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Erythema Infectiosum

3 min read

Erythema Infectiosum

Key Points

  • Erythema infectiosum (fifth disease) is caused by parvovirus B19, primarily affecting children ages 5 to 15 years.
  • Transmission occurs via respiratory droplets, blood exposure, or vertical (mother-to-fetus) transmission.
  • The hallmark “slapped cheek” rash indicates the client is no longer infectious.
  • Complications include severe anemia in clients with sickle cell disease and fetal hydrops in pregnant women less than 20 weeks’ gestation.

Pathophysiology

Parvovirus B19 is transmitted through inhalation of infected respiratory droplets, blood transfusion, or transplacental passage. Once in the body, the virus has affinity for immature red blood cells (erythroid progenitor cells), altering their production and causing transient aplastic crisis. In healthy children, this disruption is self-limited. In clients with chronic hemolytic anemias (sickle cell disease) or immunocompromised states, the effect on erythropoiesis can be profound and cause severe anemia.

Clinical Manifestations

  • Prodromal phase: Fever, malaise, muscle aches, GI upset, headache.
  • Rash phase 1: Bright red bilateral facial rash (“slapped cheek” appearance) — once this rash appears, the client is no longer infectious.
  • Rash phase 2: Maculopapular, lace-like rash on trunk and extremities (spares palms and soles); may be worsened by sun or heat exposure.
  • Joint symptoms: Arthralgia, more common in adults.

Nursing Assessment

  • Assess rash characteristics and distribution pattern.
  • Evaluate hydration status and comfort level.
  • Identify high-risk clients: pregnant women (less than 20 weeks’ gestation — risk of fetal demise), immunocompromised clients, and those with sickle cell disease or chronic hemolytic anemias.
  • Monitor hemoglobin and hematocrit in high-risk clients for signs of severe anemia.
  • Implement droplet precautions during the prodromal phase (client is infectious before the rash appears).

Nursing Interventions

  • Provide supportive care: acetaminophen or NSAIDs for fever, headache, and joint/muscle aches.
  • Maintain adequate hydration.
  • Monitor for complications in high-risk clients; blood transfusion may be required for severe anemia.
  • Educate families that the child is no longer contagious once the rash appears and can return to school.
  • Advise pregnant contacts to consult their provider for parvovirus B19 antibody testing.

Self-Check

  1. At what point in the disease course is a child with fifth disease no longer infectious?
  2. Why are clients with sickle cell disease at higher risk for complications from parvovirus B19?
  3. What is the significance of parvovirus B19 infection in a pregnant client before 20 weeks’ gestation?

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