Erythema infectiosum

Infectious diseases

Clinicals - History

Fact Explanation
Rash The rash is the most important clinical finding in erythema infectiosum. Initially rash appears on the face, cheeks are red in appearance, thus is known as the "slapped cheek" appearance. This is followed by a rash on the limbs and trunk. The rash usually has an appearance of a lace pattern on the trunk and limbs. This lace pattern is due to the erythematous macules and papules giving it a reticular appearance. Rash
The rash is the most important clinical finding in erythema infectiosum. Initially rash appears on the face, cheeks are red in appearance, thus is known as the "slapped cheek" appearance. This is followed by a rash on the limbs and trunk. The rash usually has an appearance of a lace pattern on the trunk and limbs. This lace pattern is due to the erythematous macules and papules giving it a reticular appearance.
Fever Erythema infectiosum is caused by parvovirus B19 infection. It is also known as the 'fifth disease'. Fever may be a presenting feature, but usually it is of a mild degree. Fever
Erythema infectiosum is caused by parvovirus B19 infection. It is also known as the 'fifth disease'. Fever may be a presenting feature, but usually it is of a mild degree.
Headache One of the presenting symptoms in the initial stage. Headache
One of the presenting symptoms in the initial stage.
Rhinnorhoea Erythema infectiosum is usually transmitted via droplet inhalation. This may be one of the presenting symptoms of erythema infectiosum. Rhinnorhoea
Erythema infectiosum is usually transmitted via droplet inhalation. This may be one of the presenting symptoms of erythema infectiosum.
Red eye These patients may have features of conjunctivitis and can present with red eye, itching, and lacrimation. Red eye
These patients may have features of conjunctivitis and can present with red eye, itching, and lacrimation.
If complicated with meningitis These patients can develop serous meningitis during the course of the disease. They can have fever, pain on retraction of the neck, and drowsiness. If complicated with meningitis
These patients can develop serous meningitis during the course of the disease. They can have fever, pain on retraction of the neck, and drowsiness.
If complicated with aplastic anaemia Aplastic anaemia is one of the major systemic involvement in erythema infectiosum, specially in patients with haematological disorders such as hereditary haemolytic anaemias . They can present with recurrent infections and bleeding manifestations due to low platelet and white cell count. If complicated with aplastic anaemia
Aplastic anaemia is one of the major systemic involvement in erythema infectiosum, specially in patients with haematological disorders such as hereditary haemolytic anaemias . They can present with recurrent infections and bleeding manifestations due to low platelet and white cell count.
If complicated with arthritis Sometimes patients can get arthropathies due to erythema infectiosum. It is shown that parvovirus infection trigger an arthropathy. They will have joint pain, swelling and stiffness involving the bilateral hands, feet and knee joints. It may progress to a state of chronic arthritis. If complicated with arthritis
Sometimes patients can get arthropathies due to erythema infectiosum. It is shown that parvovirus infection trigger an arthropathy. They will have joint pain, swelling and stiffness involving the bilateral hands, feet and knee joints. It may progress to a state of chronic arthritis.
If complicated with glomerulonephritis Glomerulonephritis is a rare complication of erythema infectiosum. They can present with haematuria, frothy urine and generalized body swelling. If complicated with glomerulonephritis
Glomerulonephritis is a rare complication of erythema infectiosum. They can present with haematuria, frothy urine and generalized body swelling.
High risk groups Patients with hematologic diseases, immunosuppression(organ transplant recipients, long-term steroid usage, acquired immunodeficiency syndrome etc.) and pregnant mothers are considered as high risk groups as they are vulnerable to get complications with erythema infectiosum. High risk groups
Patients with hematologic diseases, immunosuppression(organ transplant recipients, long-term steroid usage, acquired immunodeficiency syndrome etc.) and pregnant mothers are considered as high risk groups as they are vulnerable to get complications with erythema infectiosum.
Complications during pregnancy Pregnancy is a high risk condition, where they can develop hydrops fetalis and even intrauterine death due to transplacental transmission of infection. Complications during pregnancy
Pregnancy is a high risk condition, where they can develop hydrops fetalis and even intrauterine death due to transplacental transmission of infection.
Can be complicated by acute liver failure This is a rare complication of erythema infectiosum . If complicated with acute liver failure patients can present with yellowish discolouration of the eyes and right hypochondrial pain. Can be complicated by acute liver failure
This is a rare complication of erythema infectiosum . If complicated with acute liver failure patients can present with yellowish discolouration of the eyes and right hypochondrial pain.
Raynaud's phenomenon This is due to the endothelial damage which causes platelet activation and vasoconstriction. Studies have shown that this mechanism is immune-mediated. Raynaud's phenomenon
This is due to the endothelial damage which causes platelet activation and vasoconstriction. Studies have shown that this mechanism is immune-mediated.

Clinicals - Examination

Fact Explanation
Rash Dermatological findings of erythema infectiosum are the "slapped cheek" appearance on the patient's cheeks, reticular lace like appearance on trunk and limbs, a papular "gloves and-sock" appearance, maculopapular rash, petechiae and purpura. Sometimes there can be associated erythema multiforme or erythema nodosum. Rash
Dermatological findings of erythema infectiosum are the "slapped cheek" appearance on the patient's cheeks, reticular lace like appearance on trunk and limbs, a papular "gloves and-sock" appearance, maculopapular rash, petechiae and purpura. Sometimes there can be associated erythema multiforme or erythema nodosum.
Febrile Temperature may be mildly elevated. Febrile
Temperature may be mildly elevated.
Oral lesions Petechiae, vesicles, pustules and small erosions can be seen in the oral cavity in patients with parvovirus B19 infection. Oral lesions
Petechiae, vesicles, pustules and small erosions can be seen in the oral cavity in patients with parvovirus B19 infection.
Pallor Due to the aplastic anaemia. Pallor
Due to the aplastic anaemia.
Features of meningitis/encepahlitis If complicated with meningitis /encephalitis , patient's can have neck stiffness, positive Brudzinski and Kernig sign and an altered mental state. Features of meningitis/encepahlitis
If complicated with meningitis /encephalitis , patient's can have neck stiffness, positive Brudzinski and Kernig sign and an altered mental state.
Joint swelling Arthropathy due to parvovirus B19 infection. Joint swelling
Arthropathy due to parvovirus B19 infection.
Symphysio-fundal height more than period of gestationn This is a clinical finding of hydrops fetalis occurring as a complication of erythema infectiosum in the pregnant population. Symphysio-fundal height more than period of gestationn
This is a clinical finding of hydrops fetalis occurring as a complication of erythema infectiosum in the pregnant population.

Investigations - Diagnosis

Fact Explanation
IgM and IgG antibodies IgM and IgG antibodies to the parvovirus B19 antigen are detected in the serum of patients having erythema infectiosum . IgM and IgG antibodies
IgM and IgG antibodies to the parvovirus B19 antigen are detected in the serum of patients having erythema infectiosum .
Anti Nuclear Antibodies (ANA), Rheumatoid Factor (RF) and Compliment levels Done especially if the patient is having features of arthritis to exclude the possibility of Systemic Lupus Erythematosus or Rheumatoid Arthritis. Anti Nuclear Antibodies (ANA), Rheumatoid Factor (RF) and Compliment levels
Done especially if the patient is having features of arthritis to exclude the possibility of Systemic Lupus Erythematosus or Rheumatoid Arthritis.
Full blood count It is important to exclude the possibility of other infections as the patient presents with fever. eg:- bacterial infections causing leucocytosis ,viral infections causing lymphocytosis (elevated lymphocytes) and low platelets in Dengue and other viral infections. Full blood count
It is important to exclude the possibility of other infections as the patient presents with fever. eg:- bacterial infections causing leucocytosis ,viral infections causing lymphocytosis (elevated lymphocytes) and low platelets in Dengue and other viral infections.

