Fifth Disease

This viral disease primarily affects children but can also affect adults.

Fifth disease, also called Erythema infectiosum, is a mild viral illness that most commonly affects children. It is called fifth disease because it is the fifth of the five viral rash diseases of childhood (the other four being measles, rubella, chicken pox and roseola). Adults can also become infected with the virus and develop fifth disease. Adults tend to have a more severe flu-like illness but seldom develop the rash. Adults, especially women, with the disease are much more likely than children to develop joint symptoms. 


Fifth disease is caused by human parvovirus B19. It often affects preschoolers or school-age children during the spring. The disease spreads through the fluids in the nose and mouth when someone coughs or sneezes. About 20 percent of people who get the virus don't have symptoms, but they can still pass the virus along to others. 


Four to 14 days after being infected with human parvovirus B19, a child may develop cold or flu-like symptoms, such as low-grade fever, fatigue and an overall feeling of ill health. After a few days, the child may develop a rash on his face that looks as though his cheeks have been slapped (a “slapped-cheek” rash) as well as a lacy red rash on the torso and limbs. The rash may be itchy, but not in all cases. The rash will get better in seven to 10 days. About 10 percent of children with fifth disease will also have joint pain and possibly joint swelling. 

Adults who are infected will usually have more severe flu-like symptoms but may not develop the characteristic “slapped-cheek” rash. However, as many as 78 percent of adults who experience symptoms will develop joint pain and swelling one to three weeks following the initial infection. Joints of the hands, wrists and knees are most commonly affected in a symmetric pattern. Joint symptoms usually resolve in a week or two, but approximately 10 percent of adults with joint symptoms will have prolonged difficulties. Chronic joint pain has been known to last up to nine years. 


A physician usually can diagnose fifth disease by seeing the typical rash during an examination. If joint symptoms have outlasted the rash, or if the rash never developed, a blood test can detect antibodies to the virus. However, a specific diagnosis with the blood test is possible only for a short time because the level of antibodies to a recent infection is elevated for only two months after the infection. After that it is only possible to tell whether the person has ever had parvovirus B19 in their lifetime. 


The fever and joint pain of fifth disease in children may not need treatment or can be alleviated with acetaminophen or ibuprofen. Adults with joint pain and swelling may need to rest, alter their activities and take nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen sodium. In rare cases of prolonged arthritis symptoms, other slow-acting medications may be added. Occasionally, people with chronic parvovirus arthritis can benefit from drugs like hydroxychloroquine, but it is rarely necessary. 

Self Care

Fifth disease is usually mild and will go away on its own. Children and adults who are otherwise healthy usually recover completely. Having a healthy, balanced diet, drinking an adequate amount of fluids and getting rest will help you successfully manage this disease.  

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