Abstract：
BACKGROUND: Erythema infectiosum occurs worldwide. School-aged children are most often affected. Since the diagnosis is mainly clinical, physicians should be well-versed in the clinical manifestations of erythema infectiosum to avoid misdiagnosis, unnecessary investigations, and mismanagement of the disease.
OBJECTIVE: The purpose of this article is to familiarize physicians with the wide spectrum of clinical manifestations and complications of erythema infectiosum associated with parvovirus B19 infection.
METHODS: A search was conducted in July 2022 in PubMed Clinical Queries using the key terms \"Erythema infectiosum\" OR \"Fifth disease\" OR \"Slapped cheek disease\" OR \"Parvovirus B19\". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article.
RESULTS: Erythema infectiosum is a common exanthematous illness of childhood caused by parvovirus B19. Parvovirus B19 spreads mainly by respiratory tract secretions and, to a lesser extent, the saliva of infected individuals. Children between 4 and 10 years of age are most often affected. The incubation period is usually 4 to 14 days. Prodromal symptoms are usually mild and consist of lowgrade fever, headache, malaise, and myalgia. The rash typically evolves in 3 stages. The initial stage is an erythematous rash on the cheeks, with a characteristic \"slapped cheek\" appearance. In the second stage, the rash spreads concurrently or quickly to the trunk, extremities, and buttocks as diffuse macular erythema. The rash tends to be more intense on extensor surfaces. The palms and soles are typically spared. Central clearing of the rash results in a characteristic lacy or reticulated appearance. The rash usually resolves spontaneously within three weeks without sequelae. The third stage is characterized by evanescence and recrudescence. In adults, the rash is less pronounced than that in children and is often atypical. Only approximately 20% of affected adults have an erythematous rash on the face. In adults, the rash is more frequently found on the legs, followed by the trunk, and arms. A reticulated or lacy erythema is noted in 80% of cases which helps to distinguish erythema infectiosum from other exanthems. Pruritus is noted in approximately 50% of cases. The diagnosis is mainly clinical. The many manifestations of parvovirus B19 infection can pose a diagnostic challenge even to the best diagnostician. Complications include arthritis, arthralgia, and transient aplastic crisis. In most cases, treatment is symptomatic and supportive. When parvovirus B19 infection occurs in pregnant women, hydrops fetalis becomes a real concern.
CONCLUSIONS: Erythema infectiosum, the most common clinical manifestation of parvovirus B19 infection, is characterized by a \"slapped cheek\" appearance on the face and lacy exanthem on the trunk and extremities. Parvovirus B19 infection is associated with a wide spectrum of clinical manifestations. Physicians should be aware of potential complications and conditions associated with parvovirus B19 infection, especially in individuals who are immunocompromised, chronically anemic, or pregnant.
OBJECTIVE: The purpose of this article is to familiarize physicians with the wide spectrum of clinical manifestations and complications of erythema infectiosum associated with parvovirus B19 infection.
METHODS: A search was conducted in July 2022 in PubMed Clinical Queries using the key terms \"Erythema infectiosum\" OR \"Fifth disease\" OR \"Slapped cheek disease\" OR \"Parvovirus B19\". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article.
RESULTS: Erythema infectiosum is a common exanthematous illness of childhood caused by parvovirus B19. Parvovirus B19 spreads mainly by respiratory tract secretions and, to a lesser extent, the saliva of infected individuals. Children between 4 and 10 years of age are most often affected. The incubation period is usually 4 to 14 days. Prodromal symptoms are usually mild and consist of lowgrade fever, headache, malaise, and myalgia. The rash typically evolves in 3 stages. The initial stage is an erythematous rash on the cheeks, with a characteristic \"slapped cheek\" appearance. In the second stage, the rash spreads concurrently or quickly to the trunk, extremities, and buttocks as diffuse macular erythema. The rash tends to be more intense on extensor surfaces. The palms and soles are typically spared. Central clearing of the rash results in a characteristic lacy or reticulated appearance. The rash usually resolves spontaneously within three weeks without sequelae. The third stage is characterized by evanescence and recrudescence. In adults, the rash is less pronounced than that in children and is often atypical. Only approximately 20% of affected adults have an erythematous rash on the face. In adults, the rash is more frequently found on the legs, followed by the trunk, and arms. A reticulated or lacy erythema is noted in 80% of cases which helps to distinguish erythema infectiosum from other exanthems. Pruritus is noted in approximately 50% of cases. The diagnosis is mainly clinical. The many manifestations of parvovirus B19 infection can pose a diagnostic challenge even to the best diagnostician. Complications include arthritis, arthralgia, and transient aplastic crisis. In most cases, treatment is symptomatic and supportive. When parvovirus B19 infection occurs in pregnant women, hydrops fetalis becomes a real concern.
CONCLUSIONS: Erythema infectiosum, the most common clinical manifestation of parvovirus B19 infection, is characterized by a \"slapped cheek\" appearance on the face and lacy exanthem on the trunk and extremities. Parvovirus B19 infection is associated with a wide spectrum of clinical manifestations. Physicians should be aware of potential complications and conditions associated with parvovirus B19 infection, especially in individuals who are immunocompromised, chronically anemic, or pregnant.
