00:01
Now let's cover erythema infectiosum which is fifth disease.
00:05
A long time ago, fifth disease got its name
because it was the fifth on the list of six commonly recognized childhood rash forming illnesses.
00:13
And this is caused by an infection with the parvovirus B19.
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The incubation is 4 to 21 days and it's found more commonly in the spring.
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It's transmitted via respiratory secretions, including cough, saliva and sputum or contact with infected blood.
00:29
Now, this can also be transmitted vertically in pregnancy.
00:34
Usually this affects school-age children, daycare workers, teachers and parents.
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It's most infectious prior to and during the initial onset of symptoms.
00:44
But once the rash appears, they're no longer contagious so no isolation is necessary.
00:49
Let's talk about the parvovirus B19.
00:52
This is gonna cause a transient suppression of erythropoiesis.
00:55
It's usually mild and asymptomatic.
00:58
These immunocompromised children can develop a protracted viremia though for weeks to months.
01:04
Typically in the healthy population you won't see this.
01:07
Patients with hemoglobinopathy is like sickle cell disease,
can develop an aplastic crisis if they get parvovirus B19.
01:14
And it's usually self-limiting and usually mild. There's phase 1.
01:20
This is where the patient gets sick.
01:22
They have a low-grade fever, a headache, a rash and cold like symptoms.
01:26
This is pretty low on a parent's radar.
01:29
Next, the child will develop a rash and this is phase 2, a few days later.
01:34
They're gonna start with a bright red rash on their cheeks.
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It's described as a slap cheek look and it is classic.
01:41
They'll also develop a red lacy rash on the rest of their body.
01:44
And once this rash develops, the child is no longer contagious.
01:48
The rash can wane and wax and temporarily reappear during this phase.
01:53
Adolescents and adults can get a self-limited arthritis.
01:57
So when you're examining a patient that you suspect might have fifth disease,
you're gonna collect a medical history.
02:03
You're also going to review the child's immunization status and this is to exclude other causes of fever and rash.
02:10
Your gonna do a physical exam, including, looking at the vital signs,
a complete, head, eyes, ears, nose, throat exam.
02:18
You're gonna do a cardiac, respiratory and full skin exam.
02:23
So how do we diagnose fifth disease?
This is a clinical diagnosis which means you use your history
and your physical exam to drive your diagnostics.
02:33
There is no lab work or testing needed especially in children.
02:36
But you'll do this if a child has a known blood disorder or an impaired immune system
because these are the children at risk for complications.
02:45
Fifth disease is a self-limiting viral infection. Antibiotics are not effective because remember, this is a virus.
02:52
Most children are gonna feel totally fine and be playing and running around when they have fifth disease.
02:58
You can do symptomatic care for their cold-like symptoms but it's usually not necessary.
03:03
A child can have acetaminophen for their fever or joint pain if they need it.
03:08
The rash may be itchy so you want to avoid hot showers and hot baths because this can make an itchy rash even worse.
03:14
And remember, no aspirin in the pediatric population because this can cause Reye's syndrome.
03:19
And this is a rare but serious condition that causes swelling in the liver and brain.
03:24
So what are the complications?
Well, typically in healthy children, there won't be any complications.
03:29
They're just gonna have a very mild illness. In the pregnant population, this can be very serious.
03:35
It can be linked to hydrops fetalis which can cause spontaneous abortion also known as a miscarriage.
03:42
In patients with sickle cell anemia, they can develop an aplastic crisis.
03:46
And in the immunocompromised patients, they can be at increased risk for complications.