Fifth disease

Erythema infectiosum
Other namesSlapped cheek syndrome, slapcheek, slap face, slapped face[1][2]
Fifth disease.jpg
16-month-old with erythema infectiosum
SpecialtyInfectious disease

Erythema infectiosum or fifth disease is one of several possible manifestations of infection by parvovirus B19.[3]

The name "fifth disease" comes from its place on the standard list of rash-causing childhood diseases, which also includes measles (first), scarlet fever (second), rubella (third), Dukes' disease (fourth, but is no longer widely accepted as distinct), and roseola (sixth).

Signs and symptoms

Fifth disease starts with a low-grade fever, headache, rash, and cold-like symptoms, such as a runny or stuffy nose. These symptoms pass, then a few days later, the rash appears. The bright red rash most commonly appears in the face, particularly the cheeks. This is a defining symptom of the infection in children (hence the name "slapped cheek disease"). Occasionally, the rash will extend over the bridge of the nose or around the mouth. In addition to red cheeks, children often develop a red, lacy rash on the rest of the body, with the upper arms, torso, and legs being the most common locations. The rash typically lasts a few days and may itch; some cases have been known to last for several weeks. Patients are usually no longer infectious once the rash has appeared.[1][2]

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.[1][2]

The disease is usually mild,[4] but in certain risk groups, it can have serious consequences: