Which physical findings suggest parvovirus B19 (B19V) infection?

Answer

Parvovirus B19 infection may be indistinguishable from other viral illnesses in the absence of the classic exanthem.

Children are often febrile, but their appearance is nontoxic and the prodrome is nonspecific.
Patients with aplastic crisis have pallor and tachycardia secondary to anemia. Children with aplastic crisis usually do not have a rash.^[9]The absence of rash may result from prolonged viremia and lack of anti–parvovirus B19 IgM. Another hypothesis is that patients in aplastic crisis often receive blood transfusions, and any rash may be attributed to a transfusion reaction.
A friction rub may be audible if pericarditis is present. Benign flow murmurs are common in anemic children with tachycardia. Patients with myocarditis or severe anemia may present with physical findings of heart failure.
The small joints of the hands, feet, elbows, and knees may exhibit signs of arthritis.
Painful pruritic papules and purpura may be present on the hands and feet as part of PPGSS.

Did this answer your question?

Yes No

Additional feedback? (Optional)

Thank you for your feedback!

Cossart YE, Field AM, Cant B et al. Parvovirus-like particles in human sera. Lancet. 1975. 1:72.
Young NS, Brown KE. Parvovirus B19. N Engl J Med. 2004 Feb 5. 350(6):586-97. [Medline].
Pattison JR,Jones SE, Hodgson J et al. Parvovirus infections and hypoplastic crisis in sickle cell anaemia. Lancet. 1981. 1:664.
Serjeant GR, Topley JM, Mason K, Serjeant BE, Pattison JR, Jones SE, et al. Outbreak of aplastic crises in sickle cell anaemia associated with parvovirus-like agent. Lancet. 1981 Sep 19. 2(8247):595-7.
Cherry JD, Schulte DJ. Human Parvovirus B19. Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL, eds. Feigin & Cherry's Textbook of Pediatric Infectious Diseases. 6th ed. Philadelphia, PA: Saunders Elsevier; 2009. Vol 2: 1902-1920.
Servey JT, Reamy BV, Hodge J. Clinical presentations of parvovirus B19 infection. Am Fam Physician. 2007 Feb 1. 75(3):373-6. [Medline].
Anderson LJ, Hurwitz ES. Human parvovirus B19 and pregnancy. Clin Perinatol. 1988. 15:273.
Brown KE. Parvovirus B19. Bennet JE, Dolin R, Blaser M. Mandell, Douglas and Bennett's Principals and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Churchill Livingstone Elsevier; 2015. Vol 2: 1840-1847.
American Academy of Pediatrics Committee on Infectious Diseases. Parvovirus B19. Kimberlin DW, Brady M, Jackson SA, Long SS, eds. 2015 Red Book: Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Peiatrics; 2015. 593-596.
Landry ML. Parvovirus B19. Microbiol Spectr. 2016 Jun. 4 (3):1-13. [Medline].
Schneider, E. Human Parvoviruses. Long SS, Pickering LK, Prober CG, eds. Principles and Practice of Pediatric Infectious Diseases. 4th ed. Philadelphia, PA: Churchill Livingstone Elsevier; 2012. 1087-1091.
Burns K, Parish CR. Parvoviridae. Knipe DM, Howley PM, eds. Fields Virology. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007. Vol 2: 65.
Mustafa MM, McClain KL. Diverse hematologic effects of parvovirus B19 infection. Pediatr Clin North Am. 1996 Jun. 43(3):809-21. [Medline].
Ergaz Z, Ornoy A. Parvovirus B19 in pregnancy. Reprod Toxicol. 2006 May. 21(4):421-35. [Medline].
Luzzi GA, Kurtz JB. Human parvovirus arthropathy and rheumatoid factor(Letter). Lancet. 1985. 1:1218.
Conrad ME, Studdard H et al. Case report: aplastic crisis in sickle cell disorders: bone marrow necrosis and human parvovirus infection. Am J Med Sci. 1988. 295:212.
Eid AJ, Brown RA, Patel R, Razonable RR. Parvovirus B19 infection after transplantation: a review of 98 cases. Clin Infect Dis. 2006 Jul 1. 43(1):40-8. [Medline].
Lindblom A, Heyman M, Gustafsson I, Norbeck O, Kaldensjo T, Vernby A. Parvovirus B19 infection in children with acute lymphoblastic leukemia is associated with cytopenia resulting in prolonged interruptions of chemotherapy. Clin Infect Dis. 2008 Feb 15. 46(4):528-36. [Medline].
Young NS. Hematologic and hematopoietic consequences of B19 parvovirus infection. Semin Hematol. 1988. 25:159.
Bascietto F, Liberati M, Murgano D, Buca D, Iacovelli A, Flacco ME, et al. Outcome of fetuses with congenital parvovirus B19 infection: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018 Nov. 52 (5):569-576. [Medline].
