Clinical Manifestations of Parvovirus B19 Infection

Erythema infectiosum (fifth disease)

Mild flu-like symptoms (eg, low-grade fever, slight malaise)

Rash, usually both of the following:

• Indurated, confluent erythema of the cheeks (“slapped-cheek” appearance)

• Symmetric reticulated rash most prominent on the arms, legs, and trunk, usually sparing the palms and soles

Usually children, sometimes in adults

Papular-purpuric gloves-and-socks syndrome (PPGSS)

Papular, purpuric, or petechial lesions limited to the hands and feet

Often accompanied by fever and oral and/or genital lesions

Usually children, sometimes in adults

Transient aplastic crisis

Suppression of erythropoiesis, resulting in severe anemia

Usually children with hemoglobinopathies (eg, sickle cell disease) or other red blood cell disorders (eg, hereditary spherocytosis)

Sometimes in adults

Arthralgia or arthritis

Joint pain of small joints of the hands, wrists, knees, and feet—usually symmetric

Often with rash

Usually adults, most common among women

Pregnancy-related issues

Miscarriage

Stillbirth

Severe fetal anemia resulting in nonimmune hydrops fetalis

Pregnant patients

Prolonged infection

Often asymptomatic, sometimes can result in severe anemia

Patients with immunocompromise