Approach
Most cases of erythema infectiosum do not require specific therapy beyond symptomatic treatment for fever and arthritis/arthralgia and reassurance.[19] As in any viral illness, maintaining hydration and appropriate rest is indicated.
Complications of parvovirus B19 include transient aplastic crisis in people with increased red blood cell (RBC) turnover/destruction (e.g., hereditary spherocytosis, sickle cell disease, thalassemia, iron deficiency anemia). In addition, infection in pregnancy may result in fetal anemia, hydrops and fetal death. Patients affected by these complications require referral to appropriate specialists for treatment and monitoring. Rare reports of nephritis and hepatitis in association with parvovirus B19 infection have been reported.[3][4] In addition, parvovirus has been attributed to cardiomyopathy in children.[7]
Persistent infection
Persistent infection with parvovirus B19 occurs when there is insufficient antibody formation due to immunodeficiency. Patients who are immunocompromised do not form immune complexes, so they do not present initially with the classic erythema infectiosum. This patient population includes patients with HIV, people receiving chemotherapy or immunosuppression following transplant or patients with congenital immunodeficiencies.[2] The parvovirus B19 infection often responds to intravenous immunoglobulin (IVIG) with a resultant increase in RBC count. RBC transfusion may be required in the interim to prevent complications of anemia. In some patients, discontinuation of immunosuppressive therapy or institution of antiretroviral therapy in patients with HIV may terminate persistent parvovirus B19 infection and thus resolve the anemia.[2]
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