Diagnosis

Often a physician will be able to diagnose fifth disease from the characteristic rash and/or arthralgia that is evident during an examination. This is sufficient when diagnosing fifth disease in a healthy child or adult. This rash is not evident in all cases. However, in cases that occur during pregnancy or in an immunocompromised patient or in an anemic individual, it is important to confirm the diagnosis. To do this, a blood sample is taken, which is then screened for antibodies to the virus. Antibodies are proteins that are produced by our immune systems in response to a foreign invader or germ. There are 2 different types of antibodies that the physician will look for when diagnosing fifth disease: immunoglobulin G (IgG) and immunoglobulin M (IgM). If IgM is evident, then you may be in the middle of an infection or have had a very recent infection. If IgG antibodies are present, you have had the virus and do not need to worry about contracting it again. If you do not have either of the antibodies, you are susceptible to contracting the infection and should take precautionary measures if pregnant. These measures should include staying away from infected individuals, washing hands frequently and being aware of outbreaks in your area.

Treatment

Treatment of the symptoms of fifth disease is usually sufficient to give the patient relief. Some of these symptoms include fever, joint pain and itching. Adults with joint pain may need to rest and take anti-inflammatory and pain medication. Those patients who suffer from anemia may need to be hospitalized in order to receive blood transfusions. Individuals with immune problems may need special care and treatment with antibodies to assist their body in getting rid of the infection.

Treatment during pregnancy

Due to the fact that fifth disease infection is transmitted to the fetus in 30% of cases in non-immune pregnant women, it is imperative to receive the correct treatment if affected. Guidelines for the Obstetrician/Gynecologist (OB/GYN) indicate that infected pregnant women should undergo an initial fetal ultrasound to identify any congenital abnormalities in the fetus. The OB/GYN should then carry out weekly ultrasounds for 8-10 weeks after the initial infection. At this early stage, fetal injury will show up and then can be treated.

If fetal hydrops is indicated on any of the ultrasounds, further treatment may be necessary. This may involve, testing the fetal blood for fifth disease and then performing an intrauterine blood transfusion. This provides the baby with fresh, oxygenated blood.

ACOG Practice Bulletin - Clinical Management Guidelines for Obstetrician/Gynecologists
Number 20, September 2000

The following recommendations are based on limited and inconsistent scientific data (Level B): Pregnant women who have acute parvovirus B19 infection during their pregnancy should be monitored with serial ultrasound examinations for at least 10 weeks following infection for the presence of hydrops fetalis.

The following recommendations are based primarily on consensus and expert opinion (Level C): Pregnant women exposed to parvovirus B19 should have serologic screening performed to determine if they are at risk for seroconversion.