Erythema infectiosum
- Overview
- Theory
- Diagnosis
- Management
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Treatment algorithm
Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer
fever
acetaminophen plus supportive therapy
Most cases of erythema infectiosum do not require specific therapy beyond symptomatic treatment for fever and arthritis/arthralgia and reassurance.[19]Kimberlin DW, Banerjee R, Barnett ED, et al. Red book: 2024-2027 report of the Committee on Infectious Diseases. 33rd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2024.
As in any viral illness, maintaining hydration and appropriate rest is indicated.
Primary options
acetaminophen: children: 10-15 mg/kg orally every 4-6 hours when required, maximum 5 doses in 24 hours; adults: 325-650 mg orally every 4-6 hours when required, maximum 4000 mg/day
ibuprofen
Treatment recommended for SOME patients in selected patient group
Ibuprofen is sometimes used as an alternative or in combination with acetaminophen if symptomatic fever is difficult to control.
Primary options
ibuprofen: children >6 months of age: 4-10 mg/kg orally every 6-8 hours when required, maximum 40 mg/kg/day; adults: 200-400 mg orally every 4-6 hours when required, maximum 1200 mg/day
secondary arthritis
nonsteroidal anti-inflammatory drugs (NSAIDs)
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]Young NS, Brown KE. Parvovirus B19. N Engl J Med. 2004;350:586-597. http://www.ncbi.nlm.nih.gov/pubmed/14762186?tool=bestpractice.com
Primary options
ibuprofen: children >6 months of age: 4-10 mg/kg orally every 6-8 hours when required, maximum 40 mg/kg/day; adults: 200-400 mg orally every 4-6 hours when required, maximum 2400 mg/day
OR
naproxen: adults: 200-500 mg orally every 12 hours, maximum 1250 mg/day
More naproxenDose refers to naproxen base.
persistent (>3 weeks) parvovirus B19 infection
removal or reduction of underlying immunosuppression plus treatment with intravenous immunoglobulin (IVIG)
Persistent parvovirus B19 responds to IVIG with a resultant increase in red blood cell (RBC) count. The dose below has been used in research.[2]Young NS, Brown KE. Parvovirus B19. N Engl J Med. 2004;350:586-597. http://www.ncbi.nlm.nih.gov/pubmed/14762186?tool=bestpractice.com [33]Crabol Y, Terrier B, Rozenberg F, et al; Groupe d'experts de l'Assistance Publique-Hôpitaux de Paris. Intravenous immunoglobulin therapy for pure red cell aplasia related to human parvovirus b19 infection: a retrospective study of 10 patients and review of the literature. Clin Infect Dis. 2013;56:968-977. http://www.ncbi.nlm.nih.gov/pubmed/23243178?tool=bestpractice.com
In immunosuppressed 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]Young NS, Brown KE. Parvovirus B19. N Engl J Med. 2004;350:586-597. http://www.ncbi.nlm.nih.gov/pubmed/14762186?tool=bestpractice.com
RBC transfusion may be required in the interim to prevent complications of anemia.
Primary options
immune globulin (human): adults: 400 mg/kg/day intravenously for 5 days
red blood cell transfusion
Treatment recommended for SOME patients in selected patient group
Transfusion may be required to prevent complications of anemia prior to a clinical response to intravenous immunoglobulin (IVIG) in people with persistent infection.
Choose a patient group to see our recommendations
Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer
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