Skin nontumor

Infectious disorders

Parvovirus B19

Last author update: 1 May 2016
Last staff update: 16 November 2020

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PubMed Search: Parvovirus B19 [title]

Abha Soni, D.O., M.P.H.
Mowafak Hamodat, M.B.Ch.B., M.Sc.
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Cite this page: Soni A, Hamodat M. Parvovirus B19. website. Accessed May 19th, 2024.
Definition / general
  • Viral infection that typically causes mild rash in children
  • Clinical syndrome is called "Fifth disease" or erythema infectiosum
  • Parvovirus B19 is spread by respiratory droplets, and has an incubation period of 5 - 14 days
  • Viral receptor is the erythrocyte P antigen, which is expressed on endothelial cells
  • Parvovirus attacks erythroblasts; may cause acute anemic crisis in patients with accelerated erythropoiesis, immunocompromised or minimal reserve (chronic anemia, hemolytic anemia, sickle cell, fetuses), although usually recipients have no symptoms (Transfusion 2005;45:1811)
  • Pregnant women may pass virus to fetus, where it may cause marked fetal anemia and hydrops
  • Rash may be due to delayed type hypersensitivity, antibody dependent cellular immunity against microbial antigens in epidermis or endothelium, or circulating immune complexes
Clinical features
  • Causes "Fifth disease" in children, a mild illness with a "slapped cheek" facial rash
  • Characteristic skin manifestations are petechial eruption in a glove and stocking distribution, reticular truncal erythema and "slapped cheek" sign (Hum Pathol 2000;31:488)
  • May produce influenza-like illness, miscarriage, fetal hydrops and neonatal angioedema
  • Atypical presentations include generalized petechial rash (Pediatrics 2010;125:e787), asymptomatic papular eruption or lower extremity palpable purpura, red baby syndrome (Indian J Pediatr 2009;76:309), papular purpuric gloves and socks syndrome (Med Oral Patol Oral Cir Bucal 2007;12:E4); may resemble Sweet syndrome, myopathic dermatomyosis or lupus erythematosus (Intern Med 1998;37:708)
  • Immune responses usually clear infection and provide lifelong protection but virus may persist in blood or tissue (Transfus Med 2007;17:263)
  • Parvovirus B19 has been associated with some cases of Rosai-Dorfman disease (J Clin Pathol 2006;59:1320)
Case reports
  • Usually self resolving
  • Can treat symptoms of fever, joint pain, swelling and itching
  • Children and healthy adults have complete recovery
Clinical images

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Lace-like rash on extremities

Microscopic (histologic) description
  • Interstitial histiocytic infiltrate with piecemeal fragmentation of collagen and mononuclear cell-predominant vascular injury pattern
  • Extravasated red blood cells
  • Erythrocyte precursors may have intranuclear inclusions
  • Eosinophils and occasional neutrophils may be present
  • Perineuritis may also be present
  • Also interface dermatitis, eczematous alterations, papillary dermal edema; occasionally mesenchymal mucinosis, leukocytoclastic vasculitis
Microscopic (histologic) images

Images hosted on other servers:

Bone marrow

Fetal spleen

Parvovirus B19 infection in formalin - fixed and paraffin - embedded placenta and fetal tissues

B19 positive immunostain

Positive stains
  • B19 immunostain
Molecular / cytogenetics description
  • Virus identified in endothelial cells of lesional skin by several methods, including PCR
  • Also identified in keratinocytes
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