Erythema infectiosum (mega erythema epidemic); epidemic in western Germany.
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Erythema↗
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Erythema infectiosum.
BACKGROUND: Erythema infectiosum (fifth disease) is a common benign pediatric condition caused by B19 parvovirus. It can be identified clinically by a "slapped cheek" appearance that is often followed by reticulated exanthem on the trunk and extremities. OBJECTIVE: This review article provides a concise overview of erythema infectiosum. METHODS: The article is divided into the followings sections: background, epidemiologic characteristics, clinical description, diagnosis, differential diagnosis, laboratory diagnosis, prognosis, and management. RESULTS: Erythema infectiosum is found to cause a fairly prominent classic rash and generalized symptoms. CONCLUSION: Although erythema infectiosum has many distinctive symptoms, the prognosis is excellent because the condition in children is usually self-limited.
Child↗
Human parvovirus (B19) and erythema infectiosum.
An outbreak of erythema infectiosum ("fifth disease") was studied in Fukuoka, Japan, in 1980-1981. Human parvovirus (HPV) antigen was not detected in any patients, but anti-HPV, measured by countercurrent immunoelectrophoresis, was found in 33 of 34 affected children and in 21 (15%) of 141 children of the same ages without the disease. Immunoglobulin M class anti-HPV was present in all 25 children with erythema infectiosum tested. In a survey of hospital patients, the prevalence of anti-HPV detected by CIE was 12% in the cohort 5 to 9 years of age, 19% in the cohort 10 to 14 years, and 32 to 55% in the cohorts greater than or equal to 30 years. The antibody reactions in the cases of erythema infectiosum, which were already well established at the onset of disease, indicate that HPV was the cause of the outbreak.
Adolescent↗
Erythema infectiosum in children. A Clinical study.
Erythema infectiosum is a childhood illness characterized by mild constitutional symptoms and a blotchy or maculopopular lacy rash on the cheeks (slapped - cheek) spreading primarily to the extremities and trunk. The disease is caused by human parvovirus B19. Erythema infectiosum epidemics occur in a cyclic fashion, mostly during winter and spring months. The diagnosis of erythema infectiosum is usually based on the appearance and pattern of the rash. The aim of our study was to establish the frequency and clinical characteristics of erythema infectiosum in children, in the period between 2000 and 2004 at the Institute of Child and Youth Health Care, Department of Dermatology, Novi Sad There were 0.23% of children with a clinical picture of infectious erythema. There was an outbreak of erythema infectiosum from December 2001 to September 2002. The highest number of cases was detected in April and May of 2002 from 2003 to 2004, no cases with infekctious erythema were diagnosed. The average age of injected children was 7.38. Female children were affected slightly more often than male (56.41% : 43.58%). Pruritus was detected in 10.26% of children. The most constant clinical sign was reticular exanthema on the limbs, present in 100% of cases, jollowed by 89.74% of cheek exanthema, while limb and trunk exanthema was present in 7.68% of children. Adenopathies and mild constitutional symptoms were present in 5.12% of children. No complications were recorded in any of the cases.
Adolescent↗
Detection of antibodies to human parvovirus in erythema infectiosum (fifth disease).
Two Japanese outbreaks of erythema infectiosum were investigated for evidence of human parvovirus infection by a solid phase antibody capture radioimmunoassay based on a monoclonal antibody to human parvovirus. Specific IgM and high concentrations of specific IgG were detected in 37 sera from 27 children with erythema infectiosum. No anti human parvovirus IgM was detected in a remaining case of erythema infectiosum, in five patients with Kawasaki disease, or in the 17 control children. Seven of the controls were also anti human parvovirus IgG negative, and the 10 who were seropositive had lower concentrations of anti human parvovirus IgG than the patients with erythema infectiosum. These data indicate that human parvovirus is a cause of erythema infectiosum.
Antibodies, Viral↗
Erythema infectiosum and pregnancy-related complications.
Erythema infectiosum, an acute, communicable viral disease with a highly distinctive exanthem, follows the usual course of a self-limiting benign disease. In pregnant women, however, it may be associated with fetal death and nonimmune hydrops fetalis. Because of the association of human parvovirus (HPV) B19 infection with fetal damage we reviewed the current knowledge of the clinical aspects of erythema infectiosum, focusing on pregnancy and fetal outcome, to determine the magnitude of fetal risk and offer recommendations for management. Among 180 infected pregnant women 44 fetal deaths (24%) occurred, 1 to 12 weeks after the infection was noted. Pregnant women should be advised that (a) because of the high prevalence (up to 65%) of anti-HPV B19 IgG antibody among adults most of them are not at risk and (b) if maternal infection does occur therapeutic abortion is not indicated since intrauterine infection causes fetal death more often than abnormal development. Infection should be suspected in pregnant women who exhibit the symptoms of erythema infectiosum with or without arthropathy. They should be monitored for an elevated serum alpha-fetoprotein level (indicating fetal aplastic crisis) and undergo serial ultrasonography for the detection of hydrops fetalis. Although the incidence of congenital malformation is no higher than the expected rate in the general population (3% to 5%), the precise incidence of fetal adverse outcomes remains unknown and requires investigation in larger, prospective studies.
