Dr. Jeff Hersh: Common infection can cause complications later in life

Dr. Jeff Hersh

Q: More than a year ago I began to have easy bruising, visual changes, intense fatigue, swollen glands, swollen lymph nodes, myoclonic jerks and muscle fasciculations. Other symptoms emerged, but, thankfully, everything has finally become less severe, although has not yet completely resolved. I tested positive for parvovirus B19; can all this be from parvovirus?

A: Parvovirus B19 infection is very common; 5 percent to 10 percent of 5-year-olds have had this infection, and this rises to 50 percent by age 15, 60 percent by age 30 and 90 percent by age 60.

Parvovirus is very contagious; it is spread like many other viruses, from the mucus and sputum of infected patients who sneeze and cough. It is estimated that over 50 percent of susceptible household contacts of an infected person also become infected.

The childhood illness from parvovirus, erythema infectiosum, is also called fifth disease, from an early 1900s list of childhood illnesses that cause a rash and which included measles, scarlet fever (from strep infection), rubella (German measles), staph skin infection, erythema infectiosum and roseola. The classic symptoms of childhood fifth disease are "flu-like": runny nose, low-grade fever, cough and not feeling well.

Some kids who get fifth disease develop a rash of rosy red cheeks that looks like they were slapped in the face (usually both sides), so fifth disease is sometimes called slapped cheek disease. The rash may spread to the arms and legs. For the overwhelming majority of kids this is a mild, self-limited illness.

Although many adults infected with parvovirus B19 have mild or no symptoms, there can be complications, sometimes severe. These can include inflammation of the joints (arthritis), the heart (myocarditis) and/or other organ involvement.

Pregnant women who become infected can pass the infection on to the fetus growing inside them; this can sometimes cause the fetus to stop producing red blood cells and they may develop hydrops fetalis, a condition where fluids seep into their body tissues and cavities because of the very low levels of blood keeping the fluids inside their blood vessels. This condition can lead to the death of the fetus.

People with certain red blood cell disorders, such as sickle cell disease, hereditary spherocytosis or thalassemia, who are also infected with parvovirus B19 can develop an aplastic crisis, where the bone marrow stops producing blood cells. This can be severe and cause complications, often requiring transfusions and other treatments.

People with weakened immune systems can develop a chronic condition after parvovirus infection, leading to chronic low blood count and/or other conditions.

Possibly because of improved tests to diagnose parvovirus (such as PCR testing), it has become evident that parvovirus infection can also be associated with the development of autoimmune diseases, such as dermatomyositis, mixed connective tissue diseases, lupus-like seronegative arthritis and others. In these cases it is theorized that the body's immune response to the virus cross reacts with normal body proteins, causing the body to "attack" itself (this is what an autoimmune disease is).

As with many autoimmune diseases, the symptoms can be quite variable. Rashes, fatigue, joint problems, connective tissue problems and effects from essentially any body organ can occur. I could not find any specific estimates on how common parvovirus-associated autoimmune diseases are, but because of limited testing and even limited knowledge of this possibility, these may be more common than is presently realized.

I did not find any studies of the efficacy of any particular treatments for parvovirus-associated autoimmune diseases but, in general, physicians have treated these similarly to other autoimmune diseases, utilizing treatments to modify the body's immune response. There are case reports noting treatment with immunoglobulin may be beneficial, but these are not controlled clinical trials.

People with persistent, variable, puzzling symptoms should discuss their condition with their health care provider. If indicated, they may be referred to a rheumatologist to be evaluated for autoimmune conditions. Hopefully we will continue to learn more about these types of illnesses so we will be better able to help those with them in the future.

Jeff Hersh, Ph.D., M.D., F.A.A.P., F.A.C.P., F.A.A.E.P., can be reached at