Skip to Main Content

Erythroparvovirus (Parvovirus B19)

For further information, see CMDT Part 32-08: Other Exanthematous Viral Infections

Key Features

  • Widespread infection (by age 15 years, approximately 50% of children have detectable IgG)

  • Causes several syndromes

Clinical Findings

  • In children, an exanthematous illness ("fifth disease," erythema infectiosum) is characterized by

    • Fiery red "slapped cheek" appearance

    • Circumoral pallor

    • Subsequent lacy, maculopapular, evanescent rash on the trunk and limbs

    • Malaise, headache, and pruritus (especially in palms and soles) but little fever

  • Eosinophilic cellulitis (Well syndrome) is also reported with parvovirus

  • Parvovirus is one of the most common causes of myocarditis in childhood

  • A transient aplastic crisis and pure red blood cell aplasia may occur

  • Middle-aged persons (especially women): a limited symmetric polyarthritis that mimics systemic lupus erythematosus and rheumatoid arthritis that may in some cases be a type II mixed cryoglobulinemia develops

  • Symptoms of parvovirus B19 infection can mimic those of autoimmune states, such as lupus, systemic sclerosis, antiphospholipid syndrome, or vasculitis

  • Arthralgias are uncommon in children

  • Rashes, especially facial, are uncommon in adults

  • In pregnancy, premature labor, hydrops fetalis, fetal anemia, and fetal loss are reported sequelae

Diagnosis

  • Clinical diagnosis (Table 32–2) may be confirmed by an elevated titer of IgM anti- parvovirus B19 antibodies in serum or with polymerase chain reaction (PCR) on serum or bone marrow samples

  • In immunocompromised persons, reverse transcriptase PCR (RT-PCR) is the optimal test

Table 32–2.Diagnostic features of some acute exanthems (listed in alphabetical order).
View Table||Download (.pdf)
Table 32–2. Diagnostic features of some acute exanthems (listed in alphabetical order).
Disease Prodromal Signs and Symptoms Nature of Eruption Other Diagnostic Features Laboratory Tests
Atypical measles Same as measles. Maculopapular centripetal rash, becoming confluent. History of measles vaccination. Measles antibody present in past, with titer rise during illness.
Chikungunya fever 2–4 (sometimes 1–12) days, fever, headaches, abdominal complaints, myalgias, arthralgias. Maculopapular, centrally distributed, pruritus, can be bullous with sloughing in children, occasional facial edema and petechiae. History of mosquito bites, epidemiologic factors. ELISA-based IgM or IgG (fourfold increase in titers); PCR and cultures are infrequently available.
Eczema herpeticum None. Vesiculopustular lesions in area of eczema.   HSV isolated in cell culture. Multinucleated giant cells in smear of lesion.
Ehrlichiosis Headache, malaise. Rash in one-third, similar to Rocky Mountain spotted fever. Pancytopenia, elevated liver biochemical tests. PCR, immunofluorescent antibody.
Enterovirus infections 1–2 days of fever, malaise. Maculopapular rash resembling rubella, rarely papulovesicular or petechial. Aseptic meningitis. Virus isolation from stool or CSF; complement fixation titer rise.
Erythema infectiosum (erythroparvovirus) None. Usually in epidemics. Red, flushed cheeks; circumoral pallor; maculopapules on extremities. “Slapped face” appearance. White blood cell count normal.
Exanthema subitum (HHV-6, 7; roseola) 3–4 days of high fever. As fever falls, pink maculopapules appear on chest and trunk; fade in 1–3 days.   White blood cell count low.
Infectious mononucleosis (EBV) Fever, adenopathy, sore ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close