Massachusetts General Hospital

Fifth Disease

What is fifth disease?

Fifth disease is a viral illness that is associated with an exanthem. Exanthem is another name for a rash or skin eruption that occurs due to an infection or disease. Fifth disease is spread from one child to another through direct contact with discharge from the nose and throat. It can also be spread through contact with infected blood. It is moderately contagious and usually does not include a high fever, as seen with some other viral skin conditions.

What causes fifth disease?

Fifth disease is caused by the human parvovirus. It is most prevalent in the winter and spring and is usually seen in school age children. Outbreaks of the disease frequently occur in school settings.

What are the symptoms of fifth disease?

It may take between four to 14 days for the child to develop symptoms of fifth disease after being exposed to the disease. About 80 percent of children have very mild symptoms for about a week before developing the rash. About 20 percent will have no symptoms at all before the rash appears. Children are most contagious before the rash occurs. Therefore, children are contagious before they even know they have the disease. The following are the most common symptoms of fifth disease. However, each child may experience symptoms differently. Symptoms may include:

• There may be an early phase with the following symptoms, although the symptoms are sometimes very mild and nearly unnoticed. If present, symptoms may include the following:

  • Fever

  • Headache

  • Red eyes

  • Sore throat

• The rash is usually the primary symptom of fifth disease. The rash:

  • Starts on the cheeks and is bright red; The rash looks like "slapped" cheeks.

  • Then spreads to the trunk, arms, and legs, and lasts two to four days; It often has a "lacey" appearance. 

  • May then continue to reappear if the child is exposed to sunlight, very hot or cold temperature, or trauma to the skin; This may continue for several days.

Fifth disease is usually a mild illness. However, parvovirus B19 infection may cause an acute severe anemia in persons with sickle-cell disease or immune deficiencies. There is a small risk of fetal death if fifth disease is acquired during pregnancy.

The symptoms of fifth disease may resemble other conditions or medical problems. Always consult your child's doctor for a diagnosis.

How is fifth disease diagnosed?

Fifth disease is usually diagnosed based on a complete medical history and physical examination of your child. The rash and progression of fifth disease is unique, and usually allows for a diagnosis simply on physical examination. In addition, your child's doctor may order blood tests to aid in the diagnosis.

Treatment for fifth disease

Specific treatment for fifth disease will be determined by your child's doctor based on:

• Your child's age, overall health, and medical history

• Extent of the disease

• Your child's tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

The goal of treatment for fifth disease is to help decrease the severity of the symptoms. Since it is a viral infection, there is no cure for fifth disease. Treatment may include:

• Increased fluid intake

• Acetaminophen for fever (DO NOT GIVE ASPIRIN)