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FIFTH DISEASE
Nicole Mabardi, SN and Shaina Joseph, SN
University of South Florida, College of Nursing
January 30, 2014
WHAT IS FIFTH DISEASE?
• Also known as Erythema Infectiousum
• Mild rash due to parvovirus B19
– Parovirus B19 only affects humans
– Parovirus B19 can cause different symptoms depending on age; however, those
affected usually do not have any symptoms.
– It can cause the body to temporarily stop making new red blood cell
• This can lead to anemia.
• Fifth disease is mostly seen in children 2 to 15 years of age, but it can be found
in adults as well.
• Quick Fact
–
Fifth disease got its name because it was fifth in a list of historical classifications
of common skin rash illnesses in children.
SYMPTOMS
• Symptoms at first are usually mild and nonspecific.
– They include:
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LOW GRADE FEVER
RUNNY NOSE
HEADACHE
JOINT PAIN (in adults)
• After several days, an erythematous rash appears on the face-specifically
the cheeks- of the infected child, giving them a “slapped cheek”
presentation.
• Days later, the rash spreads and erythematous blotches appear on their
chest, back, arms/legs, and buttocks.
• The rash varies in intensity and comes and goes for several weeks.
• The rash may be itchy (especially if the rash is on the soles of the
feet).
• It usually goes away in 7-10 days but can last for several weeks.
TRANSMISSION
• The virus spreads through respiratory secretions like saliva, mucous, and
sputum.
• Once infected by the virus, an individual will usually get sick within 4-14
days.
• The individual is most contagious when they have the fever like symptoms
(right before the rash appears).
• The virus can also spread through blood or blood products.
• Pregnant women can also pass the virus to their baby.
• Once a person has had Fifth Disease, they will have developed immunity
to it (they won’t get it again).
Clinical Case
• Five year old, Caucasian, male
• Cultural considerations- Both parents present with child; sibling at home
with grandma.
• Admitted for Fifth Disease
• Medical history of only a circumcision done at birth.
• No known allergies
• Subjective findings:
– Mother states that patient had a fever of 101 a few days ago.
– Patient states rashes itch.
• Objective findings:
– Rash over cheeks and body
– Patient is itching
– BP: 90/55; heart rate: 88; respirations:22; temperature: 98.7 F;
02 sat 97%
What assessment data about this patient
is particularly pertinent?
-Fever/ flu-like symptoms that have lasted a few days.
- Rash that appears first on the child’s cheeks and then
spreads throughout the body after a few days of having
these flu-like symptoms.
Is there additional data that you would like to
obtain before you notify the physician about
this patient?
-When exactly symptoms appeared, if anything was
consumed to relieve symptoms, and the medical
history of the patient especially those with sickle cell
disease (high risk).
Role Play With The Doctor
• Nurse: Good morning doctor, I have a five year old Caucasian
male who came in today with rashes over his cheeks and
body. His parents say he did have a fever and other flu-like
symptoms a few days ago. His parents are very concerned.
• Doctor: Ok, I will come by and perform a physical exam. In the
meantime, have blood work drawn to check for antibodies to
the parovirus B19 virus. If IgM antibodies are seen, then the
child may be in the middle of an infection or have had a
recent infection of the parovirus B19 virus (depending on the
stage they are at).
• Nurse: Sounds good, Doc. I will get a blood sample of the
patient.
What interventions would be appropriate for
this patient? Which of these interventions are
highest priority?
- Treatment is symptomatic:
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•
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pain relief
fluids
rest
good hand washing**
What potential problems or complications do you need
to be prepared to handle? How would you do that? Are
there other people that need to be involved to help?
Consultations?
• This is usually just a mild rash that tends to go away within a
couple weeks or so, however, if the patient is a high risk
candidate (anemia) they should be closely monitored via
blood test because it can lead to transient aplastic crisis,
which is a rapid worsening of existing anemia lasting 7-10
days. These patients will become very sick (fever, lethargy,
rapid HR, and rapid breathing).
• If iron levels are low, iron supplements can be used.
• Parents should be involved to make sure treatment is
followed. The Primary Doctor should also be involved to
confirm viral illness is resolving.
How often should the nurse reassess
the patient?
• Monitor Q2h (if hospitalized)
• Educate parents and make sure they understand the
disease process
Appropriate Patient/Family
Teaching
• Handwashing is key
• Teach parents that this is a mild illness that will
resolve
• Once the rashes appear, child is able to return to
school because it will not be contagious anymore (it’s
most contagious during fever).
Problems
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Acute Pain
Knowledge Deficit
Fatigue
Body image disturbance
• Priority Nursing Diagnosis:
– Acute pain related to rashes as evidenced by verbal
statements of discomfort from patient.
Goals
• Short term goals
– Patient will rate pain 0/10 by the end of my shift.
– Patient will stop itching by the end of my shift.
• Long term goals
– Patient will not be in pain through discharge.
Developmental Stage and Milestones
• Preschool (3-5 years of age)
– Initiative vs Guilt
• Children need to begin asserting control and power over the
environment. Success in this stage leads to a sense of purpose. Children
who try to exert too much power experience disapproval, resulting in a
sense of guilt.
• Milestones
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Hops, skips, jumps, balances on one foot
Vocabulary of 2,100 words; uses sentences
Expresses through play and story-telling; imagination
Gender aware
Mood swings& dramatic behavior
Family Structure/Support System
• Both parents at the bedside of child
– Open to healthcare advice
• Sibling at home with grandma
Approach to Invasive Procedures
• Standard Precautions
• Good Hygiene/Handwashing
• Gloves
Treatment
• Treatment is symptomatic:
• pain relief
• fluids
• rest
• good hand washing
•
Child can go to school once rash is present.
Documentation
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Temperature
Flu-like symptoms
Location of rashes
OLDCART
Patient/family education.
Epidemiological and clinical features of
erythema infectiosum in children in Novi Sad
from 2000 to 2009
• The reason for this study was to analyze the epidemiological
(population) and clinical characteristics of erythema
infectiosum (EI) in children. There were 88 children observed
in the study that lasted from January 2000-December 2009 in
Vojvodina, in Novi Sad(Serbia). The clinical characteristics
were compared during and after the outbreak of EI and the
results detected that 88 (44 boys, 44 girls) out of the 41,345
children had EI. The average age of children getting infected
were 7.59 +/- 3.339. The most common signs were rashes on
the cheeks and limbs, though no children had serious
complications.
Infectious diseases in children Fifth
disease (Slapped cheek disease)
• This article describes Fifth Disease, explains why it is
important and analyzes the characteristics of the
viral outbreak it can resemble.
References
• Lowth, M. (2013). Infectious diseases in children Fifth disease
(Slapped cheek disease). Practice Nurse, 43(10), 32-35.
• Prćić, S., Gajinov, Z., Zrnić, B., Radulović, A., Matić, M., &
Djuran, V. (2013). Epidemiological and clinical features of
erythema infectiosum in children in Novi Sad from 2000 to
2009. Vojnosanitetski Pregled: Military Medical &
Pharmaceutical Journal Of Serbia & Montenegro, 70(12),
1081-1084. doi:10.2298/VSP110607026P