epocrates logo
epocrates logo
epocrates logo
  • 0

Diseases

Erythema infectiosum

OVERVIEW

  • Highlights & Basics
  • Images

DIAGNOSIS

  • Diagnostic Approach
  • Risk Factors
  • History & Exam
  • Tests
  • Differential Diagnosis
  • Criteria
  • Screening

TREATMENT

  • Tx Approach
  • Tx Options
  • Emerging Tx
  • Prevention

FOLLOW-UP

  • Overview
  • Complications

REFERENCES

  • Citations
  • Guidelines
  • Credits

PATIENT RESOURCES

  • Patient Instructions

Highlights & Basics

AAFont SizeShareMore Information
Key Highlights
  • Erythema infectiosum classically presents in childhood with a "slapped cheek" appearance followed by a reticular, erythematous eruption that is predominantly found on the extremities and may be preceded by mild systemic symptoms. Adults, more than children, may report arthritis and arthralgias.

  • Most cases do not require specific treatment beyond symptomatic therapy and reassurance.

  • Infection in pregnant women may result in fetal anemia, hydrops fetalis, or intrauterine death.

  • Persistent infection, lasting longer than approximately 3 weeks and accompanied by chronic anemia, may occur in people who have immunosuppression (e.g., patients with HIV, people receiving chemotherapy or immunosuppression following transplant, or patients with congenital immunodeficiencies).

  • People with a high red blood cell turnover/destruction (e.g., those with hereditary spherocytosis, sickle cell disease, thalassemia, iron deficiency anemia) may develop transient aplastic crisis.

Typical erythematous "slapped cheeks" of erythema infectiosum.
Typical erythematous "slapped cheeks" of erythema infectiosum.
From the collection of Gary A. Dyer, MD; used with permission

Quick Reference

  • History & Exam

    • Key Factors

      • Other Factors

        More information...
      • Diagnostics Tests

          More information...
        • Treatment Options

            More information...

          Definition

          Epidemiology

          Etiology

          Pathophysiology

          content by BMJ Group
          Last updated

          Images

          • Typical erythematous "slapped cheeks" of erythema infectiosum.

            Typical erythematous "slapped cheeks" of erythema infectiosum.

          • Lacy, reticular, erythematous eruption of erythema infectiosum on an upper extremity.

            Lacy, reticular, erythematous eruption of erythema infectiosum on an upper extremity.

          Citations

            Key Articles

            • Young NS, Brown KE. Parvovirus B19. N Engl J Med. 2004;350:586-597.[Abstract]

            • UK Health Security Agency. Parvovirus B19: guidance, data and analysis. Aug 2024 [internet publication].[Full Text]

            • Cherry JD. Parvovirus infections in children and adults. Adv Pediatr. 1999;46:245-69.[Abstract]

            • Kimberlin DW, Banerjee R, Barnett ED, et al. Red book: 2024-2027 report of the Committee on Infectious Diseases. 33rd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2024.

            • Centers for Disease Control and prevention. Parvovirus B19 and fifth disease. Nov 2019 [internet publication].[Full Text]

            Referenced Articles

            • 1. Hashimoto H, Yuno T. Parvovirus B19-associated purpuric-petechial eruption. J Clin Virol. 2011;52:269-271.[Abstract]

            • 2. Young NS, Brown KE. Parvovirus B19. N Engl J Med. 2004;350:586-597.[Abstract]

            • 3. Shimohata H, Higuchi T, Ogawa Y, et al. Human parvovirus B19-induced acute glomerulonephritis: a case report. Ren Fail. 2013;35:159-162.[Abstract]

            • 4. Huang RJ, Varr BC, Triadafilopoulos G. Acute fulminant hepatic failure associated with parvovirus B19 infection in an immunocompetent adult. Dig Dis Sci. 2012;57:2811-2813.[Abstract]

            • 5. Douvoyiannis M, Litman N, Goldman DL. Neurologic manifestations associated with parvovirus B19 infection. Clin Infect Dis. 2009;48:1713-1723.[Abstract][Full Text]

            • 6. Barah F, Whiteside S, Batista S, et al. Neurological aspects of human parvovirus B19 infection: a systematic review. Rev Med Virol. 2014;24:154-168.[Abstract][Full Text]

            • 7. Molina KM, Garcia X, Denfield SW, et al. Parvovirus B19 myocarditis causes significant morbidity and mortality in children. Pediatr Cardiol. 2013;34:390-397.[Abstract]

            • 8. UK Health Security Agency. Parvovirus B19: guidance, data and analysis. Aug 2024 [internet publication].[Full Text]

            • 9. Cherry JD. Parvovirus infections in children and adults. Adv Pediatr. 1999;46:245-69.[Abstract]

            • 10. Lowry SM, Brent LH, Menaldino S, et al. A case of persistent parvovirus B19 infection with bilateral cartilaginous and ligamentous damage to the wrists. Clin Infect Dis. 2005 Aug 15;41(4):e42-4.[Abstract][Full Text]

            • 11. Azzi A, Morfini M, Mannucci PM. The transfusion associated transmission of Parvovirus B19. Transfus Med Rev. 1999;13:194-204.[Abstract]

            • 12. Yu MY, Alter HJ, Virata-Theimer ML, et al. Parvovirus B19 infection transmitted by transfusion of red blood cells confirmed by molecular analysis of linked donor and recipient samples. Transfusion. 2010;50:1712-1721.[Abstract]

