia (the target cells of parvovirus B19 include haematopoietic stem cells).
• Aplastic crises especially in patients with pre-existing haematological diseases.
• Hydrops fetalis (in pregnancy due to anaemia or myocarditis). The risk is greatest between the 4th and 5th month of pregnancy (up to 15% of fetuses die).
• Encephalitides/meningitides
• Myocarditides/pericarditides
• Necrotising vasculitides

• Mostly regression within 14 days.
• Ban from school for 10 days.
• Lifelong immunity.
• No vaccine is available.

1. Carlsen, K.M. and A. Hornsleth, [The fifth disease--erythema infectiosum. Parvovirus infection in a family group]. Ugeskr Laeger, 1990. 152(19): p. 1383-4.
2. Chorba, T., et al., The role of parvovirus B19 in aplastic crisis and erythema infectiosum (fifth disease). J Infect Dis, 1986. 154(3): p. 383-93.
3. Nunoue, T., et al., Human parvovirus (B19) and erythema infectiosum. J Pediatr, 1985. 107(1): p. 38-40.
4. Lefrere, J.J., et al., Aplastic crisis and erythema infectiosum (fifth disease) revealing a hereditary spherocytosis in a familial human parvovirus infection. Nouv Rev Fr Hematol, 1986. 28(1): p. 7-9.
5. Mankuta, D., B. Bar-Oz, and G. Koren, Erythema infectiosum (Fifth disease) and pregnancy. Can Fam Physician, 1999. 45: p. 603-5.
6. Schwarz, T.F., [Erythema infectiosum infection can cause intrauterine fetal death. Possibilities of diagnosis and treatment]. Fortschr Med, 1992. 110(15): p. 289.
7. Hornsleth, A. and K.M. Carlsen, [Parvovirus B19 infections. The cause of fifth disease-erythema infectiosum--can also cause aplastic crises, fetal damage and polyarthritis]. Ugeskr Laeger, 1990. 152(19): p. 1354-7.
8. Takahashi, T., et al., [Five cases of erythema infectiosum in adults]. Kansenshogaku Zasshi, 2001. 75(6): p. 469-72.