Mendelson E, Aboudy Y, Smetana Z, Tepperberg M, Grossman Z. Laboratory assessment and diagnosis of congenital viral infections:Rubella, cytomegalovirus (CMV), varicella-zoster virus (VZV),herpes simplex virus (HSV), parvovirus B19 andhuman immunodeficiency virus (HIV). Reprod Toxicol. 2006. 21:350-382.
Adler SP, Koch WC. Human Parvovirus Infections. Remington JS, Klein JO, Wilson CB, Baker CJ. Infectious Diseases of the Fetus and Newborn Infant. 6th ed. Philadelphia, PA: Saunders Elsevier; 2006. 868-892.
Tolfvenstam T, Broliden K. Parvovirus B19 infection. Semin Fetal Neonatal Med. 2009 Aug. 14(4):218-21. [Medline].
Simms RA, Liebling RE, Patel RR, et al. Management and outcome of pregnancies with parvovirus B19 infection over seven years in a tertiary fetal medicine unit. Fetal Diagn Ther. 2009. 25(4):373-8. [Medline].
Infections. Cunningham FG, Leveno KL, Bloom SL, Hauth JC, Gilstrap III LC, Wenstrom KD, eds. Williams Obstetrics. 22nd Ed. USA: McGraw-Hill; 2001. chap 58.
Crane J, Mundle W, Boucoiran I, Gagnon R, Bujold E, Basso M, et al. Parvovirus B19 infection in pregnancy. J Obstet Gynaecol Can. 2014 Dec. 36(12):1107-16. [Medline].
Ornoy A, Ergaz Z. Parvovirus B19 infection during pregnancy and risks to the fetus. Birth Defects Res. 2017 Mar 15. 109 (5):311-323. [Medline].
Broliden K, Tolfvenstam T, Norbeck O. Clinical aspects of parvovirus B19 infection. Jrnl Internal Med. 2006. 260:285-304.
Hirai Y, Takeda Y. Atypical rashes in adult human Parvovirus B19 infection; atypical is typical. IDCases. 2016 Jun 23. 5:32-3. [Medline].
Dollat M, Chaigne B, Cormier G, Costedoat-Chalumeau N, Lifermann F, Deroux A, et al. Extra-haematological manifestations related to human parvovirus B19 infection: retrospective study in 25 adults. BMC Infect Dis. 2018 Jul 4. 18 (1):302. [Medline].
Grilli R, Izquierdo MJ, Farina MC, et al. Papular-purpuric "gloves and socks" syndrome: polymerase chain reaction demonstration of parvovirus B19 DNA in cutaneous lesions and sera. J Am Acad Dermatol. 1999 Nov. 41(5 Pt 1):793-6. [Medline].
Fretzayas A, Douros K, Moustaki M, Nicolaidou P. Papular-purpuric gloves and socks syndrome in children and adolescents. Pediatr Infect Dis J. 2009 Mar. 28(3):250-2. [Medline].
Ferrari B, Díaz MS, López M, Larralde M. Unusual skin manifestations associated with parvovirus B19 primary infection in children. Pediatr Dermatol. 2018 Nov. 35 (6):e341-e344. [Medline].
Tschope C, Bock CT, Kasner M, Noutsias M, Westermann D, Schwimmbeck PL. High prevalence of cardiac parvovirus B19 infection in patients with isolated left ventricular diastolic dysfunction. Circulation. 2005 Feb 22. 111(7):879-86. [Medline].
Douvoyiannis M, Litman N, Goldman DL. Neurologic manifestations associated with parvovirus B19 infection. Clin Infect Dis. 2009 Jun 15. 48(12):1713-23. [Medline].
Kleinman SH, Glynn SA, Lee TH, et al. A linked donor-recipient study to evaluate parvovirus B19 transmission by blood component transfusion. Blood. 2009 Oct 22. 114(17):3677-83. [Medline]. [Full Text].
Bredl S, Plentz A, Wenzel JJ, Pfister H, Möst J, Modrow S. False-negative serology in patients with acute parvovirus B19 infection. J Clin Virol. 2011 Jun. 51(2):115-20. [Medline].
Soderlund-Venermo M, Hokynar K, Nieminen J et al. Undefined. Persistence of human parvovirus B 19 in human tissues. 2002. 50;:307-316.
Musiani M, Zerbini M et al.Gentilomi G et al. Parvovirus B19 clearance from peripheral blood after acute infection. J Infect Dis. 1995. 172:1360-1363.
Anderson MJ, Higgins PG, Davis LR, Willman JS, Jones SE, Kidd IM. Experimental parvoviral infection in humans. J Infect Dis. 1985 Aug. 152(2):257-65. [Medline].
Onodera H, Nakagawa R, Nakagawa H, Urayama T, Haino K, Yunoki M. Long-term monitoring of virus antibody titers in human intravenous immunoglobulin lots derived from donors in Japan. Transfusion. 2018 Nov. 58 (11):2617-2626. [Medline].
Failey CK, Smoleniec JS et al. Observational study of effect of intrauterine transfusions on outcome of fetal hydrops after parvovirus B 19 infection. Lancet. 1995. 346:1335-1337.
[Guideline] Center for Disease control and Prevention. Risk associated with human parvovirus infection. MMWR. 1989. 38:81.

