Fifth's Disease

Dear Lisa,

My son was diagnosed with Fifth’s disease. My doctor says I don’t have to worry about it, but the word disease sounds so serious. He has a rash on his body that was going away and now it is coming back again. I don’t think that they will allow him to go to camp. How long should the rash take to go away?

“What is Fifth’s disease?”

Dear “What is Fifth’s disease?”,

Fifth disease or Erythema infectiosum is typically a benign self limited illness that minimally affects children who have a normal immune system. It is called Fifth disease because it was the fifth disease named that looked like the Measles but wasn’t Measles. The symptoms of Fifth disease include a very short period of virus like symptoms which can include a sore throat, low fever, tiredness and headache. Usually these symptoms are so mild that they go unnoticed.

Following this, a child with Fifth disease will feel and appear fine for 1 to 7 days. At this point a “slapped cheeked” appearing rash will appear on the cheeks of the child’s face. Next a rash quickly spreads to the arms, legs, trunk and buttocks. This rash which spreads to the arms, legs and torso looks like a diffuse, pink, flat, lacey appearing rash. Usually it is not itchy but can be itchy in only 15 % of the patients. (1) The rash on the face usually goes away in about a day but the rash on the body typically persists for three weeks.

At times the body rash may seem to lessen and almost disappear and then reappear again in response to certain situations or triggers. These triggers include hot baths, exercise, emotional stress and sunlight. In most cases this waxing and waning of the rash could go on for a few weeks, but may occur for months. (2)

The good thing about Fifth’s disease is that once the rash develops, it is no longer contagious. Transmission of Fifth’s disease occurs the week before the onset of symptoms. Therefore since your child has the rash, he is no longer contagious and should not be prevented from attending camp. Fifth disease is spread by respiratory droplets; when a child sneezes, coughs or shares food or drinks with another child. It also can spread from a pregnant mother to her unborn child. This is a major concern because the unborn child can develop complications such as anemia, hydrops fetalis and spontaneous abortion.

Complications from Fifth’s disease are rare and include arthritis and aplastic crisis. Arthritis symptoms usually occur in older adolescents and adults. Only 8% to 10% of children affected will develop arthritis symptoms. (3) The type of arthritis that develops as a result to Fifth’s disease does not cause destruction of the affected joints and usually resolves in a few weeks. (4)

Aplastic crisis is the inability to make red blood cells which leads to severe anemia. Children with a history of diseases that cause anemia such as sickle cell anemia, spherocytosis, thalassemia, glucose-6-phosphate dehydrogenase deficiency, pyruvate kinase deficiency, chronic hemolytic anemia, iron deficiency anemia, or autoimmune hemolytic anemia are at risk for developing this complication.

References:
(1)Adler, S., Koch, W. Parvovirus infections. I: Gershon AS, Hotez PJ, Katz LS, eds. Krugman’s Infectious Diseases of Children. 11th ed. Philadelphia: Mosby;2004:429-441.
(2) Leah C., Jenson, J. Erythema infectiosum (fifth disease). In: Jenson HB, Baltimore RS, eds. Pediatric Infectious Diseases. Principles and Practice. Philadelphia: WB Saunders Company; 2002:325-330.
(3)Mancini A. Erythema infectiosum (fifth disease). In: Schachner LA, Hansen RC, eds. Pediatric Dermatology. 3rd ed. New York: Mosby;2003:1064-1066.
(4) Young N., Brown K. Parvovirus B19. N Engl J Med. 2004;350:586-597.

Lisa Kelly R.N., P.N.P., C.
Certified Pediatric Nurse Practitioner

Pediatric Advice for Parents with Sick Kids