Parvovirus B19 Infection

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There are currently 5 well-established clinical conditions associated with parvovirus B19 infection:

1. Erythema infectiosum (fifth disease) – Erythema infectiosum is the most common clinical manifestation of parvovirus B19 infection and most commonly occurs in school-aged children. This is a biphasic illness with fever, myalgias, and malaise developing about 1 week after infection. Then the characteristic erythematous malar rash (slapped-cheek rash) typically occurs 2 weeks postinfection and is associated with the development of parvovirus B19-specific antibodies. A reticulated rash on the trunk and/or limbs may also develop. Recurrence of the rash following resolution of infection is not uncommon and can be triggered by a variety of stimuli, including sunlight, stress, and exercise.
2. Arthropathy – Arthropathy is a common manifestation of parvovirus B19 infection among adults and also occurs in approximately 5% of infected children. Clinical manifestations among adults and children differ. Parvovirus B19-associated arthropathy in adults typically includes symmetric involvement of the small joints of the hands, wrists, knees, and feet. While most arthropathy resolves in less than 6 weeks, a small proportion of adults have persistent or recurring symptoms lasting more than 6 months. Even among individuals who develop chronic arthropathy, joint destruction does not occur. Approximately 50% of adults also develop a faint, mildly itchy rash that accompanies the arthropathy. The development of this rash is less common and less pronounced in adults than in children. Arthropathy in children tends to be asymmetric and typically involves only the knees.
3. Transient aplastic crisis – Transient aplastic crisis (TAC) can occur following parvovirus B19 infection among individuals with pre-existing hematologic abnormalities that lead to decreased erythrocyte counts, including sickle cell anemia, hereditary spherocytosis, and iron deficiency anemia. Transient aplastic crisis occurs when, following parvovirus B19 infection in susceptible individuals, erythropoiesis is temporarily halted and severe anemia ensues. The onset of TAC corresponds to parvoviremia and typically resolves within 2 weeks following parvovirus B19-specific antibody development and clearance of the infection, at which time red blood cell production returns to baseline. In a small proportion of individuals, TAC may lead to dramatic declines in hemoglobin that cause / exacerbate congestive heart failure, cerebrovascular events, or acute splenic sequestration. See aplastic anemia.
4. Chronic red blood cell aplasia – Chronic red blood cell aplasia is most common among immunocompromised individuals (eg, individuals with HIV infection, cancer, or congenital immunodeficiencies and organ transplant recipients) with persistent parvovirus B19 infection due to their inability to mount an effective immune response. Patients may present with symptoms associated with severe anemia such as fatigue and pallor. See pure red cell aplasia.
5. Nonimmune hydrops fetalis / miscarriage / intrauterine death – Vertical transmission of parvovirus B19 infection from mother to child may lead to hydrops fetalis, miscarriage, or intrauterine death. Hydrops fetalis results from severe anemia and is associated with fetal edema and a thick, hydropic placenta. Risk for both hydrops fetalis and intrauterine fetal death varies with the timing of maternal infection. Risk for hydrops fetalis is highest when infection occurs between 9 and 20 weeks of gestation; fetal death most often occurs from infection between 20 and 24 weeks of gestation.

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