Erythema infectiosum (“fifths disease”) is a fairly common childhood disease. In childhood it is usually easily tolerated (about 60% got infected in childhood). However, fifths disease pregnancy can seriously hurt your child. According to the statistics, 1 in 400 women gets infected with the fifths disease during pregnancy.
What Is Fifths Disease?
This unusual name conceals behind itself one of the viral diseases, which is accompanied by a rash. The fifth disease, or infectious erythema, affects mainly children aged 5-15 years. The majority of children quickly overcome this disease without problems. Usually it takes place from the end of winter to the beginning of summer and spreads by airborne way among children during sneezing, coughing or physical contact. Parents first notice a typical rash on the face, but the child is most contagious even before the onset of this symptom. That’s why it is so hard to prevent the spread of the disease in groups of children. A rash is an immune response to an infection and actually appears at a time when the infection starts disappearing.
This is one of the varieties of skin diseases, which manifests itself in the form of a rash.
Erythema infectiosum is called fifths disease because it takes the fifth place in traditional medical texts describing childhood diseases that cause a reddish skin rash, namely: 1) measles; 2) scarlet fever; 3) red measles or rubella; 4) Duke’s disease; 5) the fifth disease, also called infectious erythema; 6) roseola. Spring is the time of the most frequent outbreaks of the fifth disease, when infection occurs by airborne droplets.
Infectious erythema is a viral infection that is caused by parvovirus B 19. Symptoms of this disease are similar to the flu, but, in addition, a red rash appears on the face.
What Is Parvovirus B 19?
This virus has a unique affinity- it infects the progenitor cells of erythrocytes. Inside the cell, the virus enters the nucleus and begins to multiply in it. In this case, the normal functioning of the erythrocyte progenitor is disrupted.
As a result, aging and dying red blood cells are not replaced by new ones. However, in a normal healthy person this goes unnoticed, since the life span of red blood cells exceeds the period of the virus, and its elimination by the immune system terminates earlier than anemia has time to develop.
The Course of the Fifths Disease
In children, the fifths disease usually proceeds easily. But in adults, especially in women, the disease is more complicated. There may appear pain in the joints. Some people note that the joints hurt for several weeks and even months. Very rarely the disease gives neurological and cardiac complications. Viruses from the family of parvoviruses cause diseases in animals, including cats and dogs. But these diseases are not transmitted to people. So, you cannot get infected from your pet.
The virus is transmitted by contact with the patient. The patient is contagious 7 days before the onset of the rash.
Erythema Infectiosum: Symptoms
Symptoms of infectious erythema may be different depending on the time of the disease, the dose of the virus and other factors – age, concomitant pathologies, problems with the blood system, etc. The earliest symptoms of infectious erythema can be considered respiratory manifestations resembling the onset of influenza. The temperature rises, there is a runny nose, sneezing, itching in the nose, pain and sore throat, there is general malaise, chills, headaches and decreased appetite. On the face and the body there are large elements of a rash of pink or cyanotic shade.
From the first day of the disease, a rash appears on the cheeks in the form of small spots, which then, merging, form a “butterfly”. This is a characteristic sign of the disease. The special “lacy” form of the rash is the main difference between infectious erythema and rubella. Often, the disease is accompanied by inflammation of the lymph nodes. It is noted that in some adults the disease can be asymptomatic, even without an eruption. Infectious erythema often passes itself or in the case of young children is treated with simple creams against children’s diaper rash and ointments against irritation.
The incubation period – the time from the moment of contact with the patient before the appearance of the rash – is 13-18 days.
The rash at first appears on the face, around the nose, and on the bridge of the nose, forming a butterfly pattern. Redness is observed. The skin looks like after a sunburn. On the fourth day, symptoms are relieved. In the beginning, the rash looks like dark red spots. Complete disappearance of the rash may take several weeks. Rashes usually appear after severe physical overload or stress.
Pain in the joints is usually observed in adults and older children. In adults, joint pain is more common than a rash.
