A school-aged child presents with a two-day history of low-grade fever, a “slapped cheek” appearance, and a lacy, reticulated rash on their arms. There are no known drug allergies or recent medication changes. Which of the following actions should the nurse practitioner take next?
Fifth disease, also known as erythema infectiosum is caused by parvovirus B19 and commonly presents with bright red cheeks, a low-grade fever, and a distinctive rash on the arms and body. It is viral and self-limiting. However, parvovirus B19 can cause fetal complications if contracted during pregnancy, so it is crucial to minimize exposure to pregnant individuals. The virus is especially contagious before the rash appears. Parvovirus B19 can cross the placenta and cause complications like fetal anemia and hydrops fetalis, especially during the first trimester. While streptococcal pharyngitis can present with a fever and rash, the hallmark signs of a “slapped cheek” rash and lacy rash suggest parvovirus B19 rather than a bacterial infection. Furthermore, streptococcal pharngitis will more often present with high grade fever, sore throat and lymphadenopathy. Topical corticosteroids are ineffective for fifth disease because the rash is caused by a viral infection, not an inflammatory or allergic reaction. Finally, the reticulated or ‘lacy’ rash on the arms and body is expected, is self-limiting, and resolves independently, so supportive care, like hydration and fever management, is recommended.
Fifth disease, caused by parvovirus B19, is characterized by its distinctive “slapped cheek” rash and can be contagious before the rash even appears. Avoid unnecessary antibiotic use and counsel families to protect pregnant contacts, as the virus can lead to complications in pregnancy.