Investigations - Management

Fact Explanation
Parvovirus DNA levels Viral DNA level is checked to assess response to the intravenous immunoglobulin, this level is gradually decreases as the condition improves. Parvovirus DNA levels
Viral DNA level is checked to assess response to the intravenous immunoglobulin, this level is gradually decreases as the condition improves.
Full blood count As the patients with haematological disorders and immunosuppressive state are vulnerable to aplastic anaemia, their white cell count, red cell count and platelets should be checked for evidence of bone-marrow suppression. Full blood count
As the patients with haematological disorders and immunosuppressive state are vulnerable to aplastic anaemia, their white cell count, red cell count and platelets should be checked for evidence of bone-marrow suppression.
Reticulocyte count A low reticulocyte count is indicative of aplastic anemia. Reticulocyte count
A low reticulocyte count is indicative of aplastic anemia.
IgM antibodies Detection of IgM antibodies in pregnant mothers is important , as positive mothers can be referred to an ultrasound scan to detect the development of complications such as hydrops fetalis. IgM antibodies
Detection of IgM antibodies in pregnant mothers is important , as positive mothers can be referred to an ultrasound scan to detect the development of complications such as hydrops fetalis.
Ultrasound scan Ultrasound examination of high risk pregnancies is important in detecting hydrops fetalis. Ultrasound scan
Ultrasound examination of high risk pregnancies is important in detecting hydrops fetalis.
Cerebro Spinal Fluid examination This is done if there is suspicion of meningitis during the course of erythema infectiosum. There will be an elevation of the number of lymphocytes and mild elevation of level of proteins. Cerebro Spinal Fluid examination
This is done if there is suspicion of meningitis during the course of erythema infectiosum. There will be an elevation of the number of lymphocytes and mild elevation of level of proteins.

Management - Supportive

Fact Explanation
Isolation Children can attend school, there is no need for quarantine. Because at the time of the rash, they are no longer contagious. Isolation
Children can attend school, there is no need for quarantine. Because at the time of the rash, they are no longer contagious.
Attention to high risk groups Patients with hematologic diseases, immunosuppression(organ transplant recipients, long-term steroid usage, acquired immunodeficiency syndrome etc.) and pregnant mothers are considered as high risk groups as they are vulnerable to get complications with erythema infectiosum. Attention to high risk groups
Patients with hematologic diseases, immunosuppression(organ transplant recipients, long-term steroid usage, acquired immunodeficiency syndrome etc.) and pregnant mothers are considered as high risk groups as they are vulnerable to get complications with erythema infectiosum.
Symptomatic management Patient may be having disabling symptoms such as fever, joint pain, swelling, and itching. Symptomatic treatment is indicated in such situations. This is usually with antipyretics, analgesics, decongestants that should be used where relevant. Symptomatic management
Patient may be having disabling symptoms such as fever, joint pain, swelling, and itching. Symptomatic treatment is indicated in such situations. This is usually with antipyretics, analgesics, decongestants that should be used where relevant.
Blood products transfusion Patients with aplastic crisis may need red blood cell and platelet transfusions. Blood products transfusion
Patients with aplastic crisis may need red blood cell and platelet transfusions.

Management - Specific

Fact Explanation
Self limiting Usually erythema infectiosum is a self limiting disease and requires no specific treatment. Self limiting
Usually erythema infectiosum is a self limiting disease and requires no specific treatment.
Intravenous Immunoglobulin IV Ig G is given in some situations. It also has an anti-inflammatory property, which is particularly important in the treatment of associated arthritis. Intravenous Immunoglobulin
IV Ig G is given in some situations. It also has an anti-inflammatory property, which is particularly important in the treatment of associated arthritis.

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