Fifth disease: a brief review of infections in childhood, in adulthood, and in pregnancy

Article Abstract:

Erythema infectiosum, originally called "fifth disease", is a childhood skin eruption (exanthem) which usually occurs in the winter and spring. Classic childhood exanthems are measles, scarlet fever, German measles, roseola, and erythema infectiosum, also known as "slapped-cheek" facial rash. Epidemics of fifth disease are confined to localized geographic areas. Fifth disease typically lasts from five to nine days. In adults, the disease begins with malaise and a low-grade fever lasting one to two days. Polyarthralgia, widespread joint pain, occurs in 80 percent of adults with fifth disease and usually disappears without treatment after one or two weeks. The typical rash associated with fifth disease may not develop in adults. Clinical features associated with fifth disease in children are not specific, and they may include headache, mild fever, and coryza, a profuse nasal discharge due to inflammation of the nasal mucous membrane. These symptoms occur about two days before the onset of a rash of variable form, severity, distribution, and duration; the rash begins on the face and next appears on the trunk and extremities. Fifth disease appears to be contagious via the respiratory system during its initial phase when mild fever and muscle pain are evident. A troubling feature of fifth disease is that once a rash or arthralgia has occurred, the contagious phase has already passed, and therefore exposure at the onset of an outbreak cannot be avoided. The discovery of parvovirus as the cause of fifth disease has led to an expanded understanding of the complications that may be associated with this illness. Parvovirus is now known to cause aplastic crisis (abnormal organ or tissue development) in patients with diseases of hemoglobin. The parvovirus immunoglobulin G (IgG) antibody confers protection against fifth disease. Research has also demonstrated the danger of fifth disease to pregnant women and the fetus; parvovirus infecting fetuses in the second trimester has resulted in spontaneously aborted hydropic fetuses. No fetus has been reported to survive congenital malformations due to maternal parvovirus infection. Of the 37 documented cases of parvovirus infection during pregnancy, 14 resulted in fetal death. Studies to develop screening tests for parvovirus susceptibility and infection during pregnancy are in progress.

Virus diseases, Communicable diseases in children, Virus diseases in pregnancy, Pediatric communicable diseases

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Alcohol and the heart: the long-term effects of alcohol on the cardiovascular system

Article Abstract:

Although the mechanism is unknown, the connection between heavy alcohol consumption and disease of the heart muscle (cardiomyopathy) is well recognized. Alcohol is calorie-rich and nutrient-poor, leading to complications caused by malnutrition and vitamin deficiencies. In addition, some alcoholic beverages contain toxic substances, including arsenic in wine and lead in ''moonshine.'' Women metabolize alcohol less well than men, and the elderly of either sex also are at increased risk for heart damage from a given quantity of alcohol. Chronic social drinkers may have abnormal heart function, especially of the left ventricle, which may often be below the level detectable by the usual tests. The early stages of alcohol-induced heart damage are easy to overlook, and it takes 10 years of constant heavy drinking before they become apparent. Even then, the rate of damage varies greatly among individuals. The first symptoms may be fatigue or an episode of abnormal heart rhythm, but without treatment and abstention, the disease may progress to cardiac failure and death. Alcohol can cause angina (chest pain due to restriction of blood flow to the heart) by causing the blood vessels to constrict. Apparently, calcium channel blockers are effective at dilating blood vessels constricted by alcohol, but beta blockers are not. Alcohol consumption during pregnancy may cause damage to the fetus, and congenital heart disease is a common complication of fetal alcohol syndrome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Fetus, Alcoholism, Alcohol, Ethanol, Cardiomyopathy, Myocardial diseases, Fetal alcohol syndrome, Alcoholic myopathy, Alcoholism in pregnancy

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Parvovirus B19-associated hemophagocytic syndrome

Article Abstract:

Parvovirus B19, a type of virus, was recently shown to cause a wide variety of clinical symptoms, including erythema infectiosum, a contagious, rose-colored skin rash; chronic hemolytic anemia or a chronic decrease in red blood cells due to their rupture; acute or sudden arthritis in adults; infection of the uterus leading to hydrops fetalis, a blood disease of the newborn; encephalitis or inflammation of the brain; pseudoappendicitis or a false attack of appendicitis; and purpura, a skin and mucous membrane disorder. A case is described of a 12-year-old boy who was infected with parvovirus B19 and developed the hemophagocytic syndrome, in which histiocytes (connective tissue cells that ingest particles) destroy red blood cells. The patient had symptoms of fever, nausea, fatigue, dizziness, loss of appetite, and disease of the liver and kidney. Antibodies to parvovirus B19, which are immune proteins that bind and inactivate this specific virus, were detected in the patient's blood. He developed pancytopenia, a decrease in all cell components of the blood, which resolved after a splenectomy, or surgical removal of the spleen. The patient fully recovered after surgery and remained clinically well during a three-month postoperative follow-up period. This case is the first report of parvovirus-associated hemophagocytic syndrome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Blood, Phagocytosis

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