Infectious Erythema (Fifth Disease)

What is Infectious Erythema (Fifth Disease)?

Infectious erythema – a group of acute infectious diseases of unknown etiology. Characterized by fever, symptoms of intoxication and the appearance of large elements of the rash, merging into erythematous fields.

Causes of Infectious Erythema (Fifth Disease)

The pathogen is not selected. In some forms (infectious erythema of Rosenberg, Chamera, sudden rash), it probably refers to viruses. Erythema nodosum is a symptom that occurs in a number of infectious diseases, especially with severe allergic restructuring (rheumatism, tuberculosis, tularemia, pseudotuberculosis, cat scratch disease, etc.). Erythema multiforme exudative, in particular its more severe variant – Stevens-Johnson syndrome, is associated with the use of a number of drugs, especially long-acting sulfonamides.

Diseases occur as sporadic cases. The source and reservoir of the infection are unknown. Patients are not dangerous to others.

Pathogenesis during Infectious Erythema (Fifth Disease)

Pathogenesis has not been studied.

Symptoms of Infectious Erythema (Fifth Disease)

The main clinical forms of erythema are:

  1. Erythema infectiosum Rosenberg,
  2. Erythema infectiosum Tschamer,
  3. Erythema nodosum,
  4. Erythema exudative multiforme,
  5. Erythema subitum,
  6. Undifferentiated infectious Erythema.

Erythema infectiosum Rosenberg is characterized by acute onset, severe fever, and symptoms of general intoxication (severe headache, insomnia, myalgia and arthralgia). On the 4th-6th day, a copious, mottled or maculopapular rash appears with predominant localization on the extensor surfaces of the extremities, thickening in the area of ​​the large joints and on the buttocks, where they form solid erythematous fields. There is no rash on the face. After 5-6 days, the exanthema disappears, leaving behind a scaly or lamellar peeling. Fever lasts 8-12 days. The liver and spleen are often enlarged. Individual patients may have swelling of the joints, as well as meningeal phenomena.

Erythema infectiosum Tschamer. The incubation period lasts 9-14 days. The disease is easy. Most children get sick. Body temperature is normal or low-grade. From the first day of the disease, a characteristic rash appears on the skin of the face, first in the form of small spots, which then merge to form a butterfly shape. Individual elements of the rash can be on the trunk and extremities. Elements of the rash turn pale from the center. The exanthema persists for a long time (about 2 weeks). Sometimes the almost disappeared elements of the rash appear again in the same place. The reappearance of the rash can be triggered by fever, overheating, and physical exertion. Some patients have moderately pronounced inflammatory changes in the upper respiratory tract and conjunctival hyperemia. In some patients, mainly in adults, moderate pain and swelling of the joints are noted. Currently, the pathogen of this infection is identified as a human parvovirus (B 19). Infection often occurs inapparently (asymptomatically), since antibodies to this virus are found in 30-40% of healthy people.

Erythema nodosum is one of the manifestations of a number of infectious diseases (tularemia, rheumatism, tuberculosis, etc.). It is characterized by an increase in body temperature (if it has not already been elevated due to the underlying disease), sore limbs, especially in large joints, and characteristic exanthema. The rash appears on symmetrical areas of the legs and forearms, less often on the hips and feet. Elements of the rash are nodes (up to 3-5 cm in diameter), dense and painful on palpation, towering above the skin level, an infiltrate is felt in the depths of the skin. The color of the skin above the nodes is red at first, then cyanotic, and when the infiltrate decreases, it is greenish-yellow. Nodes remain up to 3 weeks.

Erythema exudative multiforme is characterized by fever (39-40°C), symptoms of general intoxication (headache, weakness, arthralgia). On the 4-6th day there is a copious polymorphic rash, exciting body and extremities. Sometimes there is a symmetry of the rash. Elements of the rash are spots, papules. Especially characteristic is the formation of bubbles filled with transparent contents. After a bubble breaks, a red abrasion is formed in its place, and then a brownish crust. At the site of the rash, patients note itching and burning of the skin. With a more severe variant of erythema – Stevens-Johnson syndrome, in addition to skin lesions, erosive-ulcerative changes of the mucous membrane of the mouth, nasopharynx, genital organs, anus occur. The disease usually lasts 1~3 weeks, and Stevens-Johnson syndrome lasts up to 6 weeks or more. Described lethal outcomes.

