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Slapped Cheek Disease / Parvovirus Infection

Definition :
Doctors today refer to it as parvovirus infection or erythema infectiosum. Some people may call it slapped-cheek disease because of the face rash that develops resembling slap marks. Parvovirus infection is also commonly called fifth disease because it was fifth of a group of once-common childhood diseases that all have similar rashes. The other four diseases are measles, rubella, scarlet fever and Dukes' disease.

Whatever the name, parvovirus infection is still a common but mild infection in children that generally requires little treatment. However, parvovirus infection in some pregnant women can lead to serious health problems for the fetus. Parvovirus infection is also more serious for adults with some kinds of anemia or who have a compromised immune system.

The human parvovirus B19 causes parvovirus infection. This isn't the same as the parvovirus seen in dogs and cats, so you can't get the infection from a pet or vice versa. Parvovirus B19 is most common among elementary school-age children during outbreaks in the winter and spring months, but anyone can become ill with it any time of the year. It spreads from person to person, just like a cold, often through respiratory secretions and hand-to-hand contact. The illness is contagious in the week before the rash appears. Once the rash appears, the person with the illness is no longer considered contagious and doesn't need to be isolated.

When to seek medical advice :
If your child develops what appear to be signs and symptoms of parvovirus infection, but you're not sure, contact your doctor to see if there may be some other cause for the signs and symptoms. Also contact your doctor if your child has a temperature greater than 102 F or if you have other concerns.

If you have sickle cell disease or a similar type of chronic anemia, parvovirus infection can lead to severe anemia. See your doctor for treatment. Once the infection is under control, the anemia will get better.

If you're pregnant and you suspect you've been exposed to parvovirus, see your doctor. A pregnant woman with parvovirus infection may pass the illness along to her baby. Although the great majority of pregnant women who have parvovirus infection will deliver normal, healthy children, there's a small risk to the unborn baby of severe and even life-threatening health conditions.

Also, see your doctor for help with treatment if you have a weakened immune system, perhaps because of another preexisting disease, cancer treatment or an organ transplant.

Symptoms :
Most children with parvovirus infection feel well. Some develop mild, cold-like signs and symptoms early in the illness :

  • Sore throat
  • Slight fever
  • Upset stomach
  • Headache
  • Fatigue
  • Itching

Several days later, a distinctive bright red facial rash usually appears on both cheeks. Eventually it may extend to the arms, trunk, thighs and buttocks where the rash has a pink, lacy, slightly raised appearance.

Generally the rash occurs near the end of the illness. It's possible to mistake the rash for other viral rashes or a medicine-related rash. Infants and toddlers develop the same signs and symptoms that school-age children do.

The initial symptoms typically last five to 10 days. The rash may come and go for up to three weeks, becoming more visible when a child is exposed to extreme temperatures or spends time in the sun.

In adults, the most prominent symptom of parvovirus infection is joint soreness (arthralgia), lasting days to weeks. Joints most commonly affected are the hands, wrists, knees and ankles.

Parvovirus infection can also occur without any signs or symptoms in either children or adults.

If a rash is present, your doctor may be able to make a diagnosis by examination. About half of adults are immune to parvovirus infection, most likely because of a previous, unnoticed, childhood infection. If you're pregnant or if you're an adult with a compromised immune system, blood tests can help determine if you're immune to the infection or if you've recently become infected. The blood tests commonly used are tests for antibodies that are specific for parvovirus infection. Subsequent action depends on test results.

  • If the blood tests indicate immunity, you don't need to be concerned. You can't be reinfected:
  • If the tests confirm evidence of recent parvovirus infection, you may need additional testing to determine what, if any, complications — such as anemia — need treatment.
  • If you're pregnant and you have parvovirus infection, your doctor may perform additional tests such as ultrasound and possibly additional blood tests to watch for potential fetal complications.

Complications :
If you're pregnant and you become infected with parvovirus B19, particularly in the first half of your pregnancy, there's a chance your fetus may develop serious complications, such as severe anemia. But this occurs in only a small percentage of infected pregnant women.

Fetal anemia can cause congestive heart failure in your baby, manifested by a severe form of edema — swelling of body tissues due to excessive fluid — called fetal hydrops, which may lead to miscarriage. If you have parvovirus infection, your doctor may monitor your pregnancy with ultrasound examinations for the possible development of fetal complications.

The fetal anemia, congestive heart failure and edema can improve over several weeks. Your doctor may suggest steps to try to correct the anemia, congestive heart failure or edema. Possible approaches include a blood transfusion directly to your fetus or giving you medications that pass through your placenta to your fetus.

Most pregnant women with parvovirus infection have normal, healthy babies. Parvovirus infection doesn't increase the risk of birth defects or mental retardation.

Other complications in adults include the following :

  • In people with sickle cell anemia (or other types of anemia in which red blood cells are used up faster than your bone marrow can replace them), parvovirus infection can lead to severe anemia.
  • In people with weakened immune systems (particularly people who've undergone chemotherapy), signs and symptoms of the infection can be severe, requiring medical care.

For a noncomplicated parvovirus infection, self-care treatment at home is generally sufficient. The rash itself doesn't need treatment.

People with severe anemia may need to be hospitalized and receive blood transfusions. Those with weakened immune systems may receive antibodies (immune globulin) to treat the infection.

If you're pregnant and develop parvovirus infection, your doctor may wish to monitor possible effects on your baby. Treatments may include blood transfusions and medications if your baby has anemia, congestive heart failure or edema.

There's no vaccine to prevent parvovirus infection. Washing your hands and your child's hands frequently may help diminish the chances of getting an infection. Throw away used tissues immediately after use — wash your hands after handling them.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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