Fifth disease, so named because it was the fifth identified childhood disease that causes a red rash, is caused by human parvovirus B19. The other four are measles, scarlet fever, rubella, and roseola. It’s a highly contagious but not very severe illness in children, characterized by a lacy rash, a bright red “slapped cheek” appearance, and sometimes a mild fever and flu symptoms. In adults, the slapped cheek appearance is less common, but other symptoms are often more severe. It can first present in adults as a rheumatic syndrome or arthritis, mimicking rheumatoid arthritis, as well as an allergic reaction or hives, and both rash and joint pain can wax and wane for several weeks. Joint pain tends to be symmetrical, but will travel and change in severity throughout different joints. Joint pain in adults can last as long as several months, and can recur. The symptoms of Fifth disease are primarily caused by the host’s immune response, rather than viremia.

Fifth disease is caused by Parvovirus B19, …“a small DNA virus that is the only parvovirus presently known to be a human pathogen.” 1 By 1985, B19 was recognized as a major cause of Fifth disease. “Recognition of the spectrum of illness caused by B19 continues to grow and in addition to the above illnesses, presently includes (1) an arthritis syndrome associated with acute infection in adults; (2) hydrops fetalis, (severe fetal anemia) and (3) chronic anemia in immunocompromised hosts.” 1

Symptoms start 1-2 weeks after exposure, and the disease is most contagious about one week before the onset of the rash. Once the rash starts, it probably cannot be spread to others.

Parvovirus is troublesome for pregnant women. “The virus doesn't cause birth defects but 10% of babies who are infected with fifth disease before birth develop severe anemia and 1-2% may even die. A pregnant person should take an antibody test as soon as they are exposed to a child with fifth disease; this will tell if they have already had the disease and are protected from becoming infected again. If the person is not immune, during the first trimester there is a slight 1-2% increase in risk of miscarriage. If the person is in the last trimester the virus could break down some of the baby's red blood cells causing anemia but it is unlikely to be severe enough to harm the baby. Monthly ultrasounds are used to follow the baby for signs of hydrops. “ 2

Treatment is supportive, prednisone and benadryl to reduce the itching and inflammation of the joints, and rest and fluids. Hoemeopathic remedies include Urtica and Apis, both treatments for rash and inflammation. I found that acupuncture reduced the intensity of the rash sensitivity, as well as my overall crabbiness.



doyle tells me, as do some of the on-line references, that roseola is actually the 6th disease - there was a Duke's disease designated as number 4, but that was likely a form of strep (scarlet fever), so now there are only five total.
doyle The viremia can cause flu-like symptoms, but usually does not in children, and by the time the rash appears, the virus under control. The symptoms then caused by immune complexes.
doyle If you have a hemolytic anemia, such as sickle cell, parvo B19 can kill by causing aplastic anemia.

Thanks for the additions!! I would prefer not to be the vector for a deadly anemia amongst my friends.

References: 1) Johns Hopkins University website. http://pathology5.pathology.jhmi.edu/micro/v16n35.htm
2) Kid’s health for parents. http://kidshealth.org/parent/infections/bacterial_viral/fifth.html

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