Erythema infectiosum

Alternative Names : Fifth disease,slapped cheek syndrome, slapcheek, slap face or slapped face.

Definition:
Erythema infectiosum  is a peculiar disorder of the skin.  The condition commonly affects children and young adults.  Typically it appears as a red rash on the face that gives a slapped cheek appearance.  A few days later a fish net like pattern of redness may appear on the arms and trunk.

The incubation period is usually four to 20 days and the virus is spread mainly through droplets in the air. It can also be transmitted through blood transfusions and from mother to unborn child.

It is highly contagious to those who have not had a previous infection. Unfortunately Erythema infectiosum is contagious before the rash appears, not after.  There is no way to prevent exposure.   Because it is such a mild infection no special precautions need to be taken, and children do not need to be kept home from school as they are not contagious once the rash appears.

Any age may be affected although it is most common in children aged five to fifteen years. By the time adulthood is reached about half the population will have become immune following infection at some time in their past. Outbreaks can arise especially in nursery schools, preschools, and elementary schools.

Erythema Infectiosum can also cause serious illness in those with leukemia or cancer, in those who have received an organ transplant, and in those with human immunodeficiency virus (HIV). Fifth disease causes the majority of episodes of transient aplastic crisis (TAC) in persons with chronic hemolytic anemia. Occasionally, serious complications may develop from parvovirus B 19 infection during pregnancy.

Symptoms:
In many cases the early symptoms are so mild they go unnoticed, but they may include a runny nose, headache, mild fever, sore throat and lethargy.

Some children also experience nausea, abdominal pain, diarrhoea and painful joints.

After a few days, a bright red rash may appear on the cheeks, but not on the nose or around the eyes or mouth.

After two to four days the rash, which looks a little like sunburn, usually disappears but another, non-itchy rash may appear on the extremities, including the palms and soles. This fades over a couple of weeks but may recur if the skin is exposed to heat, such as when in the bath, or physical stimuli such as friction.

Teenagers and adults may present with a self-limited arthritis. It manifests in painful swelling of the joints that feels similar to arthritis. Older children and adults with Fifth Disease may have difficulty in walking and in bending joints such as wrists, knees, ankles, fingers, and shoulders.

The disease is usually mild, but in certain risk groups it can have serious consequences:-

*In pregnant women, infection in the first trimester has been linked to hydrops fetalis, causing spontaneous abortion.

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*In people with sickle-cell disease or other forms of chronic hemolytic anemia such as hereditary spherocytosis, infection can precipitate an aplastic crisis.

Transmission:
Erythema infectiosum  is transmitted primarily by respiratory secretions (saliva, mucus etc.) but can also be spread by contact with infected blood. The incubation period (the time between the initial infection and the onset of symptoms) is usually between 4 and 21 days. Individuals with fifth disease are most infectious before the onset of symptoms. Typically, school children, day-care workers, teachers and mothers are most likely to be exposed to the virus. When symptoms are evident, there is little risk of transmission; therefore, symptomatic individuals need not be isolated

Causes:
Erythema infectiosum is one of several possible manifestations of infection by erythrovirus previously called parvovirus B19.  The virus is a parvovirus, but not related to the parvovirus that pets may get.  You cannot get this parvovirus from an animal. This is a mild virus, and most people feel well when infected.  A few people may have minor itching, tiredness, a sore throat, or a slight fever. Outbreaks tend to occur in late winter or early spring, in cycles of every four to seven years.

Diagnosis:
The symptoms, especially the typical rash on the face, are a good guide to the diagnosis. Blood tests can be used to confirm it, but are rarely necessary.

Treatment:
It needs no specific treatment, but paracetamol or ibuprofen may be used for fever and discomfort.

It will gradually fade over about one month.  It commonly fades and reappears several times during the month.  Excessive exposure to sun, temperature changes and emotional upsets may stimulate a reappearance.

Most children suffer no long-term effects, but adults, pregnant women and children who are immunocompromised or have anaemia may develop more serious complications and should get medical advice.

Prevention:
*Follow standard precautions. Always wash your hands thoroughly before and after any contact with patients.

*Patients with TAC or chronic B 19 infection should be considered infectious and placed on isolation precautions in private rooms for the duration of their illness or until the infection has cleared. B 19-infected patients may share a room if there are no other contraindications. Persons in close contact with these individuals should wear masks, gowns if soiling is likely, and gloves.

*To avoid the risk of fetal loss and other complications of parvovirus infection, pregnant health care workers should consult their health care professional if there is an outbreak in the workplace.

*Because persons with fifth disease were already contagious before their rash appeared, it is not necessary to exclude them from work, school, or child care centers.

*Instruct patients with chronic hemolytic diseases to be aware of the risk of aplastic crisis if exposed to erythema infectiosum.

*Teach patients that frequent and proper hand washing helps reduce the risk of becoming infected with fifth disease.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.orlandoskindoc.com/erythema_infectiosum.htm
http://www.bbc.co.uk/health/physical_health/conditions/erythema2.shtml
http://www.health-care-tips.org/diseases/erythema-infectiosum.htm
http://en.wikipedia.org/wiki/Fifth_disease

http://www.aafp.org/afp/20000815/804.html

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