History and exam

Key diagnostic factors

common

close contact with other infected individuals

Parvovirus B19 is spread via direct contact and respiratory droplets; close contact with infected individuals is a risk factor for the epidemics seen in late winter and early spring.[9]

bright red macular erythema of the bilateral cheeks with sparing of the nasal ridge and peri-oral areas

Initial presentation, resembling slapped cheeks. [Figure caption and citation for the preceding image starts]: Typical erythematous 'slapped cheeks' of erythema infectiosum.From the collection of Gary A. Dyer, MD; used with permission [Citation ends].com.bmj.content.model.Caption@2ce5905a

erythematous macules and papules evolving into lacy reticular erythema, most notable on the extremities

Macules and papules appear 1 to 4 days after initial facial rash.

Lacy reticular erythema lasts for 1 to 3 weeks although it may persist for longer.

The generalised exanthem may intensify with increased body temperature; parents should be cautioned that this does not reflect the recrudescence of the disease.

The exanthem is occasionally pruritic and is most common in paediatric patients.[2]

[Figure caption and citation for the preceding image starts]: Lacy, reticular, erythematous eruption of erythema infectiosum on an upper extremity.From the collection of Gary A. Dyer, MD; used with permission [Citation ends].com.bmj.content.model.Caption@7f92f17d

uncommon

immunodeficiency

This patient population includes patients with HIV, those receiving chemotherapy or immunosuppression following transplant, or patients with congenital immunodeficiencies.[2]

Persistent parvovirus B19 infection with resultant anaemia may occur.

Patients who are immunocompromised do not form immune complexes, so they do not present initially with classic erythema infectiosum.

Other diagnostic factors

common

arthralgia/arthritis

Present in up to 10% of paediatric patients, up to 60% of female patients, and up to 30% of male patients.[11]

Typically involves the small joints of the hands, wrists, knees, or ankles and is self-limited.

Arthritis is more common in adults, especially women.[2]

prodrome (fever, headache, pharyngitis, coryza, abdominal pain)

There have been a variety of mild prodromal symptoms reported.

These usually occur about 1 week after exposure and 1 to 2 weeks prior to onset of the exanthema.

Prodromal symptoms are more common in adults.

uncommon

symptoms of anaemia

Persistent parvovirus B19 infection (usually in individuals with immunosuppression) or infection in a patient with haemoglobinopathies and/or haemolytic anaemia can result in symptoms of severe anaemia such as fatigue, shortness of breath, tachycardia, pallor, and, light-headedness due to red cell aplasia.

Risk factors

strong

close contact with other infected individuals

Parvovirus B19 is spread via direct contact and respiratory droplets; close contact with infected individuals is a risk factor for the epidemics seen in late winter and early spring.[9]

weak

immunodeficiency

This patient population includes patients with HIV, those receiving chemotherapy or immunosuppression following transplant, or patients with congenital immunodeficiencies.[2]

Persistent parvovirus B19 infection with resultant anaemia may occur.

Patients who are immunocompromised do not form immune complexes, so they do not present initially with classic erythema infectiosum.

age 6 to 10 years

Parvovirus B19 can affect people of any age but is most common in children aged 6 to 10 years.[8]

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