摘要：
背景：传染性红斑在世界范围内发生。学龄儿童最常受到影响。由于诊断主要是临床，医生应精通感染性红斑的临床表现，以避免误诊，不必要的调查,和疾病管理不善。
目的：本文的目的是使医生熟悉与细小病毒B19感染相关的感染性红斑的广泛临床表现和并发症。
方法：于2022年7月在PubMed临床查询中使用关键术语“传染性红斑”或“第五疾病”或“脸颊拍打病”进行了搜索。搜索策略包括所有临床试验，观察性研究，以及在过去十年内发表的评论。本评论仅包括在英语文献中发表的论文。从上述搜索中检索到的信息用于本文的汇编。
结果：传染性红斑是一种由细小病毒B19引起的儿童期常见的发疹性疾病。细小病毒B19主要通过呼吸道分泌物传播,在较小程度上，感染者的唾液。4至10岁的儿童最常受到影响。潜伏期通常为4至14天。前驱症状通常较轻微，包括低烧，头痛,萎靡不振,和肌痛。皮疹通常分为3个阶段。初始阶段是脸颊上的红斑皮疹，具有典型的“拍打脸颊”外观。在第二阶段,皮疹同时或快速扩散到躯干，四肢,臀部为弥漫性黄斑红斑。皮疹倾向于在伸肌表面上更强烈。手掌和鞋底通常可以幸免。皮疹的中央清除导致特征性花边或网状外观。皮疹通常在三周内自发消退，无后遗症。第三阶段的特征是消失和复发。在成年人中,皮疹不如儿童明显，通常是非典型的。只有大约20％的受影响的成年人脸上有红斑皮疹。在成年人中,皮疹更常见于腿部，后面是后备箱，和手臂。在80％的病例中注意到网状或蕾丝红斑，这有助于将感染性红斑与其他exanthem区分开。在大约50%的病例中注意到瘙痒。诊断以临床为主。细小病毒B19感染的许多表现甚至对最好的诊断医生也构成了诊断挑战。并发症包括关节炎，关节痛,和短暂的再生危机。在大多数情况下,治疗是对症和支持。当孕妇发生细小病毒B19感染时，胎儿积水成为一个真正的问题。
结论：传染性红斑，细小病毒B19感染最常见的临床表现，其特点是脸上出现“拍打脸颊”，躯干和四肢出现花边。细小病毒B19感染与广泛的临床表现有关。医生应该意识到与细小病毒B19感染相关的潜在并发症和条件。尤其是在免疫功能低下的个体中，慢性贫血,或怀孕。
目的：本文的目的是使医生熟悉与细小病毒B19感染相关的感染性红斑的广泛临床表现和并发症。
方法：于2022年7月在PubMed临床查询中使用关键术语“传染性红斑”或“第五疾病”或“脸颊拍打病”进行了搜索。搜索策略包括所有临床试验，观察性研究，以及在过去十年内发表的评论。本评论仅包括在英语文献中发表的论文。从上述搜索中检索到的信息用于本文的汇编。
结果：传染性红斑是一种由细小病毒B19引起的儿童期常见的发疹性疾病。细小病毒B19主要通过呼吸道分泌物传播,在较小程度上，感染者的唾液。4至10岁的儿童最常受到影响。潜伏期通常为4至14天。前驱症状通常较轻微，包括低烧，头痛,萎靡不振,和肌痛。皮疹通常分为3个阶段。初始阶段是脸颊上的红斑皮疹，具有典型的“拍打脸颊”外观。在第二阶段,皮疹同时或快速扩散到躯干，四肢,臀部为弥漫性黄斑红斑。皮疹倾向于在伸肌表面上更强烈。手掌和鞋底通常可以幸免。皮疹的中央清除导致特征性花边或网状外观。皮疹通常在三周内自发消退，无后遗症。第三阶段的特征是消失和复发。在成年人中,皮疹不如儿童明显，通常是非典型的。只有大约20％的受影响的成年人脸上有红斑皮疹。在成年人中,皮疹更常见于腿部，后面是后备箱，和手臂。在80％的病例中注意到网状或蕾丝红斑，这有助于将感染性红斑与其他exanthem区分开。在大约50%的病例中注意到瘙痒。诊断以临床为主。细小病毒B19感染的许多表现甚至对最好的诊断医生也构成了诊断挑战。并发症包括关节炎，关节痛,和短暂的再生危机。在大多数情况下,治疗是对症和支持。当孕妇发生细小病毒B19感染时，胎儿积水成为一个真正的问题。
结论：传染性红斑，细小病毒B19感染最常见的临床表现，其特点是脸上出现“拍打脸颊”，躯干和四肢出现花边。细小病毒B19感染与广泛的临床表现有关。医生应该意识到与细小病毒B19感染相关的潜在并发症和条件。尤其是在免疫功能低下的个体中，慢性贫血,或怀孕。
