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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

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Questions (6)
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(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:
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 C

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(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
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 D

Select Answer to see Preferred Response

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Evidence (4)
EXPERT COMMENTS (6)
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