Her mother states that the patient began feeling extremely tired and complaining of a headache, lack of appetite, and severe fatigue 5 days ago. Yesterday the patient awoke with “tomato red cheeks” and looked like she had been slapped in the face. Her temperature was 102. The mother gave patient Tylenol as directed on the package, which reduced her temperature to 99, however today the fever has returned. The patient states she is tired and does not feel like eating. She denies nausea, vomiting, or dizziness. Last menses was 1 week ago. She also complains of itching on her hands and feet and nonspecific body aches.
The patient states several children at the preschool where she works have recently been absent because of rashes. Past Medical History Kayla and Mrs. B deny any significant illnesses. Kayla has not been vaccinated for HPV. Family History Negative for CVD, DM, CA Social History Kayla is an only child, lives in a 3-bedroom home with her parents. She does well in school, plays in the band, and plays football in the spring. Kayla is currently working at a preschool as a teacher’s helper from 4-6 PM weekdays. Mrs. B is 5 months pregnant. Physical Exam BP 100/68; P 84; R 20; T 101. 4; Ht 63”; Wt 103 lb.
Patient is alert, cooperative, and in no apparent acute distress. HEENT exam is significant for bright erythematous cheeks bilaterally and slight erythema of the oropharynx, without tonsillar enlargement. Necks supple without lymphadenopathy. Lungs are clear to A&P. Heart rate is regular without murmur or rub. Abdomen is soft and non-tender without organomegaly. Hands and feet are erythematous and exhibit popular lesions. There are no bruises or other rashes detected. Musculoskeletal exam is negative. Neurologic exam is WNL.
Diagnosis Parvovirus B19 (Erythema Infectiosum, Fifth Disease); the disease begins with a low-grade fever, headache, and cold like symptoms. Once these symptoms pass and the illness appears to be gone; a rash appears a few days later and usually begin on the face. Other symptoms that may occur include swollen glands, sore throat, and red eyes. In cases that involve adults and older teens the attack of disease may be followed by joint pain (Dighe, Pattan, Bhawar, Dighe, Kale, et. al. , 2009). Patient’s immunization record should have been included in assessment. The patient is a healthy teenager and diagnosis can be made with examination.
Pathophysiology The human parvovirus B19 is primary cause of erythema infectiosum (fifth disease). B19 is a common virus and most infections occur in children aged 5-15, adults at risk are usually parents of children in that age group, or those that work in day cay care centers or schools. The fifth disease (FD) is named because it is the fifth in series of childhood rash-associated infections. FD is more contagious during 4-14 day incubation period and rash may last 2-39 days (Garcia, 2013). A rash with the appearance of a slapped check and a lacy rash that appears on trunk and limbs following a low-grade fever characterize the disease.
Children may experience pruritus, lymphadenopathy, atypical papular, or vesicular rashes (Mandel, 2009). A mild temperature, sore throat, and cold symptoms may be experienced by the patient and may occur after the rash. Given Kayla’s presentation of clinical signs she has symptoms associated with the disease (malaise, headache, red rash on cheeks, swollen glands, joint pain, and inflammation of hands and feet). To prevent transmission of disease it is necessary to follow protocols for isolation procedures. Educate staff, visitors, and healthcare workers to maintain strict hand washing and precautions to prevent transmission.
After the rash the patient is probably not contagious and is safe to return to school/work. There is no medicine or vaccine that can prevent the disease. Treatment involves relieving symptoms including fever, itching, and pain (Center for Disease Control and Prevention, 2012). Differential Diagnoses Differential diagnoses include Systemic Lupus Erythematosus (SLE), Contact Dermatitis, and Rubella. SLE is an autoimmune inflammatory disease with similar presentations of FD. The predominant age of the disease is 15-45 with history of fever, rash, lymphadenopathy, malaise, and cold symptoms. This disease is less likely because SLE is a multisystem inflammatory disease affecting systems including renal, nervous, vascular, and gastrointestinal (Kalunian & Joan, 2009).
The patient works at a preschool; Contact Dermatitis can be an acute or chronic eczematous eruption that may occur from direct irritation to the skin. In Contact Dermatitis the rash may be localized as in this patient with facial involvement. Her feet and hands are erythematous and exhibit papular lesions; Contact Dermatitis patients may present with a history of itchy rash and physical exam may show signs of papules, vesicles, and bullae with surrounding erythema (Hogan, 2011). FD has an airborne transmission; allergic contact dermatitis is due to individuals sensitized to a substance such as plants, chemicals, and topical medicines.
FROM HTTP://WWW. CDC. GOV/VACCINES/PUBS/SURV-MANUAL/CHPT15-CRS. HTML. Dighe, N. , Pattan, S. , Bhawar, S. , Dighe, S. , Kale, S. , et. al. (2009). “Fifth Disease: A review”. Pharmaceutical Sciences and Research 1(4): 15-25. HealtyPeople. gov (2010). Immunization and infectious diseases. Retrieved from http://www. healthypeople. gov/2020/topicsobjectives2020/overview. aspx Hogan, D. J. (2011). Contact dermatitis. Retrieved from http://emedicine. medscape. com/article/1049216-overview.