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This disease is often referred to as Fifth Disease because it is the fifth common childhood disease. The classic description of the patient is that of a slapped cheek.   Patients usually have mild prodromal illness of respiratory symptoms and low grade fever. The slapped cheek rash appears first, predominately occurring on the cheeks and sparing the bridge of the nose and perioral area. When this eruption occurs, antibodies are formed. The rash becomes generalized and appears as lacy reticulated macules over the trunk and extremities, occurring as the facial rash fades. This generalized rash may flare with physical stimuli such as light, heat, or physical activity. In 15% of cases, it is pruritic. The majority of cases resolve within 1-2 weeks but occasional cases may last for 6 weeks.

It was only recently that the agent of infection has been identified as the parvovirus B19.  This virus has been associated with numerous other symptoms including fetal miscarriage, hydrops fetalis, and anemia. Thus it is important to identify all infectious exposures of the patient, especially to pregnant women.

SYNONYMS Fifth disease
AGE RANGE-MEDIAN 4-15 years of age
Peak incidence during the winter and spring


Arthritis and arthralgias

More common in adult patients
Usually the MCP, PIP, knees, wrists, and ankles

In children, occurs in 10% of cases


Mandell GL. etal. Principles and Practice of Infectious Disease. Fourth Edition. Churchill Livingstone 1995.

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Last Updated 12/29/2000

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