Media Gallery

Note the right side of this boy's face displaying signs of erythema infectiosum, or Fifth disease. Image courtesy of CDC.
Elementary school child with Fifth Disease. Image courtesy of CDC.

of 2

Author

David J Cennimo, MD, FAAP, FACP, AAHIVS Assistant Professor of Medicine and Pediatrics, Adult and Pediatric Infectious Diseases, Rutgers New Jersey Medical School; Hospital Epidemiologist and Co-Director of Antimicrobial Stewardship, University Hospital

David J Cennimo, MD, FAAP, FACP, AAHIVS is a member of the following medical societies: American Academy of HIV Medicine, American Academy of Pediatrics, American College of Physicians, American Medical Association, HIV Medicine Association, Infectious Diseases Society of America, Medical Society of New Jersey, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Coauthor(s)

Arry Dieudonne, MD Associate Professor of Pediatrics, Division of Pulmonology, Allergy, Immunology and Infectious Diseases, Rutgers New Jersey Medical School; Clinical Director, Francois-Xavier Bagnold Center for Children, University Hospital

Arry Dieudonne, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa

Disclosure: Received research grant from: Pfizer;GlaxoSmithKline;AstraZeneca;Merck;American Academy of Pediatrics, Novavax, Regeneron, Diassess, Actelion<br/>Received income in an amount equal to or greater than $250 from: Sanofi Pasteur.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Glenn Fennelly, MD, MPH Director, Division of Infectious Diseases, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center; Clinical Associate Professor of Pediatrics, Albert Einstein College of Medicine

Glenn Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthor Dennis Cunningham, MD, to the original writing and development of this article.

Which physical findings suggest parvovirus B19 (B19V) infection?

Related Questions:

About

Membership

Apps

WebMD Network

Editions

Which physical findings suggest parvovirus B19 (B19V) infection?

Related Questions:

References

Tables

Contributor Information and Disclosures

Find Us On

About

Membership

Apps

WebMD Network

Editions