Internal Medicine

Erythema infectiosum


Erythema infectiosum or Fifth disease is a common exanthematous illness of childhood caused by parvovirus B19.


  • Transmission: Respiratory route
  • Incubation period: 4-28 days (average 16-17 days)


Parvovirus B19 (ssDNA virus)

The virus has tropism for cells of the erythroid lineage at the pronormoblast stage

Clinical features

Peak age: 5-15 yr

Prodrome (mild)

Child will be febrile, non-toxic with nonspecific prodrome
  • Low-grade fever
  • Headache
  • Mild upper respiratory tract infection

Characteristic rash

  • Appears as erythematous flushing on the face in a ‘slapped cheek‘ appearance
  • Papular purpuric ‘gloves and socks’ syndrome (PPGSS): Distinctive viral rash characterised by painful redness and swelling of the feet and hands
  • Spread: Face → Trunk and proximal extremities
  • Progression: Diffuse erythematous macular rash → Central clearing → Lacy or reticulated pattern → Fades (over 1-3 weeks)
A 16 month old child with Fifth Disease (aka Slapped face, Parvovirus B19). | Andrew Kerr – Public Domain,


  • Idiopathic thrombocytopenic purpura
  • Aseptic meningitis
  • Adolescents or adults: Arthralgia and arthropathy
  • Patients with chronic hemolytic anaemias, chronic anaemia, pancytopenia or
    marrow suppression: Transient aplastic crises
  • Immunocompromised individuals: Virus-associated hemophagocytic syndrome
  • Pregnant women: Hydrops fetalis
  • Healthy children or adults: (Rare) Myocarditis

Differential diagnosis:

The name “fifth disease” comes from its place on the standard list of rash-causing childhood diseases:
  1. Measles (first)
  2. Scarlet fever (second)
  3. Rubella (third)
  4. Dukes’ disease (fourth, but is no longer widely accepted as distinct)
  5. Erythema infectiosum (fifth)
  6. Roseola (sixth)
Classic Exanthems and Viral Rashes | Approach to the Pediatric Patient with a Rash | Clinical Gate. Retrieved February 05, 2021, from


  • Symptomatic management



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