Erythema↗
Erythema infectiosum. An elementary school outbreak.
An outbreak of erythema infectiosum (fifth disease) occurred in a North Carolina elementary school. Because rubella virus has been implicated as a possible cause of some cases of erythema infectiosum, we conducted an investigation to determine if the children were infected with rubella virus and to learn whether or not rubella virus vaccination prevents the disease. Throat swabs were obtained for viral isolation from 20 children with erythema infectiosum and from 25 healthy classmates; questionnaires were completed for 617 of the school's 817 students. One hundred fifty children (24%) reported having an acute exanthematous illness during the study period, and 45% of the ill children had one or more household contacts with a similar rash. No viruses were recovered from the children, and a history of rubella vaccination did not affect the risk of developing erythema infectiosum.
Child↗
Epidemiology of an outbreak of erythema infectiosum in Tokyo.
Endemic outbreaks of erythema infectiosum were observed in various areas of Japan from 1977 to 1981. Even in a limited district of Tokyo, we recorded 395 cases until June 1981, so this might be the largest epidemic in Japan. Most cases occurred from January to June. The peak incidence was at the age of 7 years and the average age was 8.9 years. The outbreak also occurred among our hospital nurses, but no severe case was observed in hospitalized patients. Furthermore, the symptoms in adults were as mild as in children, suggesting the little participation of immunity in this disease. By epidemiologic survey, erythema infectiosum was distinct from rubella.
Adolescent↗
The role of parvovirus B19 in aplastic crisis and erythema infectiosum (fifth disease).
In 1984, simultaneous outbreaks of aplastic crisis and erythema infectiosum occurred in northeastern Ohio. Sera were analyzed from 26 patients with aplastic crisis: 24 had IgM specific for parvovirus B19, five had B19-like particles by electron microscopy, and 13 had DNA from B19; no sera from 33 controls had evidence of recent infection with B19 (P less than .0001). DNA from B19 was also detected in specimens of throat gargle and urine from two patients with aplastic crisis. Sera from 36 of 51 children with erythema infectiosum had B19-specific IgM, compared with serum from one of 42 susceptible controls (P less than .0001). DNA from B19 was detected in sera from only two of 51 patients who had erythema infectiosum. The secondary attack rates among susceptible contacts decreased with age (overall total, 49.6%). Differential rates of asymptomatic infection were observed among black (68.8%) and white (20.0%) household members (P = .003). These were the first identified simultaneous outbreaks of aplastic crisis and erythema infectiosum. Their occurrence provided an opportunity to study the epidemiology and spectrum of B19 infection with geographically and temporally matched comparison groups; our results support the hypothesis that infection with parvovirus causes these two clinical entities.
Adolescent↗
Occupational risk of human parvovirus B19 infection for school and day-care personnel during an outbreak of erythema infectiosum.
Human parvovirus B19, the cause of erythema infectiosum, has recently been associated with adverse fetal outcomes. During a large outbreak of erythema infectiosum in Connecticut, a survey was conducted on 571 (90%) of 634 school and day-care personnel to determine the risk of acquiring B19 infection. Serologic evidence of B19 infection was determined by using an enzyme-linked immunosorbent assay. Of the school and day-care personnel, 58% had evidence of previous B19 infection. The minimal rate of B19 infection in susceptible personnel during the outbreak was 19%. The risk was increased for teachers and day-care providers who had contact with younger children and with greater numbers of ill children. These results suggest that B19 infection is an occupational risk for school and day-care personnel.
Adult↗
[Acute serous meningitis in a patient with erythema infectiosum].
BACKGROUND: Clinical manifestations caused by parvovirus B19 (PVB19) are various and depend on the age and immunity of an infected person. In children, the most frequent clinical manifestation of parvovirus B19 primary infection is erythema infectiosum (EI). CASE REPORT: In this case report we presented a 12-year-old patient with 2 clinical syndromes: erythema infectiosum and serous meningitis. Erythema infectiosum was manifested as fever, typical skin lesions ("slapped cheeks"), erythematous macules and papules confluent with reticular appearance on the extremities and the trunk. Serous meningitis had a mild course with an increased number of lymphocytes (120/ mm3) and the mildly increased level of proteins (0.75 g/l). The serological examination showed the presence of IgM and IgG antibodies against parvovirus B19 in serum, as well as in cerebrospinal fluid (CSF). The reduction of serum/CSF ratio of IgG antibodies was present. The symptomatic therapy was used in the treatment. The course and the prognosis were benign. CONCLUSION: Human PVB19, although non-specifically associated with CNS diseases could be an etiological factor that might cause serous meningitis. So, it should be considered in different diagnosis in patients with aseptic meningitis, especially during the outbreaks of erythema infectiosum.
Acute Disease↗
[Optic neuropathy after erythema infectiosum].
