Snapshot A 25-year-old woman presents to the emergency room for painful joints. She has had pain in her bilateral hands and wrists for the past few days. She also had a low-grade fever and mild upper respiratory symptoms. She is 14-weeks pregnant and has had good prenatal care. She works as a kindergarten teacher. On physical exam, the joint in her hands are slightly swollen and tender. A fetal ultrasound shows hydrops fetalis. Introduction Classification parvovirus B19 non-enveloped, linear, single-stranded DNA virus causes a variety of diseases aplastic crisis in patients with red blood cell disorders pure red blood cell aplasia in adults rheumatoid arthritis-like symptom in adults erythema infectiosum (fifth disease) in children hydrops fetalis in fetuses if pregnant women are infected transmission via respiratory droplets Epidemiology incidence highest in winter and spring demographics children > adults risk factors sickle cell disease thalassemia hereditary spherocytosis close proximity to others (e.g., school or daycare centers) Pathogenesis infects red blood cells through the P antigen viral replication in bone marrow causes the death of erythroid progenitor cells causes hydrops fetalis in fetuses due to severe fetal anemia Presentation Symptoms prodrome with flu-like symptom hydrops fetalis and fetal death in pregnant women polyarthropathy small joints (e.g., hands) Physical exam erythema infectiosum first rash appears as slapped cheeks subsequent rash is an erythematous maculopapular rash on the trunk and limbs, which may appear reticular or lacy Studies Labs parvovirus-specific immunoglobulin M detection of parvovirus on polymerase chain reaction anemia low or absent reticulocyte Making the diagnosis based on clinical presentation may be confirmed with laboratory studies Differential Measles distinguishing factors confluent maculopapular rash without slapped cheeks rash Koplik spots on buccal mucosa Rubella distinguishing factor non-confluent maculopapular rash that spreads from face to body Treatment Management approach mainstay of treatment is supportive care Conservative supportive care indication all patients modalities analgesics hydration Medical non-steroidal anti-inflammatory drugs indication polyarthropathy Complications Myocarditis Behcet syndrome Aplastic crisis
QUESTIONS 1 of 6 1 2 3 4 5 6 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.MC.14.201) A 17-month-old male is brought to your office by his mother for evaluation of a rash. Four days ago, the child experienced low-grade fever, irritability, and rhinorrhea. Physical examination is notable for the rash seen in Figure A. To which viral family does the most likely etiologic agent belong? QID: 106228 FIGURES: A Type & Select Correct Answer 1 Hepadnavirus 5% (4/73) 2 Herpesvirus 16% (12/73) 3 Parvovirus 56% (41/73) 4 Togavirus 7% (5/73) 5 Picornavirus 12% (9/73) M 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (M1.MC.13.10) A 9-year-old male presents to your office with an indurated rash on his face. You diagnose erythema infectiosum. Which of the following is characteristic of the virus causing this patient's disease? QID: 101469 Type & Select Correct Answer 1 Enveloped virus with double-stranded DNA 18% (64/357) 2 Enveloped virus with single-stranded DNA 18% (65/357) 3 Enveloped virus with single-stranded RNA 11% (40/357) 4 Non-enveloped virus with double-stranded DNA 11% (39/357) 5 Non-enveloped virus with single-stranded DNA 40% (142/357) M 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK