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Erythema infectiosum

Last reviewed: 10 Nov 2024
Last updated: 15 Nov 2024
15 Nov 2024

Clinicians urged to consider parvovirus B19 in people with fever, myalgia, arthralgia, and rash, after US and Europe report increased cases

​Recent data indicates an increase in parvovirus B19 activity, the virus responsible for erythema infectiosum. Since March 2024, there has been a significant rise in cases reported in 14 European countries, and in August 2024, the US Centers for Disease Control and Prevention (CDC) issued a Health Alert about increased activity in the US.[14][15]​ The surge in cases has affected all age groups, with the largest increase seen among children aged 5-9 years. Reports also indicate a higher incidence of infections among pregnant individuals, with an increased number of fetal complications.[16]

Clinicians should maintain increased suspicion for infection with parvovirus B19 in people presenting with common symptoms (e.g., fever, myalgia, malaise, reticular rash, arthralgia, characteristic facial rash) or for pregnant people with known exposure to individuals with parvovirus B19.​[16]

See Epidemiology

Original source of update

Summary

Definition

History and exam

Key diagnostic factors

  • close contact with other infected individuals
  • bright red macular erythema of the bilateral cheeks with sparing of the nasal ridge and peri-oral areas
  • erythematous macules and papules evolving into lacy reticular erythema, most notable on the extremities
  • immunodeficiency
Full details

Other diagnostic factors

  • arthralgia/arthritis
  • prodrome (fever, headache, pharyngitis, coryza, abdominal pain)
  • symptoms of anaemia
Full details

Risk factors

  • close contact with other infected individuals
  • immunodeficiency
  • age 6 to 10 years
Full details

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
Full details

Investigations to consider

  • FBC
  • reticulocyte count
  • serology
  • DNA assays
Full details

Treatment algorithm

ACUTE

fever

secondary arthritis

ONGOING

persistent (>3 weeks) parvovirus B19 infection

Contributors

Authors

Joseph M. Lam, MD

Clinical Associate Professor, Department of Pediatrics

Associate Member, Department of Dermatology and Skin Sciences

University of British Columbia, BC Children’s Hospital

Vancouver

BC

Canada

Disclosures

JML declares that he has no relevant competing interests.

Alexander K. C. Leung, MD

Department of Pediatrics

The University of Calgary, Alberta Children's Hospital

Calgary

Alberta

Canada

Disclosures

AKCL declares that he has no relevant competing interests.

Acknowledgements

Dr Joseph M. Lam and Dr Alexander Leung would like to gratefully acknowledge Dr Kari L. Martin, Dr Christine T. Lauren, Dr Jon Dyer, and Dr Jennifer Holman, the previous contributors to this topic. KLM has served as a board member for Women's Dermatologic Society and American Contact Dermatitis Society. CTL, JD, and JH declare that they have no competing interests.

Peer reviewers

Nevio Cimolai, MD

Professor

Department of Pathology and Laboratory Medicine

Children's and Women's Health Centre of British Columbia

Vancouver

Canada

Disclosures

NC declares that he has no competing interests.

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