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It is a well-known fact that multiple pathogenic microorganisms endanger a human being’s life. Everyone is at potential risk of contracting an infectious disease that can significantly compromise his/her immune system and cause serious intoxication. Various contagious afflictions start to develop when diverse viruses or bacteria enter the body, entailing an immune response, and fifth disease is one of them. Despite the fact that the disease is a mild one, it can worsen the quality of life. Therefore, sufficient knowledge about fifth disease, its signs and symptoms, and diagnostic as well as therapeutic methods can be useful for the identification and appropriate management of the illness and, consequently, for general health maintenance. Moreover, knowledge of preventive care related to fifth disease can minimize the chance of catching it.
Fifth disease belongs to common and contagious viral infections that greatly weaken the immune system. It is frequently called either erythema infectiosum or parvovirus infection which is characterized by “a slapped-cheek appearance and lacy exanthema” (Zellman, 2017). The affliction occupies the fifth place in the list of the most common “childhood illnesses associated with rashes” (Ferry Jr., 2016). It is caused by human parvovirus B19 that can penetrate the human body through the air, such respiratory secretions as nasal mucus, saliva, and sputum, and ultimately through blood and blood products. Hand-to-hand contact is one more mode of transmission of parvovirus B19. Parvovirus B19 is “a single-stranded virus that targets red cells in the bone marrow,” which can result in severe anemia (Nordqvist, 2017). Despite the fact that the progression of the disease is asymptomatic or mild, it can cause severe complications, particularly in patients with immune deficiencies or blood disorders. Additionally, this virus can be dangerous for pregnant women who may transmit it to fetuses.
The disease equally affects children and adults of any age and sex. However, children between 5 and 14 years as well as pregnant females are at greater risk of acquiring fifth disease. It is estimated that approximately 70% of clinical cases associated with erythema infectiosum occur in children aged 5-15 years (Zellman, 2017). Various surveys show that the described disease is a frequent occurrence in winter and spring months, though it can occur any time of the year. However, it prevails in countries with “temperate climates and various strains implicated” (Zellman, 2017). Americans, Asians, and Europeans equally suffer from parvovirus B19.
The onset of fifth disease can progress asymptomatically or mildly. Furthermore, the conducted investigations show that approximately 50% of the adult population is even unaware of being infected with parvovirus B19 as individuals have minor or no clear symptoms (Ferry Jr., 2016). It generally becomes apparent at the advanced stage with more evident clinical manifestations. The incubation period lasts from two to three weeks. At this time, the disease is most contagious. When the disease progresses, people affected by erythema infectiosum begin to suffer from cold-like symptoms such as slight fever, malaise, headaches, and pruritus that primarily precede the rash. They may also have complaints about a sore throat, abdominal pain, and acute coryza. The disease is rarely accompanied by nausea and diarrhea, though in some cases these manifestations are present. At the same time, adult patients with symptoms of fifth disease may experience “neurological or cardiovascular problems” (Nordqvist, 2017). However, the most typical symptom that differentiates fifth disease from other viral infections is a reddish rash on cheeks that appears after a week and gradually spreads all over the body. The exanthem begins with “the slapped-cheek appearance, which typically fades over 2-4 days” (Zellman, 2017). The rash frequently develops in children whereas adults primarily experience joint pain or swelling. The presence of joint pains and aches constitutes the further progression of the disease. Fifth disease is associated with the development of arthritis and arthropathy in patients infected with parvovirus B19 that can become a long-term health problem. Knees, wrists, and finger joints are most commonly affected by arthritis against a background of fifth disease (Mayo Clinic Staff, 2015). Health care providers differentiate polyarticular and pauciarticular joint damage. When patients have acute polyarticular arthritis caused by fifth disease, more than five of their joints can be affected, while only four or a smaller number of their joints are damaged when they suffer from pauciarticular arthritis. It is estimated that females are more likely to have joint pain than males. People who suffer either from arthritis or arthropathy experience stiffness and “swelling of the same joints on both sides of the body” (Jerry Jr., 2016). Patients infected with erythema infectiosum may have reticulocytopenia and mild bone marrow suppression. In certain cases, clinical tests can help to discover that an individual has thrombocytopenia, neutropenia, and lymphopenia that can be caused by parvovirus infection.
A precise and comprehensive diagnostic evaluation of erythema infectiosum (or fifth disease) is necessary for developing appropriate treatment plans. Diagnosticians involve traditional diagnostic techniques and tests for the identification of fifth disease. A careful physical examination and interview with a patient are the primary diagnostic tools that can largely assist in evaluating physical abnormalities specific to fifth disease. The interview with patients can help doctors to obtain more information about clinical manifestations and genetic factors that may facilitate the diagnosis. Depending on the extent of the rash, specialists can specify the stage of the disease. IgG and IgM tests can also help them to determine whether a patient has “susceptibility or immunity to parvovirus B19 infection” (Centers for Disease Control and Prevention, 2015). These tests are particularly recommended for individuals who are at high risk of having complications. Such specific tests as “enzyme-linked immunosorbent assay, radioimmunoassay, dot blot hybridization, polymerase chain reaction assay and loop-mediated isothermal amplification” can be used to prove that a person is infected with parvovirus (Zellman, 2017). Moreover, in case the virus is detected in a pregnant woman, additional tests such as an ultrasound scan, Doppler examination, and complete blood count are required. These tests allow revealing hydrops fetalis. A full blood count is also advised to children with hemolytic anemia to monitor blood values.
