Slapped cheek syndrome

• This is also known as Parvovirus B19 infection, fifth disease or erythema infectiosum

• It presents as a diffuse erythematous facial rash which is evident on one or both cheeks (the cheek appears as though it has been slapped) and usually fades after 1–2 weeks. A pink-red maculopapular rash may develop several days after the facial rash., which, again, typically resolves over a few days or weeks. The rash may be itchy, particularly on of the soles of the feet. Additionally, there may be arthropathy of the knees and ankles, but this is not common (it may affect women more than men) and can last for months or years. Prior to the development of the rash, the person may have several prodromal symptoms for a few days (such as: a low-grade fever, nasal discharge, headache, sore throat, myalgia, nausea and diarrhoea). However, in healthy adults, symptoms may be atypical or the person may be asymptomatic

• The infection can occur at any age, but is most commonly seen in children of primary school age (4-11 years)

• The following people are at increased risk of complications which could be life-threatening, necessitating urgent referral for medical advice:
  
  
  • Pregnant women (it can cause a miscarriage among other issues. Complications depend on when exposure occurred in relation to the stage of pregnancy)
  • People who are immunocompromised due to a medical condition or medication (for example, those with leukaemia, HIV infection or receiving chemotherapy)
  • People with a haematological disorder (for example, sickle cell disease or autoimmune haemolytic anaemia)

• Signs of anaemia: very pale skin, shortness of breath, extreme tiredness or fainting

• People with an atypical presentation or those failing to improve (or if symptoms are getting progressively worse)

For most healthy people, this will be a mild, self-limiting illness which normally lasts for a few weeks followed by life-long immunity

• NB: A red rash affecting the trunk and limbs may recur in children months after the acute infection (triggers include sunlight, heat, stress, or exercise). In adults, polyarthropathy may persist for months or years, or may recur several months after the acute infection

• The following strategy is for immunocompetent children and adults (who are not pregnant):

• Infection control measures are required to limit the spread. The virus is usually transmitted by droplet spread through respiratory secretions, by vertical transplacental transmission from a pregnant woman, or blood transfusion. Remember to advise contact tracing and explain about the infectivity period (7–10 days before to the day after the onset of rash). As previously stated, people at risk of complications if they contract the infection (and thus need to seek medical advice if exposure was possible) include pregnant women, immunocompromised or those with a haematological disorder

• Provide reassurance that it is normally a mild, self-limiting illness

• Ensure adequate fluid intake (particularly if a fever is present) and rest

• Simple analgesia such as paracetamol or ibuprofen may be useful for symptomatic relief of pain and/or pyrexia
• Emollients may be useful for itchy skin (and potentially a sedating antihistamine, product licence permitting)