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Erythema infectiosum
Classification and external resources

16 month old with fifth disease
ICD-10 B08.3
ICD-9 057.0
DiseasesDB 4442
eMedicine emerg/378 derm/136 ped/192
MeSH D016731

Erythema infectiosum or fifth disease is one of several possible manifestations of infection by erythrovirus previously called parvovirus B19.[1] The disease is also referred to as slapped cheek syndrome, slapcheek, slap face or slapped face.[2][3] In Japan the disease is called 'apple sickness' or 'ringo-byou' (りんご病)in reference to the symptom of facial redness.



The name "fifth disease" derives from its historical classification as the fifth of the classical childhood skin rashes or exanthems. The other common skin rashes are: 1.measles, 2. scarlet fever, 3.rubella, 4. Duke's disease. Following fifth disease is 6. roseola.

It was described by Anton Tschamer in 1889 as a rubella variant, identified as a distinct condition in 1896 by T. Escherich, and given the name "erythema infectiosum" in 1899.[4]


Bright red cheeks are a defining symptom of the infection in children (hence the name "slapped cheek disease"). Occasionally the rash will extend over the bridge of the nose or around the mouth. In addition to red cheeks, children often develop a red, lacy rash on the rest of the body, with the upper arms and legs being the most common locations. The rash typically lasts a couple of days and may itch; some cases have been known to last for several weeks. Patients are usually no longer infectious once the rash has appeared.[2][3]

Teenagers and adults may present with a self-limited arthritis. It manifests in painful swelling of the joints that feels similar to arthritis. Older children and adults with Fifth Disease may have difficulty in walking and in bending joints such as wrists, knees, ankles, fingers, and shoulders.[2][3]

The disease is usually mild,[5] but in certain risk groups it can have serious consequences:


Fifth disease is transmitted primarily by respiratory secretions (saliva, mucous etc.) but can also be spread by contact with infected blood. The incubation period (the time between the initial infection and the onset of symptoms) is usually between 4 and 21 days. Individuals with fifth disease are most infectious before the onset of symptoms. Typically, school children, day-care workers, teachers and mothers are most likely to be exposed to the virus. When symptoms are evident, there is little risk of transmission; therefore, infected individuals need not be isolated.[2][3]


Any age may be affected although it is most common in children aged five to fifteen years.[6] By the time adulthood is reached about half the population will have become immune following infection at some time in their past.[2][3] Outbreaks can arise especially in nursery schools, preschools, and elementary schools.

See also


  1. ^ Weir E (March 2005). "Parvovirus B19 infection: fifth disease and more". CMAJ 172 (6): 743. doi:10.1503/cmaj.045293. PMID 15767606. PMC 552884. 
  2. ^ a b c d e f Sabella C, Goldfarb J (October 1999). "Parvovirus B19 infections". Am Fam Physician 60 (5): 1455–60. PMID 10524489. Retrieved 2009-11-06. 
  3. ^ a b c d e f Servey JT, Reamy BV, Hodge J (February 2007). "Clinical presentations of parvovirus B19 infection". Am Fam Physician 75 (3): 373–6. PMID 17304869. Retrieved 2009-11-06. 
  4. ^ Altman, Lawrence K (November 30, 1982). "THE DOCTOR'S WORLD". The New York Times. Retrieved November 7, 2009. 
  5. ^ Mankuta D, Bar-Oz B, Koren G (March 1999). "Erythema infectiosum (Fifth disease) and pregnancy". Can Fam Physician 45: 603–5. PMID 10099795. 
  6. ^ Kwon, Kenneth T (March 19, 2009). "Pediatrics, Fifth Disease or Erythema Infectiosum". eMedicine. Retrieved November 7, 2009. 

External links



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