Erythema subitum. The incubation period lasts 3-5 days. The disease begins acutely with a rapid rise in body temperature up to 38–40°C and relatively mild symptoms of general intoxication. On the 3-4th day of illness, the temperature drops to normal, and at this time a rash appears (or after 1-2 days), exciting face, torso and limbs. Elements of the rash are small pale pink spots (up to 5 mm in diameter), which sometimes coalesce and resemble a measles rash (but not so bright) or rubella. After 2-3 days, the rash disappears, leaving no peeling, no pigmentation. In the blood in the first days of the disease neutrophilic leukocytosis is noted, with the appearance of a rash – leukopenia, neutropenia, lymphocytosis.

Undifferentiated infectious erythema is a group of infectious diseases of unclear (or unspecified) etiology, characterized by fever, mild symptoms of general intoxication and exanthema, which is not typical of any known infectious diseases.

Diagnosis of Infectious Erythema (Fifth Disease)

The recognition of infectious erythema is based on clinical symptoms. Quite a few varieties of erythema are observed in skin diseases, but all of them can be excluded due to the absence of fever and signs of general intoxication characteristic of infectious diseases. Only in some infectious diseases, erythematous changes occur without fever (tuberculoid type of leprosy, cutaneous leishmaniasis, filariasis with skin changes, etc.).

Among the infectious diseases in which there is a hyperemia of the skin, there are 2 groups. In one of them, erythema proper is observed, i.e. hyperemia of the skin due to the merger of large spots in the erythematous field, in another group of diseases there is a hyperemia of the skin in the area of ​​local inflammatory changes (erysipelas, erysipeloid, anthrax). This group can be easily differentiated from erythema. Erythematous rash can be observed sometimes in some infectious diseases (infectious mononucleosis, leptospirosis, atypical exanthema in paratyphoid A, enterovirus exanthema). They have to be differentiated not according to exanthema, but according to other clinical manifestations characteristic of each nosological form, as well as according to laboratory data confirming their diagnosis.

With infectious erythema, it is sometimes necessary to differentiate systemic lupus erythematosus, although it does not belong to infectious diseases, but it occurs with fever and severe symptoms of general intoxication. It differs in a long chronic course. The exanthema is polymorphic both in the character of the elements and in localization (face, limbs, body). In addition to erythema, there can be scattered spotted and nodular elements. Characterized by damage to the joints, muscles, internal organs.

Laboratory methods are used mainly to exclude other infectious diseases. There are no specific laboratory methods for the diagnosis of infectious erythema. It should be borne in mind that the diagnosis of undifferentiated infectious erythema can hide a variety of infectious diseases, sometimes atypical, and therefore the diagnosis is valid only after a thorough examination of the patient and the exclusion of other infectious diseases.

Treatment of Infectious Erythema (Fifth Disease)

In milder forms, erythema is limited to symptomatic treatment. With erythema nodosum, vigorous etiotropic therapy of the underlying disease is carried out, and antihistamines are also prescribed (diphenhydramine, suprastin, diprazin, etc.). With exudative erythema multiforme, medications that can cause the development of this disease are canceled (prolonged sulfonamides). In severe Rosenberg erythema and exudative erythema multiforme, corticosteroids are prescribed (prednisone starting at 30–40 mg and gradually decreasing the dose, or equivalent doses of other hormonal drugs) for 7–15 days.

The prognosis is favorable. In severe cases of polymorphic exudative erythema (Stevens-Johnson syndrome), the prognosis is more serious, deaths have been observed.

Prevention of Infectious Erythema (Fifth Disease)

Prevention is not developed. Patients do not pose a danger to others, activities in the outbreak are not carried out.