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Updated: Feb 3 2021

Parvovirus B19

  • 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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