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Parvovirus B19

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Introduction


Slapped cheek syndrome is a common childhood viral infection. However, it can affect people of all ages. The most common symptom of slapped cheek syndrome is the appearance of a bright red rash on both cheeks (hence the name). Slapped cheek syndrome is cause by a virus called parvovirus B19.

Slapped cheek syndrome is also sometimes known as:

  • fifth disease, and
  • erythema infectiosum.

How common is slapped cheek syndrome?

Slapped cheek syndrome is thought to be very common. Most people do not realise that they have been infected by the parvovirus B19 virus because it often causes very mild symptoms that are similar to a cold, or no symptoms at all.

It is estimated that 50-80 per cent of all adults have been infected by parvovirus 19. Once you are infected, your body will develop life-long immunity against further infection.

Slapped cheek syndrome usually affects children who are between 3-15 years of age. Most cases develop during the late winter months or early spring. Males and females are equally affected by the condition.

Cases of slapped cheek syndrome usually follow a cyclical pattern with an upsurge in cases occurring every 4-7 years.

Parvovirus B19 is contagious

Airborne viruses are viruses that can survive for a short period of time in the outside environment.

Parvovirus B19 is an airborne virus that is spread in much the same way as the cold or flu viruses. It can be spread through coughs and sneezes that release tiny droplets of contaminated saliva which are then breathed in by another person.

At risk groups

In children, slapped cheek syndrome is almost always a mild, self-limiting infection, which means that it will get better by itself without the need for treatment.

However, there are certain groups of people in which a parvovirus B19 infection can cause serious symptoms and complications. These are listed below.

  • People with certain blood disorders, such as sickle cell anaemia, where the blood does not contain enough healthy red blood cells (anaemia) and where infection can lead to a further and more severe loss of red blood cells.
  • Pregnant women without immunity - parvovirus B19 infection can increase the risk of a miscarriage because the virus can cause severe anaemia in the unborn child.
  • People with a weakened immune system (immunocompromised) either due to a side effect of treatment, such as chemotherapy, or from a condition such as HIV. These groups can experience prolonged, and sometime severe, symptoms of infection.

Outlook

The outlook for children with slapped cheek syndrome is excellent. The symptoms will usually pass within 4-5 weeks, and serious complications are very rare.

The outlook for people who are in 'at risk' groups is generally good, as long as the condition is recognised and treated promptly.

People with blood disorders will usually require a blood transfusion to restore the full amount of red blood cells.

Pregnant women with a potential risk of having a miscarriage may require an admission to hospital so that their unborn babies can be given a blood transfusion.

Immunocompromised people (those with weakened immune systems) can usually be treated with an injection of antibodies that have been donated by a person who has immunity to infection.

See the complications section for more information about 'at risk groups' and recommended treatments.

Disease

A disease is an illness or condition that interferes with normal body functions.

Fever

A fever is when you have a high body temperature (over 38C or 100.4F).


Symptoms of slapped cheek syndrome


Slapped cheek syndrome - children

The symptoms of slapped cheek syndrome usually begin between 13-18 days after your child develops the parvovirus B19 infection. The symptoms usually follow three distinct stages.

First stage

The first stage is usually characterised by mild flu-like symptoms such as:

  • a high temperature (fever) of 38C (100.4F) - although your child's temperature will not usually rise above 38.5C (101F),
  • sore throat,
  • headache,
  • upset stomach,
  • fatigue, and
  • itchy skin.

During the first stage of symptoms, your child will be most contagious.

Second stage

Between 3-7 days after the onset of symptoms, your child will develop a bright red rash on both cheeks (the so called 'slapped cheeks). The rash may be particularly noticeable in bright sunlight.

Third stage

The third stage of symptoms usually begins 1-4 days after the appearance of the 'slapped cheek' rash.

During the third stage, the rash will usually spread to your child's chest, stomach, arms, and thighs. The rash usually has a raised, lace-like appearance, and may cause discomfort and itching.

By this time, your child should no longer be contagious and they will be able to return to nursery, or school, without the risk of passing the infection onto others.

Parvovirus B19 infection - adults

The most common symptom of a parvovirus B19 infection in adults is joint pain and stiffness usually involving:

  • your hands,
  • knees,
  • wrists, and
  • ankles.

Half of all affected adults will also experience a rash, however, the 'slapped-cheek syndrome' is uncommon in adults and usually only affects around 1 in 10 people.

Other symptoms, such as a fever and sore throat, are rare in adults.

In most people, the symptoms of a parvovirus B19 infection will pass within 1-3 weeks, although 1 in 5 adults will experience recurring episodes of joint pain and stiffness for several months, sometimes years.

When to seek medical advice

Slapped cheek syndrome in children and parvovirus B19 infection in adults is usually mild and the infection should clear up without treatment.

You will probably only need to contact your GP if:

  • your, or your child's, temperature rises to 39C or above, and/or
  • your, or your child's, symptoms suddenly worsen.