Mild cases of fifth disease generally do not require any specific clinical intervention. However, there are certain treatment options that can be used to reduce symptoms associated with the disease. Health care providers prescribe nonsteroidal anti-inflammatory medications, topical antipruritics, and antihistamine drugs to relieve “fever, malaise, headache, and arthralgia” (Zellman, 2017). Moreover, antihistamine drugs can be effective in reducing pruritis. Blood transfusions can be beneficial in case patients with fifth disease have severe anemia. Patients with significantly weakened immune systems may receive immune globulin injections, providing antibodies that combat infection. Increased fluid consumption and sufficient relaxation as well as rest can alleviate symptoms of the disease and accelerate the process of recovery. Antibiotic therapy is not used in the medical management of fifth disease, considering that it is a viral infection.
Any kind of preventive care can minimize risks of catching diseases, including parvovirus B19 infection. There are no available vaccines or medicines that can protect people from this virus. Therefore, such preventive measures as proper hand washing, good personal hygiene, and avoiding sick people and congregated places during periods when the virus is prevalent can be effective in reducing chances of having fifth disease. Staying at home when one is sick and good ventilation can also assist in precluding health decline due to parvovirus B19. Increased fluid intake and good nutrition contribute to the immune system reinforcement, which can be considered preventive care as well.
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In most clinical cases, fifth disease does not entail serious complications. However, parvovirus B19 can be dangerous for pregnant women, immunocompetent individuals, and people with blood abnormalities, considering that it affects “red blood cell production” causing acute anemia (Nordqvist, 2017). Sometimes, the disease is responsible for miscarriage and stillbirth. Additionally, it can damage the development of the fetus and provoke fetal death. Furthermore, erythema infectiosum can cause “fetal hydrops, which can lead to congestive heart failure and a severe form of edema” due to anemia (Nordqvist, 2017). Newborns delivered by women with fifth disease are at high risk of developing anemia. It is estimated that parvovirus infection is capable of impairing blood formation and causing severe anemia in children with sickle-cell or other types of anemia. People with compromised immune systems may have problems with their bone marrow if they contract fifth disease. In this case, the bone marrow ceases the production of the normal quantity of red blood cells, which may result in erythrocyte aplasia or aplastic anemia. Severe forms of fifth disease can provoke the progression of rheumatoid arthritis in children and polyarthropathy in adults. Chronic forms of parvovirus infection can cause “erythropoietin-resistant anaemia, proteinuria, and glomerulosclerosis in a renal allograft” in immunodeficient patients (Oakley, 2015). Amegakaryocytic thrombocytopenia, myositis, hepatitis, encephalitis, non-occlusive bowel infarction, and heart disease are rare, but possible complications of fifth disease.
Immunocompetent patients are likely to have lifelong immunity after being infected with erythema infectiosum. When the disease progresses, they may have minor symptoms and completely recover if they follow medical recommendations. However, immunocompromised patients, previously anemic individuals, and pregnant women are at risk of developing severe anemia that should be appropriately treated to avoid life-threatening conditions.
To conclude, fifth disease, which is also known as erythema infectiosum, belongs to benign conditions. It is caused by parvovirus B19 that weakens the immune system and worsens overall health, particularly that of pregnant women and people with blood disorders as well as immunodeficiencies. The affliction equally affects adults and children, though it is more common among young people. The asymptomatic onset and progression of the disease do not allow doctors to timely diagnose it. Therefore, it is frequently revealed at the advanced stage or even post factum. Fifth disease is primarily characterized by cold-like symptoms. However, the reddish rash or erythema allows distinguishing the disease from other viral infections with similar symptoms. A physical examination is a primary diagnostic tool for detecting fifth disease. A complete blood count, other specific blood tests, and ultrasound scan are also used to reveal parvovirus in pregnant females and children with hereditary anemia. Mild cases of fifth disease do not require any specific treatment. However, the prescription of anti-inflammatory and antihistamine medications can be effective in relieving symptoms associated with the disease. Blood transfusions are also helpful in case a person has severe anemia caused by fifth disease. Good personal hygiene, avoidance of sick people, and immune system reinforcement are the main preventive measures taken to decrease the number of people having fifth disease. Severe anemia and fetal death are the most frequent complications of fifth disease. People with healthy immune systems are likely to develop lifelong immunity to the affliction.