Fifth disease

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Erythema infectiosum
Classification and external resources
Fifth disease.jpg
16-month-old with erythema infectiosum
ICD-10 B08.3
ICD-9 057.0
DiseasesDB 4442
MedlinePlus 000977
eMedicine emerg/378 derm/136 ped/192
Patient UK Fifth disease
MeSH D016731
Not to be confused with sixth disease. see Exanthema subitum.

Erythema infectiosum or fifth disease is one of several possible manifestations of infection by erythrovirus, previously called parvovirus B19.[1] The disease is also referred to as slapped cheek syndrome, slapcheek, slap face or slapped face.[2][3] In Japan the disease is called "apple sickness" or ringo-byou (りんご病)in reference to the symptom of facial redness. In Hungary it is called "butterfly pox" as the red cheeks look like the wings of a butterfly.

The name "fifth disease" comes from its place on the standard list of rash-causing childhood diseases, which also includes measles, scarlet fever, and rubella.


Fifth disease starts with a low-grade fever, headache, rash, and cold-like symptoms, such as a runny or stuffy nose. These symptoms pass, then a few days later the rash appears. The bright red rash most commonly appears in the face, particularly the cheeks. This is a defining symptom of the infection in children (hence the name "slapped cheek disease"). Occasionally the rash will extend over the bridge of the nose or around the mouth. In addition to red cheeks, children often develop a red, lacy rash on the rest of the body, with the upper arms, torso, and legs being the most common locations. The rash typically lasts a couple of days and may itch; some cases have been known to last for several weeks. Patients are usually no longer infectious once the rash has appeared.[2][3]

Teenagers and adults may present with a self-limited arthritis. It manifests in painful swelling of the joints that feels similar to arthritis. Older children and adults with fifth disease may have difficulty in walking and in bending joints such as wrists, knees, ankles, fingers, and shoulders.[2][3]

The disease is usually mild,[4] but in certain risk groups it can have serious consequences:


Fifth disease is transmitted primarily by respiratory secretions (saliva, mucus, etc.) but can also be spread by contact with infected blood. The incubation period (the time between the initial infection and the onset of symptoms) is usually between 4 and 21 days. Individuals with fifth disease are most infectious before the onset of symptoms. Typically, school children, day-care workers, teachers and mothers are most likely to be exposed to the virus. When symptoms are evident, there is little risk of transmission; therefore, symptomatic individuals need not be isolated.[2][3]


Any age may be affected although it is most common in children aged five to fifteen years.[6] By the time adulthood is reached about half the population will have become immune following infection at some time in their past.[2][3] Outbreaks can arise especially in nursery schools, preschools, and elementary schools.


The name "fifth disease" is not typically capitalized, since the name derives from its historical classification as the fifth of the classical childhood skin rashes or exanthems. Their classification is as follows:

  1. Measles
  2. Scarlet fever
  3. Rubella
  4. Dukes' disease
  5. Fifth disease (erythema infectiosum)
  6. Roseola

It was first described by Robert Willan in 1799 as "Rubeola, sine catarrho". It was better defined by Anton Tschamer in 1889 as a rubella variant ("Ortliche Rotheln"), identified as a distinct condition in 1896 by T. Escherich, and given the name "erythema infectiosum" in 1899.[7]


Treatment is supportive as the infection is frequently self-limiting. Anti-pyrogens (i.e., fever reducers) are commonly used. The rash is painless and usually non-pruritic (not itchy). There is no specific therapy.

See also[edit]



  1. ^ Weir E (March 2005). "Parvovirus B19 infection: fifth disease and more". CMAJ 172 (6): 743. doi:10.1503/cmaj.045293. PMC 552884. PMID 15767606. 
  2. ^ a b c d e f Sabella C, Goldfarb J (October 1999). "Parvovirus B19 infections". Am Fam Physician 60 (5): 1455–60. PMID 10524489. Retrieved 2009-11-06. 
  3. ^ a b c d e f Servey JT, Reamy BV, Hodge J (February 2007). "Clinical presentations of parvovirus B19 infection". Am Fam Physician 75 (3): 373–6. PMID 17304869. Retrieved 2009-11-06. 
  4. ^ Mankuta D, Bar-Oz B, Koren G (March 1999). "Erythema infectiosum (fifth disease) and pregnancy". Can Fam Physician 45: 603–5. PMC 2328398. PMID 10099795. 
  5. ^ Yoto, Y., et. al, (2003). "Retrospective study on the influence of human parvovirus B19 infection among children with malignant diseases". Acta Haematol pg.8-12, PMID 8237278
  6. ^ Kwon, Kenneth T (March 19, 2009). "Pediatrics, Fifth Disease or Erythema Infectiosum". eMedicine. Retrieved November 7, 2009. 
  7. ^ Altman, Lawrence K (November 30, 1982). "THE DOCTOR'S WORLD". The New York Times. Retrieved November 7, 2009. 

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