Figure 1. The lips are swollen and 2 shallow ulcers are visible on the undersurface of the tongue.
Figure 2. A discrete petechial rash is present on the feet.
Figure 3. A discrete petechial rash is present on the hand and the fingers are swollen.
Parvovirus B19, discovered in 1974, is a small, nonenveloped, single-stranded DNA virus, belonging to the family Parvoviridae.1,2 Infection with Parvovirus B19 is common. The prevalence of IgG antibodies to the virus ranges from 2% to 15% in children from 1 to 5 years of age and from 30% to 60% in adults.3,4 Clinical infection with this virus is most common in school-aged children. The mode of spread is believed to be by respiratory droplets. Secondary spread among susceptible household members occurs in about 50% of contacts.3
In the immunologically normal host, Parvovirus B19 infection may be asymptomatic, may result in erythema infectiosum (fifth disease), or may induce arthritis.5,6 Erythema infectiosum, characterized by the "slapped cheek" appearance and lacey erythema of the proximal extremities, is the most common clinical manifestation of Parvovirus B19 infection and occurs most frequently in school-aged children. Once the rash appears, the children are no longer capable of transmitting the disease.
Petechial rashes, with or without thrombocytopenia and vesiculobullous lesions, have also been associated with Parvovirus B19 infections.7,8 More recently, a distinctive exanthem known as the papular-purpuric "gloves and socks" or the petechial gloves and socks syndrome has been described in older children and adults, many of whom have demonstrated evidence of Parvovirus B19 infection.9- 11 The clinical picture of this illness is characterized by pruritic edema and erythema of the hands and feet in a gloves and socks distribution, oral lesions, and fever, followed by the rapid development of petechiae on the hands and feet.
Parvovirus B19 may cause an aplastic crisis in patients with chronic hemolytic anemias. Although megakaryocytes and myeloid cells are not infected, neutropenia, thrombocytopenia, or both are commonly found in these patients.12,13 In patients with immunodeficiency, congenital or acquired, Parvovirus B19 infection may become chronic, resulting in persistent viremia and bone marrow failure. Most of these immunodeficient patients do not experience the rash, fever, or polyarthropathy frequently associated with this infection.14
Parvovirus B19 infection has also been implicated as a possible cause of idiopathic thrombocytopenic purpura. In a series of 35 previously healthy children with classic idiopathic thrombocytopenic purpura, almost half had evidence of Parvovirus B19 DNA in peripheral blood or bone marrow, while none of 14 control patients had polymerase chain reaction or anti–B19 IgM antibodies.15Parvovirus B19 infection also accounts for as much as one fourth of the cases of nonimmune fetal hydrops by causing red blood cell aplasia.16
In addition, Parvovirus B19 has been demonstrated to be a cause of arthritis, chronic encephalitis, and aseptic meningitis among otherwise normal children.6
In the healthy host, detection of IgM antibodies to Parvovirus B19 denotes a recent infection. Both IgM and IgG antibodies are present soon after the onset of illness and reach peak titers in the first 30 days. IgG antibodies persist for years, but IgM antibody levels begin to decline 30 to 60 days after the onset of the illness. Hybridization techniques or polymerase chain reaction may also be useful in detecting Parvovirus B19 infection. These techniques have been used to detect viral DNA in clinical samples of serum, urine, respiratory secretions, and body tissues.
Antiviral therapy for this infection is unavailable. For most patients, supportive care only is indicated. Intravenous immunoglobulin therapy may be effective in treating Parvovirus B19 infection in immunodeficient patients.14
Accepted for publication September 5, 1997.
Reprints: Basim Asmar, MD, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201-2196.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Thank you for submitting a comment on this article. It will be reviewed by JAMA Pediatrics editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 4
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.