An Illinois teacher who started experiencing flu-like symptoms thought that was exactly what she had after testing negative for COVID and strep. But the symptoms that followed quickly changed her diagnosis.
Abby Parks, a 27-year-old special education teacher in Springfield, was about 18 weeks pregnant when she started feeling very sick with a fever.
The fever was followed by joint pain, then the rash appeared.
Her school nurse, who had seen students with “really pink and red cheeks,” suggested that Parks might have the same infection.
“I got sicker and sicker,” she said. “I had to stay in bed with a fever for four or five whole days.”
Blood tests performed by her obstetrician-gynecologist came back positive for parvovirus B19.
Parks was referred to a maternal-fetal medicine specialist, where a doctor discovered that the virus had been transmitted to the fetus in utero. The fetus had developed anemia, a very dangerous condition, and doctors gave her a blood transfusion in utero.
Parks wasn’t the only one to receive this diagnosis.
Cases of parvovirus B19 — more commonly known as fifth disease or “slapped cheek syndrome” because of the red rash that covers an infected patient’s face — are on the rise in the United States. On Tuesday, the Centers for Disease Control and Prevention issued an alert to doctors to watch for signs of the highly contagious seasonal virus.
Here’s what you need to know about the infection.
What is parvovirus or fifth disease?
According to the CDC, parvovirus B19 infection can cause anything from flu-like symptoms to rashes and joint pain, but in people with blood disorders or weakened immune systems, “infection can cause low red blood cell counts.” Infection during pregnancy can also lead to complications, similar to Parks’.
“Most people who are infected have no symptoms, and most people are already infected by the age of 20 to 40,” Dr. Scott Goldstein of Northwestern Children’s Practice said in a video posted to social media this week. “They say about half of people by age 20 and 70% of people by age 40 will have had this virus, whether they know it or not.”
Who is most exposed to parvovirus?
Most infections occur in children ages 5 to 9, according to the CDC. Since March, parvovirus has been circulating in Europe at unusually high rates, according to the European Center for Disease Prevention and Control.
Most adults were infected as children and are still protected. However, the CDC has warned that pregnant women and people with sickle cell disease who have never been exposed to the virus are at risk for serious illness.
Parks’ doctor, Kathy Bligard, an obstetrician-gynecologist at Washington University Hospital in St. Louis, said: “Abby is not the only patient whose fetus has needed a blood transfusion in the last few months for parvovirus. It’s certainly something I saw maybe once every couple of years and have seen several times in the last few months.”
Bligard said parvovirus is dangerous for pregnant women because it can cross the placenta and infect the fetus and make it anemic, which could lead to fetal death.
Parks has recovered from the virus, but her pregnancy is still in danger.
On Wednesday morning, after an ultrasound showed the fetus was not receiving enough blood from the placenta, Parks was admitted to a Springfield hospital to care for the baby.
“I think it saved the life of the fetus,” Parks said of the earlier transfusion. ““Because if that anemia had persisted, with those low blood counts, the baby could have died,” Parks said in an interview Wednesday from her hospital bed.
According to Bligard, the virus makes it harder for the fetus to produce new red blood cells. “In order for oxygen to get to all the important organs in our body, our body needs these red blood cells. So this can cause heart failure or even progression to death due to low blood counts.”
Although the disease primarily affects children, in adults it can cause more serious symptoms, including joint pain and anemia, which result from problems producing red blood cells, said Dr. Vincent Iannelli, a Dallas-area pediatrician. Low red blood cell counts can lead to complications during pregnancy.
Patients with sickle cell disease are also at high risk.
“In the last month or two, I think we’ve seen more cases,” Iannelli said. Typically, Iannelli would get one case of fifth disease a month; he said he’s now getting one to two a week, noting that the virus is more common in the spring and summer.
What are the symptoms of parvovirus?
In children, fifth disease is usually mild: its most distinctive symptoms include fever and respiratory symptoms, followed by a red rash on the cheeks, then a “lace”-shaped rash over the rest of the body, which may be itchy.
The rash appears toward the end of the infection and usually disappears within seven to ten days, but it can last for several weeks. It is important to note that a person with fifth disease is no longer contagious once the rash appears.
“In infected children, symptoms – if they have them – typically start with fever, muscle aches, sore throat and cough, which are basically flu-like symptoms,” Goldstein said. “This is usually followed by a characteristic rash that gives parvovirus its third name, called slapped cheek syndrome. Once the rash appears, children are no longer contagious, but during the fever, sore throat and aches phase, the virus is quite contagious, as are most respiratory viruses.”
The rash may become more pronounced in heat and sun, but that doesn’t make the infection worse, Iannelli said.
The rash is more common in children, but adults who develop parvovirus may not experience it. The Mayo Clinic notes that the most common symptom in adults is joint pain, which can last from a few days to a few weeks.
Pregnant women who experience symptoms such as joint pain and problems producing red blood cells should notify their doctor immediately, especially if they know they have been in contact with patients infected with fifth disease, doctors say.
How does it spread?
According to Goldstein, “parvovirus spreads like the common cold.”
“It spreads from person to person, much like a cold, often through breathing, coughing and saliva, so it can spread through close person-to-person contact and hand-to-hand contact,” the Mayo Clinic reported.
How worrying is this?
Iannelli does not believe the increase in cases is a cause for concern.
“Fortunately, most pregnant women had it as children, so they are immune, but occasionally we see adults get it,” he said.
Ultimately, “if you’re healthy, it’s a benign illness,” Iannelli said. “If you have immune system problems or are pregnant, you should tell your doctor early in your pregnancy. But for everyone else, it’s just a rash.”
He stressed that the CDC alert was intended to raise awareness among doctors, not to alarm the public.
Goldstein agreed.
“On a scale of one to five … in terms of general concern for people who have just had children and are not pregnant, I would probably give it a one or a little bit above one,” he said. “If you are pregnant, I would give it maybe a one or a three. This is the kind of situation where, if you are pregnant and you don’t know if you have had parvovirus, and you can’t tell, it might be worth being a little bit more aware of groups of children who could potentially be sick during this outbreak.”
How to treat parvovirus?
According to the CDC, infections are usually mild and go away on their own in otherwise healthy children and adults.
“Treatment usually involves relieving symptoms, such as fever, itching, joint pain and swelling. For people who develop low blood counts, treatment may include supportive care, blood products, and other specialized therapies,” the CDC notes.
Why is it called the fifth disease?
In the early 1900s, doctors compiled a list of common childhood rashes to help them make more accurate diagnoses. They identified six main rashes:
- Measles, a highly contagious virus that can cause rash, high fever and respiratory symptoms.
- Scarlet fever, a bacterial infection caused by group A streptococcus.
- Rubella is a viral infection also known as measles. If a person is exposed to the virus during pregnancy, it can cause miscarriage or stillbirth. The CDC recommends two doses of the mumps, measles, and rubella vaccine for children.
- Filatov-Dukes disease is no longer considered a separate disease.
- Fifth disease, or parvovirus B19, also known as erythema infectiosum.
- Roseola, a viral infection sometimes also called sixth disease, can cause high fever and rash.
There are now more recognized childhood rashes, such as chickenpox, so the numbering system is no longer used except for fifth disease.
At the hospital, Parks, who is now 30 weeks pregnant, is being closely monitored. She wants other pregnant women to be aware of the virus and get tested if they have been exposed.
“It was a very difficult experience,” Parks said. “It was uncertain whether he would survive the fetal anemia.”
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