By Ashli Collins, M.D.
My patients and parents often give me help in ideas for this column. This month, when I informed a dad that his child had Fifth Disease, he responded by saying, “Well, Doc, I don’t know…I’ll have to check with my wife to see if he’s had the first four yet.” Confusion over names of diseases is common but by adding a number, instead of a descriptive term (like hand, foot and mouth disease), makes it hard on both parents and medical students trying to learn all the different childhood illnesses!
Years ago, when diseases were being categorized and named, “first disease” was measles. Thankfully, with the help of vaccines, that is no longer a common illness we see. Second disease was scarlet fever or strep throat with a rash. Rubella, also vaccine preventable, was third disease, and fourth disease honors go to Staph aureus infections. Fifth disease has remained without a common name in our culture and mystifies parents with its name.
Fifth disease also goes by erythema infectiosum or slapped cheek disease. To our infectious disease physicians, it is parvovirus B19. I always thought that sounded like a parasite with a vitamin deficiency. With all this confusion and funny naming, a description of this common childhood illness follows.
Fifth’s is a viral illness that has infected around 50-60% of people by adulthood. In children, agesfour to tenare most affected. It can affect girls and boys equally and is most common in the winter and spring months.
Symptoms of fifth disease can range from mild to severe. Many adults who test positive as having the disease before do not recall ever having the illness. The most common symptoms are fevers and mild joint/muscle achiness followed by a slapped cheek appearing rash with a lacy rash on arms and legs. The rash itself may last five to seven days (on average), but it is not uncommon to see it last for a few weeks. While the child has the fever, it is often difficult to differentiate from many other viruses. It is the classic rash that makes the diagnosis.
Some children will have fairly severe myalgias and pain. Rarely, but occasionally, children will have lingering arthritis type pain for weeks to months. Knees, fingers and wrists are the most common joints to have arthritis, but interestingly, the arthritis is usually symmetric with both sides of the body affected.
While a child has the fever, they are generally considered contagious. However, once the fever dissipates and the rash occurs, they are no longer able to spread the disease. During the contagious period, the virus is spread via droplets. Sneezing, coughing, drooling and runny nose are all mechanisms to pass on the virus.
One major concern with this disease is for pregnant women. Pregnant women who have not had the disease should avoid people with fifth’s disease. Fifth disease virus can cause miscarriages in 2-10% of unprotected (not previously infected) moms. Protecting these moms from infected children is tricky in that the diagnosis is usually made at the time the rash appears, but during the rash phase, a patient is no longer contagious. If you are pregnant and find out a child you have had close contact with has fifth disease, you should contact your obstetrician.
Treatment for fifth disease is mostly supportive. Rest, acetaminophen and fluids are the mainstay. As with any virus, antibiotics will not be helpful. If there is significant joint pain/arthritis, anti-inflammatories, such as ibuprofen (Advil/Motrin) or naproxen (Aleve), may be helpful.
Dr. Collins is a pediatrician with Oldham County Pediatrics, PLLC. They have offices in LaGrange and in Louisville near the Summit. For more information, call 502-225-6277 or www.oldhamcountypeds.com.