When to seek urgent medical advice

People who are in the risk groups listed below are advised to contact their GP as soon as possible if they think they have developed a parvovirus B19 infection. If this is not possible, you should contact your local out-of-hour service, or NHS Direct on 0845 46 47.

  • Pregnant women.
  • People with a condition that is known to cause chronic anaemia, such as sickle cell anaemia, thalassaemia, and hereditary spherocytosis (an uncommon genetic condition that causes red blood cells to have a much shorter life-span than normal).
  • People with a weakened immune system - as a result of a condition such as HIV, or acute leukaemia, or having invasive treatments, such as chemotherapy or steroid medication. You may also have a weakened immune system if you are taking medication to suppress your immune system because you have recently receive a bone marrow transplant, or organ donation.

Glossary

Chronic
Chronic usually means a condition that continues for a long time or keeps coming back.
Aches
An ache is a constant dull pain in a part of the body.
Nausea
Nausea is when you feel like you are going to be sick.
Brain
The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Joints
Joints are the connection point between two bones that allow movement.
Fever
A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37°C (98.6°F).
Foetal
A foetus is an unborn baby, from the eighth week of pregnancy until birth.
Tissues
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.
Contagious
Contagious is when a disease or infection can be easily passed from one person to another through infection.
Swelling
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Heart
The heart is a muscular organ that pumps blood around the body.
Immune system
The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.
Diarrhoea
Diarrhoea is the passing of frequent watery stools when you go to the toilet.

Causes of slapped cheek syndrome


Parvovirus B19

Slapped cheek syndrome is caused by parvovirus B19. The parvovirus family of viruses causes a wide range of infections in animals, but the B19 virus is the only type of parvovirus to affect humans. Therefore, you cannot spread parvovirus B19 to your pets, or vice versa.

A parvovirus B19 infection is spread in the same way as a cold or flu. When an infected person coughs, sneezes, or laughs, they release tiny droplets of contaminated saliva which can be breathed in by another person.

The infection can also be spread by hand to hand contact. For example, if an infected person coughs or sneezes on their hand and then touches someone else's hand, that person may then catch the infection if they then touch their mouth or nose.

Alternatively, if an infected person touches an object, such as a door handle, or telephone, the virus may be transferred to the object. If someone else touches the object a short time later, and then touches their mouth, nose or eyes, they may also become infected.

Once parvovirus B19 enters the body, it targets cells called erythroid progenitor cells which are found in bone marrow and blood. It is the fact that the parvovirus B19 infection targets blood and bone marrow that makes it a particular serious infection for people with blood and bone marrow disorders.

Most of the symptoms of a parvovirus B19 infection are not caused by the virus itself but by the immune system releasing antibodies to kill the virus.

Glossary

Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.

Diagnosing slapped cheek syndrome


Most cases of slapped cheek syndrome can be diagnosed by making a visual examination of the distinctive rash.

If you are in a high-risk group - for example, if you are a pregnant woman, or you have a weakened immune system, a blood test may be recommended if you have been in close contact with someone who is known to have a parvovirus B19 infection. The blood test can be used to check your immunity status (to see if you are immune to the infection).

If testing shows that you are not immune to parvovirus B19, treatment can begin immediately in order to prevent complications.

Glossary

Red blood cell
Red blood cells transport oxygen around the body and remove carbon dioxide.
Antibodies
Antibodies and immunoglobins are proteins in the blood. They are produced by the immune system to fight against bacteria, viruses and disease.
Blood test
During a blood test, a sample of blood is taken from a vein using a needle, so it can be examined in a laboratory.
Chronic
Chronic usually means a condition that continues for a long time or keeps coming back.

Treating slapped cheek syndrome


There is no vaccination for slapped cheek syndrome and, for most people, the infection is usually a mild illness, which quickly passes without the need for treatment.

There are a number of self-care techniques that you can use to help relieve symptoms. These are explained below.

  • Painkillers, such as paracetamol, or ibuprofen, can be used to relieve symptoms, such as a high temperature, headache, and joint pain. Children who are 16 years of age, or under, should not take aspirin.
  • Antihistamines can be used to relieve the symptoms of itchy skin. Some antihistamines are not suitable for children who are under two years of age, so you should check with your pharmacist beforehand.
  • Another way to soothe itchy skin is to use a moisturising lotion.
  • Make sure that you (or your child) get plenty of rest and drink plenty of fluids as this will help to relieve the symptoms of sore throat and a high temperature.

Glossary

Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Fever
A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37°C (98.6°F).
Anti-inflammatory
Anti-inflammatory medicines reduce swelling and inflammation.
Joint
Joints are the connection point between two bones that allow movement.
Swelling
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Complications of slapped cheek syndrome


In the majority of cases, slapped cheek syndrome does not lead to complications. However, sometimes complications can arise due to an already existing condition, such as those outlined below.

Pregnancy

If you develop a parvovirus B19 infection during pregnancy, and you do not have immunity, there is a one in three chance that you will pass the infection onto your unborn baby.

There is then a risk that your baby will develop severe anaemia. This in turn can cause heart failure and an abnormal collection of fluid inside the tissue of your baby (hydrops fetalis).

Due to this risk, it is likely that you will be given regular ultrasound scans so that the health of your baby can be carefully assessed. If your baby does show signs of severe anaemia, they may be treated with a blood transfusion.

A parvovirus B19 infection during pregnancy carries a risk of miscarriage or still birth that is estimated to be between 3-10 per cent.

Parvovirus B19 infection does not cause birth defects.

Blood abnormalities

If you have sickle-cell anaemia, or other abnormalities of the haemoglobin (red blood cells), parvovirus B19 can cause acute, severe anaemia. This is known as an aplastic crisis.

Symptoms of an aplastic crisis include:

  • very pale skin,
  • fatigue,
  • headache,
  • high temperature (fever) of or 38C (100F) or above,
  • rapid heartbeat (tachycardia),
  • dizziness, and
  • fainting.

If you experience an aplastic crisis, it is likely that you will need to be admitted to hospital and given a blood transfusion. After having a blood transfusion, most people will make a full recovery.

Weakened immune system

If a person with a weakened immune system (immunocompromised) develops a parvovirus B19 infection, the virus can quickly spread through their bone marrow and interfere with the production of red blood cells. This can cause symptoms of severe anaemia, a high temperature, and a sense of feeling very unwell.

Treatment will usually require being admitted to hospital where a blood transfusion can be used to treat anaemia. Antibodies that have been donated by someone who is immune to parvovirus B19 can be used to treat the underlying infection.

Glossary

Chronic
Chronic usually means a condition that continues for a long time or keeps coming back.
Acute
Acute means occuring suddenly or over a short period of time.
Joints
Joints are the connection point between two bones that allow movement.
Blood test
During a blood test, a sample of blood is taken from a vein using a needle, so it can be examined in a laboratory.
Foetus
A foetus is an unborn baby, from the eighth week of pregnancy until birth.
Ultrasound
Ultrasound scans are a way of producing pictures of inside the body using sound waves.
Antibodies
Antibodies and immunoglobins are proteins in the blood. They are produced by the immune system to fight against bacteria, viruses and disease.
Fatigue
Fatigue is extreme tiredness and lack of energy.
Immune
The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.
Blood transfusions
A blood transfusion involves transferring blood into a person using a tube that goes directly into a vein in the arm.

Preventing slapped cheek syndrome


At present there is no vaccination available to prevent slapped cheek syndrome. People who have already been infected with parvovirus B19 in the past are immune to another infection.

To prevent the spread of slapped cheek syndrome try to make sure that everyone in your household washes their hands frequently in order to reduce the chances of the infection spreading.

Glossary

Immune
The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.
Vaccination
Vaccination or immunisation is usually given by an injection that makes the body's immune system produce antibodies that will fight off a virus.

References


Al-Khan A, et al. Parvovirus B-19 infection during pregnancy. Infectious Diseases in Obstetrics and Gynecology. 2003 Jan 1;11(3): 175-9

Florea AV, et al. Parvovirus B19 Infection in the Immunocompromised Host. Archives of Pathology and Laboratory Medicine: Vol. 131, No. 5, pp. 799-804.

Kishore J, Kapoor A. Erythrovirus B19 infection in humans. Indian Journal of Medical Research. 2000 Nov 1;112 149-64

Mandel E.. Erythema infectiosum: Recognizing the many faces of fifth disease. JAAPA : Journal of the American Academy of Physician Assistants. 2009 Jun 1;22(6): 42-6

Servey JT, Reamy BV, Hodge J. Clinical Presentations of Parvovirus B19 Infection. American Family Physician. 2007 Feb 1;75(3): 373-6.

Tolfvenstam T, et al. Frequency of human parvovirus B19 infection in intrauterine fetal death. The Lancet. 2001 May 12;357(9267): 1494-7.

Young NS, Brown KE. Parvovirus B19. The New England Journal of Medicine. 2004 Feb 5;350(6): 586-97.

Zellman GL. Erythema Infectiosum (Fifth Disease). eMedicine.com. 2008
available online at: http://emedicine.medscape.com/article/1132078-print


The materials in this website are provided by Medicine Chest and NHS Choices.  Neither Co-operative Group Limited or Co-operative Healthcare Limited (trading as The Co-operative Pharmacy or otherwise) shall be in any way responsible or liable for its content.

The materials in this website are in no way intended to replace the professional medical care, advice, diagnosis or treatment of a doctor.  The website does not have answers to all problems and answers to specific problems may not apply to everyone.  If you notice medical symptoms or feel unwell, you should consult your doctor.  For further information, consult the terms and conditions.


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