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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


  • 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).

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