Fifth Disease

Symptoms

Early symptoms of fifth disease are similar to the flu. A characteristic rash follows several days later, and some people develop joint pain. Fifth disease can be confused with other conditions with similar symptoms.

Flu-like symptoms

Symptoms of fifth disease arise within 2 to 3 weeks after exposure to the virus. Typically, initial symptoms resemble the flu and may be so mild that they are not noticed. Some people with fifth disease do not have any symptoms. Early symptoms include:

• Runny nose and sore throat.
• Headache and abdominal pain.
• In rare cases, a mild fever around 100°F (37.8°C).
• Mild body weakness and joint pain.

Rash

About 7 days after the onset of flu-like symptoms, a distinctive rash may appear, although not as often in adults as in children. Some people never get a rash.

If a rash develops, usually it follows a predictable pattern with two or three distinct stages:

1. A bright red rash occurs on the sides of the face (often referred to as a "slapped cheek" appearance) and sometimes on the forehead and chin. This rash usually fades within 2 to 5 days.
2. Another rash appears on the neck, trunk, forearms, upper legs, and buttocks. This rash starts as round red spots and begins to take on a lacy appearance. It can be itchy, especially in older children. The second stage lasts a week or less.
3. After the body rash fades, it may reappear following exposure to sunlight, warm temperatures, or stress. This rash lasts an additional 1 to 3 weeks. Even though a rash reappears, it does not mean your condition is worse.

Joint pain

Joint pain in the hands, wrists, ankles, and feet commonly occurs in adults, especially in women. The pain usually lasts 1 to 3 weeks, although in rare cases, it can last longer. It usually does not cause permanent damage to the joints.

Complications

In healthy people, fifth disease usually is a mild illness that resolves within a few weeks without further problems. However, people with impaired immune systems or blood disorders, such as sickle cell disease or thalassemia, are at increased risk for developing complications. Fifth disease can also cause problems for the fetus of a pregnant woman who is infected.

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Author:	Debby Golonka, MPH	Last Updated: March 7, 2007
Medical Review:	Michael J. Sexton, MD - Pediatrics Christine Hahn, MD - Epidemiology
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