BACKGROUND: Optic neuropathies can not always easily be classified as neuritis or ischemic disease. CASE REPORT: A 39 year old woman suffered from unilateral optic neuropathy 9 days after the acute onset of a general disease with erythema and joint swellings. The optic disc swelling and visual fields resembled an anterior ischemic optic neuropathy, however, a marked improvement was achieved by steroid treatment. The general disease proved to be erythema infectiosum. CONCLUSIONS: Erythema infectiosum as a frequent children's disease causes very rarely central nervous involvement, optic neuropathy has not been reported yet. In cases of atypical optic neuropathies search for an underlying systemic disease is of value.
Adult↗
[Five cases of erythema infectiosum in adults].
The similarities between clinical features of erythema infectiosum and collagen disease or other viral infections prompted us to investigate clinical manifestations and laboratory data of parvovirus B19 (B19) infection in adults. We diagnosed all five patients as acute B19 infection by antibody assays. The age of patients ranged from 18 to 39 years old (mean 29), and all patients were female. All five patients showed high fever, arthralgia and edema of the extremities. Four of the five patients showed skin rash of the extremities or cheeks. Two patients were diagnosed as erythema infectiosum by family physicians before coming to us. The three remaining patients were suspected to be systemic lupus erythematosus, adult Still disease or rubella indivisually and referred to our hospital. A-27-old female (case 5) visited our hospital because of polyarthralgia and butterfly rash on her face. A test for antinuclear antibodies (ANA) was positive at a dilution of 1:320. Rheumatoid factor (RF) was also detected by latex fixation test. Her AST was 51 IU/L, ALT 68 IU/L and LDH 568 IU/L. Her symptoms persisted for 3 weeks and hepatic dysfunction recovered within 3 weeks. Five months later. ANA was negative at the dilution of less than 1:40. We suggest that the similarities between some symptoms of B19 infection and clinical and serological manifestation of collagen diseases merit closer attention.
Adolescent↗
An outbreak of erythema infectiosum associated with human parvovirus infection.
Erythema infectiosum (EI) or fifth disease is a mild, acute exanthematous disease, occurring mainly among children, for which a causative virus has long been sought. In May 1983 an outbreak of exanthematous illness was reported in a primary school in North London. Children attending the school were investigated by questionnaire and 162 (43.9%) reported an illness with the features of EI. In each of 36 cases investigated virologically the illness was associated with parvovirus infection. Moreover, pre-existing antibody to parvovirus was correlated with protection from EI in 16 of 17 close family contacts of cases. We propose therefore that EI is the common manifestation of infection with the human parvovirus.
Adult↗
Detection of parvovirus B19 in a case of erythema infectiosum with myositis.
A well documented case of erythema infectiosum is being reported here for the first time from India which was associated with myositis that has not been reported globally. A 9-year-old child presented with moderate to high grade fever, mild anemia, and erythematous rash involving face, trunks and limbs associated with arthralgia, myalgia and myositis. Parvovirus B19 infection was confirmed by detection of IgM antibodies (inhouse ELISA) and DNA (nested PCR) in patient's serum.
Child↗
Encephalopathy with erythema infectiosum.
A 9-month-old boy developed encephalopathy associated with the noset of erythema infectiosum, which resulted in permanent neurologic sequelae. This is the second reported case of encephalitis following erythema infectiosum and the first, to our knowledge with permanent sequelae.
Electroencephalography↗
[Epidemiologic characteristics of human parvovirus B19. Report of an epidemic of erythema infectiosum in the area of Belgrade].
During the period 29.10.1987-10.5.1988 an outbreak of an illness with rash resembling Erythema Infectiosum occurred among school children in one part of Belgrade-Mladenovac. This is the first outbreak of Erythema Infectiosum reported in Yugoslavia and confirmed in University College of Middlesex School of Medicine, London, in November 1989. Of 720 school children exposed to infection of Human Parvovirus B 19 two hundred and eighty four (39.4%) have had clinical symptoms and 166 (58.4%) of them were in the age group 10-14. The sero-epidemiologic investigations excluded infection of Rubella virus, Cytomegalovirus and Coxsackie viruses A 9 and B 5. To detect the infection Elisa IgM antibody, complement fixation, inhibition of hemagglutination and isolation have been used. Clinical symptoms of illness have been manifested as Rubella like exanthemas on extremities in 92.5%, extremities and body in 26.5% and the phenomenon "slapped Cheek" was discovered in 76.25% of all patients. Reappearance of rash has been observed in 25% of cases.
Adolescent↗
[Parvovirus B19 infection: not confined to exanthema of erythema infectiosum].
The well-known condition of erythema infectiosum is caused by parvovirus B19, a single-stranded DNA virus discovered in 1975. The characteristic erythema obviously does not always appear: antibodies are present in 50%-60% of all adults. The virus is transmitted by airborne droplets, and the incubation period is 13-17 days. Clinically, there are unspecific prodromes, and aside from exanthema these can take the form of lymphadenopathy, influenza-like symptoms, and arthralgia. Parvovirus B19 has a marked affinity for erythropoietic cells. The infection may be of clinical importance in patients with haematological disease and can cause fetal death during pregnancy. The diagnosis is confirmed by detection of specific antibodies of the IgM or IgG class.
Adult↗