The Incubation Period
The incubation period of this disease is about 13-18 days. As mentioned above, the child is most infectious before the onset of the rash. Infection is transmitted from person to person through the fluids of the nose, mouth, throat, sneezing, coughing, the use of common dishes, etc. In families where there is a child with a fifth disease, the other members of the family have about 50% chance of getting infected.
Fifths Disease Pregnancy
If you become infected with fifths disease during pregnancy, your baby can also be infected. Parvovirus easily enters the bloodstream and overcomes the placental barrier. In rare cases, the disease leads to miscarriage or the birth of a dead child. Mostly this applies to those mothers who got infected with the disease before 20 weeks. However, the probability (it is about 50%) is high, that in the past you already suffered from infectious erythema and developed immunity.
It happens that fifths disease pregnancy significantly reduces the number of red blood cells in the fetus. As a result, a still unborn baby develops severe anemia, which leads to a serious condition, such as dropsy of the fetus (fluid accumulation in the body cavities of the baby).
The Danger of Fifths Disease Pregnancy
In 70% of cases, a person gets sick with this virus at the age of 5 – 15 years. Still, the infection can develop at any time. More than half of all the population of developed countries have already transferred it, and now they have lifelong immunity.
For children and previously unaffected adults, parvovirus is not dangerous. In children, it flows easily, frightening parents mostly only with a rash. In adults, it is a little less pleasant, usually accompanied by pain in the joints, but also not dangerous.
Fifths disease presents the danger mainly for a pregnant woman, more specifically not for her, but for her fetus, since the virus can penetrate the placenta and infect the baby.
The risk of diaplacental infection, according to various sources, is 17-33%. If the fetus is infected, then there is a risk of anemia and dropsy. Conditions are dangerous, and the risks of losing a fetus infected with parvovirus B 19 are:
- 13% if infected before the 20th week of gestation
- 0.5% for infection after the 20th week of gestation
The difference is significant. The higher the gestation period of getting infected, the less dangerous this infection is. As the fetus grows up, the life span of erythrocytes increases, and the pathogenic effect of the virus becomes less significant.
Fifths Disease Pregnancy Treatment
In general, there is no treatment for the fifth disease. The disease is usually mild and goes away by itself.
If you are pregnant and become infected, your gynecologist will closely monitor your pregnancy and development of the baby. The doctor can recommend undergoing ultrasound once or twice a week for the next 8 – 12 weeks. If during this time ultrasound does not reveal any problems, you will no longer need to do ultrasound so often.
When ultrasound indicates that the child has a problem, you will have to do an amniocentesis to confirm the infection. If a child has been infected with the fifth disease, then most likely, the infection will pass by itself, but the child needs increased attention from the doctor.
The fifth disease causes severe anemia in children in less than 5% of infected pregnant women. Severe anemia can cause swelling, an accumulation of liquid in the body of the baby, which is called dropsy. Dropsy in its turn can lead to heart failure and the death of a child. If the ultrasound shows that the baby has a dropsy, the woman will have to go through the cordocentesis procedure to check the severity of the anemia in the baby. During this procedure, the doctor introduces a thin needle into the umbilical vein and takes a blood sample of the child for further investigation.
If your child has an extremely serious anemia that pose a threat to life, the baby can be given a blood transfusion through the umbilical cord. Usually 2-3 transfusions are required within 3-6 weeks. The results of 14 clinical studies showed that after transfusions the fetal survival with severe dropsy increases 1.5 times, in comparison with active expectant management.
There are no other methods of treatment, except for observation and transfusions. Antiviral drugs against parvovirus infection also do not exist. However, in most cases anemia is not serious, and the doctor will simply monitor the child’s condition to identify any new problems with the baby’s health before birth.
Preventing Fifths Disease during Pregnancy
In general, there is no means of fifth disease pregnancy prevention. There is no way to prevent the spread of the virus. As a precaution, it is advisable to focus on maintaining proper hygiene. You can protect yourself from fifths disease pregnancy in the following ways:
- Wash your hands thoroughly after having communicated with children (after all, the child can already be infected, but not yet have obvious symptoms);
- Do not use cups, glasses, forks or other houseware with anyone who is sick with fifth disease or in contact with a sick person.