            • 13. Centers for Disease Control and Prevenion. Emergency preparedness and response​: increase in human parvovirus B19 activity in the United States. Aug 2024 [internet publication].[Full Text]

            • 14. European Centre for Disease Prevention and Control. Risks posed by reported increased circulation of human parvovirus B19 in the EU/EEA. Jun 2024 [internet publication].​[Full Text]

            • 15. American College of Obstetricians and Gynecologists. Increase in human parvovirus B19 activity in the United States​. Aug 2024 [internet publication].[Full Text]

            • 16. Cohen B. Parvovirus B19: an expanding spectrum of disease. BMJ. 1995;311:1549-1552.[Abstract][Full Text]

            • 17. Brown KE, Hibbs JR, Gallinella G, et al. Resistance to parvovirus B19 infection due to lack of virus receptor (erythrocyte P antigen). N Engl J Med. 1994;330:1192-1196.[Abstract][Full Text]

            • 18. Anand A, Gray ES, Brown T, et al. Human parvovirus infection in pregnancy and hydrops fetalis. N Engl J Med. 1987;316:183-186.[Abstract]

            • 19. Kimberlin DW, Banerjee R, Barnett ED, et al. Red book: 2024-2027 report of the Committee on Infectious Diseases. 33rd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2024.

            • 20. Bernstein DI, Sahly HM, Keitel WA, et al. Safety and immunogenicity of a candidate parvovirus B19 vaccine. Vaccine. 2011;29:7357-7363.[Abstract]

            • 21. Bansal GP, Hatfield JA, Dunn FE, et al. Candidate recombinant vaccine for human B19 parvovirus. J Infect Dis. 1993;167;1034-1044.[Abstract]

            • 22. Ballou WR, Reed JL, Noble W, et al. Safety and immunogenicity of a recombinant parvovirus B19 vaccine formulated with MF59C.1. J Infect Dis. 2003;187;675-678.[Abstract][Full Text]

            • 23. Chandramouli S, Medina-Selby A, Coit D, et al. Generation of a parvovirus B19 vaccine candidate. Vaccine. 2013;31:3872-3878.[Abstract]

            • 24. Public Health England. Investigation, diagnosis and management of exposure to viral rash illness in pregnancy. Mar 2019 [internet publication].[Full Text]

            • 25. ​American College of Obstetricians and Gynecologists. Practice bulletin no.151: cytomegalovirus, parvovirus B19, varicella zoster, and toxoplasmosis in pregnancy. Jun 2015 [internet publication].[Full Text]

            • 26. Koch WC, Harger JH, Barnstein B, et al. Serologic and virologic evidence for frequent intrauterine transmission of human parvovirus B19 with a primary maternal infection during pregnancy. Pediatr Infect Dis J. 1998;17:489-494.[Abstract]

            • 27. Rosa C. Rubella and rubeola. Semin Perinatol. 1998;22:318-322.[Abstract]

            • 28. Centers of Disease Control and Prevention. Measles (rubeola): specimen collection, storage, and shipment. Jun 2022 [internet publication].[Full Text]

            • 29. Stoeckle MY. The spectrum of human herpesvirus 6 infection: from roseola infantum to adult disease. Annu Rev Med. 2000;51:423-430.[Abstract]

            • 30. Manders S. Toxin-mediated streptococcal and staphylococcal disease. J Am Acad Dermatol. 1998;39:383-398.[Abstract]

            • 31. Bratton RL, Nesse RE. St Anthony's Fire: diagnosis and management of erysipelas. Am Fam Physician. 1995;51:401-404.[Abstract]

            • 32. Centers for Disease Control and prevention. Parvovirus B19 and fifth disease. Nov 2019 [internet publication].[Full Text]

            • 33. Crabol Y, Terrier B, Rozenberg F, et al; Groupe d'experts de l'Assistance Publique-Hôpitaux de Paris. Intravenous immunoglobulin therapy for pure red cell aplasia related to human parvovirus b19 infection: a retrospective study of 10 patients and review of the literature. Clin Infect Dis. 2013;56:968-977.[Abstract]

            • 34. Miller E, Fairley CK, Cohen BJ, et al. Immediate and long term outcome of human parvovirus B19 infection in pregnancy. Br J Obstet Gynaecol. 1998;105:174-178.[Abstract]

            • 35. Gratacos E, Torres PJ, Vidal J, et al. The incidence of human parvovirus B19 infection during pregnancy and its impact on perinatal outcome. J Infect Dis. 1995;171:1360-1363.[Abstract]

            • 36. Fairley CK, Smoleniec JS, Caul OE, et al. Observational study of effect of intrauterine transfusions on outcome of fetal hydrops after parvovirus B19. Lancet. 1995;346:1335-1337.[Abstract]

            • 37. Selbing A, Jesefsson A, Dahlo LO, et al. Parvovirus B19 infection during pregnancy treated with high-dose intravenous gammaglobulin. Lancet. 1995;345:660-661.[Abstract]

          Have feedback?
          Tell us about your experience
          Scroll to Top
          epocrates logo

          Sign in to access our clinical decision support tools

          Sign inCreate Account
          Download Epocrates from the App StoreDownload Epocrates from the Play Store
          About UsFeaturesBusiness SolutionsHelp & Feedback
          © 2026 epocrates, Inc.   Terms of UsePrivacy PolicyEditorial PolicyDo Not Sell or Share My Information