Click here to view next page of this article


Erythema Infectiosum (Fifs Disease)

Most of the common viral exanthems are part of self-limited illnesses. Viral exanthems, bacterial and rickettsial infections can also be a cause of febrile exanthems, and failure to correctly distinguish viral from bacterial exanthems can have fatal consequences. Fulminant illnesses with an early exanthematous phase such as meningococcemia, Kawasaki syndrome, or the bacterial toxic shock syndromes require prompt intervention. Viral illnesses such as rubella and erythema infectiosum can lead to serious complications for developing fetuses when pregnant women.

Although the clinical morphology of certain exanthems can be highly specific (ie, "slapped-cheek appearance" and reticulated erythema in erythema infectiosum), in most cases the skin eruption alone will not permit accurate diagnosis. Cutaneous physical findings must be interpreted in concert with the

In a study of 100 children with acute febrile illness and rash, infectious agents were identified in 65, with viruses accounting for 72%. Bacterial pathogens were detected in 20%.

Erythema infectiosum is a common childhood eruption with several distinctive clinical features. The most characteristic feature is the rapid appearance of facial erythema, which is typically bright red.

The exanthem of fifth disease is occasionally preceded by a mild prodrome of low-grade fever, malaise, sore throat, and coryza. For most children it is a benign illness that resolves spontaneously over a period of 1 to 2 weeks. In some patients, however, the rash may recur periodically for a period of a month or longer before it disappears completely.

Fifth disease derives its unusual name from the assignment of numbers to the childhood exanthems. Cheinisse of Paris assigned the number 5 to erythema infectiosum in 1905. The cause of fifth disease is now known to be human parvovirus B19. Parvovirus B19 infection, which is often asymptomatic.

Parvovirus B19 infection in adults may also cause a reticulated erythematous eruption associated with a symmetrical polyarthropathy involving the hands, feet, and knees. Parvovirus B19 is also implicated.

Papular-Purpuric Gloves and Socks Syndrome

Acute parvovirus B19 infection has recently been associated with Fifs disease, a unique exanthem that localizes to the hands and feet. In 1990 Harms and colleagues reported an acute, self-limited dermatosis occurring in five young adults, characterized by the sudden onset of confluent erythema.