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Slapped Cheek Disease

02 Feb 2013

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HEALTH & FITNESS

Slapped cheek disease or fifth disease is also medically referred to as erythema infectiosum. It is an infection caused by the parvovirus B19 virus. It most commonly occurs in children aged 4-12 years, but anyone can be affected. It is infectious, which means it can be passed on from one person to another. The infectious period is for 4-20 days before the rash appears. By the time the rash develops, it is usually no longer infectious.

A number of individuals have had this infection in the past, usually without realising it. One normally has slapped cheek disease only once in a lifetime. This is because antibodies made during the infection protect one from future infections with this same virus.

Parvoviruses are among the smallest DNA-containing viruses known to infect mammals (hence the name parvus, which is Latin for small). The only parvovirus known to be pathogenic in humans is parvovirus B19, discovered in 1974 whilst testing for serum hepatitis B antigens. It was so called because it occurred in serum sample 19, panel B. It is a single-strand DNA virus with no lipid coat, which makes it very resistant to the normal means of killing viruses, such as disinfectants and freezing.

Parvovirus is an extremely common infection. Approximately 60% of adults are seropositive to parvovirus B19 by the age of 20 years. The most common clinical encounter with parvovirus B19 is as the causative agent of erythema infectiosum (fifth disease).

Infectivity and transmission
•Transmission is usually via respiratory secretions, but it can also be passed on via blood transfusion, bone marrow transplant, other blood products (but not intramuscular immunoglobulins), and from mother to baby via the placenta.
•The incubation period for clinical erythema infectiosum is 13-18 days. The illness is infective from 10 days pre-rash until the onset of the rash. Once the rash appears, it is no longer infectious.
•Infectivity is medium. For susceptible individuals during epidemics, the attack rate is 50% for household contacts and schoolchildren, and 30% for teachers.
•One attack confers lifelong immunity

Symptoms of slapped cheek disease
May be asymptomatic (about 25 percent of infections); or may present only with nonspecific coryzal symptoms (common).
Prodromal symptoms are mild but may include headache, rhinitis, low-grade fever and malaise. Less commonly, nausea, diarrhoea, abdominal pain or arthropathy may develop.
After 3-7 days, the classic ‘slapped cheek’ rash appears as erythema on the cheeks, sparing the nose, regions around the eyes and the mouth. This disappears after 2-4 days.

Rash
Typically, the rash looks like a bright red scald on one or both cheeks. It looks as if the cheek(s) have been slapped. Sometimes there is just a blotchy redness on the face. The rash is painless.
Sometimes a more widespread faint rash appears on the body, arms, and legs. Occasionally, the rash on the face and body keeps fading and returning several times for up to four weeks. However, it is more common for the rash to come and go completely within a few days.

Other symptoms
Although the rash can look quite dramatic, the illness itself is usually mild. Usually one feels not so ill. Headache or mild temperature (fever) for a few days may occur before the rash appears. Occasionally, mild pain and stiffness develop in one or more joints for a few days. This is more common in adults than children.
One the other hand, around one in five people who become infected with this virus do not develop any symptoms at all. Some people just have a fever and feel generally unwell, without any rashes.

Tests for slapped cheek disease
This condition is usually diagnosed by the appearance of the classical rash on the cheeks.
A blood test is sometimes performed. This will show if one has the disease and can also show if you have had this disease in the past, although, if you have had the disease in the past (even if you had it without developing any symptoms) then you will be immune to it.

Complications
Usually there are no complications. Rarely, the aching joint symptoms last for some time after the other symptoms have gone. The only times the illness may become more serious are:

Sickle cell disease
In children with some types of hereditary anaemia such as sickle cell disease, beta-thalassaemia and hereditary spherocytosis. This virus can cause these types of anaemia to become suddenly much worse.

Reduced immunity
In people with a weakened immune system. If you have leukaemia or cancer, have had an organ transplant or have HIV infection then you may develop a more serious illness with this infection.

Risk to pregnancy
In pregnant women. Most pregnant women are immune to this virus, or will not be seriously affected if they become infected by it. However, like some other viruses, the virus that causes slapped cheek disease can sometimes harm an unborn child. Miscarriage is more common in women who are infected with this virus before 20 weeks of pregnancy. Therefore, if you are pregnant, keep away from people who have slapped cheek disease. If you are pregnant and have been in contact with a person with the virus then your doctor may arrange for you to have a blood test.

Treatment
One does not usually need any treatment. If you have a headache, temperature or aches and pains, then painkillers such as paracetamol or ibuprofen will help.
Although, in those who develop complications (which is very rare) treatment and special hospitalization may be required.

Preventing slapped cheek disease
There is no vaccine or treatment that prevents this infection. Frequent handwashing reduces the risk of this infection been transmitted to other people, hence promoting the culture of routine hand washing with soap remain ever a very important public health message.
There is no benefit of disallowing the child from going to school or one not going to work. since if one has this infection one is only infectious before the rash developed and not after, when it only becomes obvious.

GOKE’S CLINIC

Worried about Vaginal Thrush and Painful Menses


My concern is about a previous article of yours on Vaginal Thrush and I want to say I have been a victim for sometime now.
Aside the thrush, another problem is my menses; my periods are extraordinarily painful and it does come out in clumps of blood clots. It is slimy and also kind of dark in colour. I have always thought this was due to my bouts of thrush but given your comment that thrush is not harmful as regards reproduction, I’m quite worried.

I have gone for a high vaginal swab test before but nothing was found to be wrong with me. Please, I want to know if I am alright because I would not want any problem in future as regards childbearing.
Looking forward to hearing from you.

Bose


Bose,

I will quickly reiterate that vaginal thrush which is caused by Candida, a variant of fungi, does not have any direct bearing with the pattern of menses and menstrual flow problems.

Similarly, I should also mention in clearer terms that vaginal thrush do not cause infertility, bearing in mind that more than 70 percent of our womenfolk probably have vaginal thrush and most of them are undoubtedly fertile. As a matter of fact, vaginal thrush is more common and troublesome in pregnant women.  
From what you have mentioned above about your menstrual flow problems, my thinking is that you should look elsewhere for the cause of the problem,

it is certainly not due to the thrush coming out of the vagina. As a matter of fact, both have different places of origin; while the thrush is a product of Candida infection in the vagina, the menses originates higher up in the womb (uterus). 
Menstrual flow problems could be due to a variety of causes. It could be psychogenic in origin, it can be a sign of a hormonal problem and in some cases the presence of fibroid in the womb can lead to menstrual flow being heavy and longer than usual.

My advice is that you should see a doctor who will assess you clinically and based on this decide on the next thing to do and the necessary investigations to be carried out on you. Hormonal blood tests and Pelvic Ultrasound Scan, among other investigations would be of great diagnostic benefit for your case.

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