Erythema Infectiosum – Fifth Disease (Pediatric Nursing)

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.

00:17 The incubation is 4 to 21 days and it's found more commonly in the spring.

00:21 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.

00:39 It's most infectious prior to the onset of symptoms.

00:42 But once a patient's symptomatic, they're no longer contagious so no isolation is necessary.

00:48 Let's talk about the parvovirus B19.

00:51 This is gonna cause a transient suppression of erythropoiesis.

00:55 It's usually mild and asymptomatic.

00:57 These immunocompromised children can develop a protracted viremia though for weeks to months.

01:03 Typically in the healthy population you won't see this.

01:06 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.

01:19 This is where the patient gets sick.

01:21 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.

01:28 Next, the child will develop a rash and this is phase 2, a few days later.

01:33 They're gonna start with a bright red rash on their cheeks.

01:37 It's described as a slap cheek look and it is classic.

01:40 They'll also develop a red lacy rash on the rest of their body.

01:43 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.

02:02 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.

02:44 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.

02:57 You can do symptomatic care for their cold-like symptoms but it's usually not necessary.

03:02 A child can have acetaminophen for their fever or joint pain if they need it.

03:07 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.

03:34 It can be linked to hydrops fetalis which can cause spontaneous abortion also known as a miscarriage.

03:41 In patients with sickle cell anemia, they can develop an aplastic crisis.

03:45 And in the immunocompromised patients, they can be at increased risk for complications.