Prather Pediatric and Allergy Center - Ask Doctor Brent

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Title: Fifth's Disease and Sixth's Disease

Category: Child Care


Fifth's disease, or erythema infectiosa, has been recognized much more in the past few years. We now know that it is caused by the human parvo virus B19-3. It is called Fifth's disease after four more common viral rash illnesses seen in children which are measles, scarlet fever, rubella and scarlatina. The Sixth's disease is roseola. Fifth's disease virus, or human parvo virus B19, is attracted to rapidly dividing cells in the body. Therefore people with weak immune systems and with weak red blood cells are at high risk. This includes people with sickle cell disease, hereditary spirochaetosis, any serious immune disease or cancer, and AIDS. It also might include someone with recurrent blood loss and anemia. In these patients, a very severe with profound anemia and a very severe disease without the typical rash. These patients obviously need the care of an experienced physician and frequently a hematologist.

For the majority of patients, however, Fifths disease is a mild viral infection which starts with typical cold

like symptoms in adults and sometimes vague muscle aches and headache. This is the time in which the patient is actually contagious and the virus is multiplying in the body. After a few days, the virus clears and antibodies to the virus cause a classic rash in the skin. In adults, there is usually some joint swelling and tenderness. In children the rash is a slightly raised, bright red patch over the facial cheeks with some clearing directly around the mouth. Also present is a lacy pink to red rash scattered over the extremities and trunk. Usually palms and soles are spared. About 50% of the time, the rash itches. The rash seems to fade and come back whenever the child is stressed or exposed to a lot of sun or overheating. In older adolescents and adults, the rash may not appear as the typical rash seen in children.

The predominant symptoms seen in up to 60% of adults is joint swelling usually the wrist, hands or ankles. This may last for up to a few weeks but does not cause any permanent changes and does not cause rheumatoid arthritis. The joint symptoms are only found in about 3% of children up to age nine. Again, most children will acquire Fifth's disease at some time in their life and most adults, when tested for antibodies show evidence of having had it sometime in their life. The risk to a pregnant woman is considered about .6% and should be taken into account since a growing fetus does have both a weak immune system and rapidly dividing red cells and is, therefore, susceptible to the virus. It is not recommended that children with Fifth's disease be excluded from school because by the time the rash appears, they are actually not contagious. It is also not recommended that pregnant women be excluded from day care or other work situations because of the relative low risk to them. They should be aware, however, of any epidemics taking place and use good hand washing as a means of decreasing the spread of the virus. There is presently no vaccine but there is some experimental evidence that IV gamma globulin may help in high risk patients; however it is not presently recommended for routine patients. Infants of mothers who contract parvo virus B19 in early pregnancy are at risk for severe blood loss but do not develop birth defects. In cases where the diagnosis is picked up there have been fetal blood exchanges done and the infants have been saved through this procedure. Obviously this is something that would require a sophisticated medical center and a team of perinatologists and obstetrician.

Sixth's disease, or roseola, it is caused by human Herpes virus #6. It is also a common virus, about 90% of adults have antibodies to it and about 60% of all their children. It causes abrupt onset of high fever (sometimes over 104 degrees) usually in children between six and twenty-four months. It tends to occur more in the winter but can occur year round. In older children and adults it causes a mononucleosis like illness without fever but with some painless swelling of lymph nodes. Typically the white count is low, usually about 3,000 white count with a predominance of lymphocytes. There may be a transient increase in liver enzymes. At present, there is no therapy for Sixth's disease. The important medicine to give a child with Sixth's disease is Tylenol and reassurance that it will clear, usually within a few days.