PANCE Blueprint Infectious Disease (6%)

Erythema infectiosum (Slapped Cheek/ReelDx + Lecture)

600 REEL-DX-ENHANCED

Fifth disease ReelDx

4 y/o with low-grade fever, rash on cheeks x 24h now spreading to the trunk

Patient will present as → a 4-year-old who is brought to the office by his mother. The child has had a low-grade fever, headache, and sore throat for the past week. Four days ago, he suddenly developed a bright red rash on his cheeks, which during the past two days has spread to the trunk, arms, and legs. On physical examination, the child has erythema of the cheeks and a maculopapular rash with central clearing on the trunk spreading to the extremities. There are no other significant findings.

Erythema infectiosum (also known as Fifth's disease) is a common viral exanthem observed in pediatric patients caused by parvovirus B19

  • Slapped cheek rash on the face with circumoral pallor 2-4 days of lacy reticular rash (blanching) on extremities
  • Often preceded by prodrome sequence with a low-grade fever
  • Sickle cell patients are at high risk of developing aplastic crises with this disease

Diagnosis is based primarily on clinical observations, history, and physical exam

  • Serology: associated with enlarged nuclei with peripherally displaced chromatin
  • PARVO B19-specific IgM antibodies and PCR

Observation alone

  • Treatment is symptomatic
  • The rash may last a few days to several weeks. It is frequently pruritic
  • There is no specific antiviral used and no vaccine is available
  • Parvovirus B19 is a droplet infection that is no longer contagious once the rash breaks out. Children may return to school and resume activities as symptoms allow.
osmosis Osmosis

(Erythema infectiosum lecture begins at 1:15)

Picmonic
View Fifth’s Disease

IM_NUR_EythemaIfectiosumFifthsDisease_v1.2_

Erythema infectiosum or Fifth’s Disease is a mild viral infection that is characterized by the slapped face appearance. It typically occurs in school-age children; however, adults can contract the disease. Pain and swelling in the joints (polyarthropathy syndrome) is a common finding in adult women with the disease. It is transmitted by respiratory secretions, blood, and blood products. The period of communicability is uncertain and the incubation period is 4 to 14 days and may be as long as 21 days. Isolation is not necessary.

Play Video + Quiz

Question 1
Which of the following is responsible for the skin lesion shown in the video above?
A
Staphylococcus
Hint:
See B for explanation
B
Parvovirus-B19
C
Herpes simplex virus
Hint:
See B for explanation
D
Cytomegalovirus
Hint:
See B for explanation
Question 1 Explanation: 
The skin lesion is the classic ‘slapped-cheek’ appearance of erythema infectiosum caused by Parvovirus-B19
Question 2
Parvovirus-B19 is unlikely to cause aplastic crisis in which of the following conditions
A
Sickle cell anemia
Hint:
See B for explanation
B
Megaloblastic anemia
C
Thalassemia
Hint:
See B for explanation
D
G6PD deficiency
Hint:
See B for explanation
Question 2 Explanation: 
Parvovirus-B19 causes aplastic crisis in patients with chronic hemolytic anemia. Megaloblastic anemia is not associated with chronic hemolysis. All other options are associated with chronic hemolysis.
Question 3
One of the following cross-matches is correct?
A
Lyme disease ------------- Erythema marginatum
Hint:
Lyme disease ------------- Erythema migrans
B
Rheumatic fever ------------- Erythema nodosum
Hint:
Rheumatic fever ------------- Erythema marginatum
C
Parvovirus-B19 --------------- Erythema infectiosum
D
Infectious mononucleosis ------------ Erythema migrans
Hint:
Infectious mononucleosis ------------ Erythema nodosum
Question 3 Explanation: 
A: Lyme disease ------------- Erythema migrans B: Rheumatic fever ------------- Erythema marginatum C: Infectious mononucleosis ------------ Erythema nodosum
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Lesson Intro Video

Epstein-Barr virus infections (ReelDx + Lecture) (Prev Lesson)
(Next Lesson) Herpes simplex (ReelDx)
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