1. FIFTH DISEASE Nicole Mabardi, SN and Shaina Joseph, SN University of South Florida, College of Nursing January 30, 2014

2. WHAT IS FIFTH DISEASE? Also known as Erythema Infectiousum Also known as Erythema Infectiousum Mild rash due to parvovirus B19 Mild rash due to parvovirus B19 – Parovirus B19 only affects humans – Parovirus B19 can cause different symptoms depending on age; however, those affected usually do not have any symptoms. – It can cause the body to temporarily stop making new red blood cell This can lead to anemia. This can lead to anemia. Fifth disease is mostly seen in children 2 to 15 years of age, but it can be found in adults as well.Fifth disease is mostly seen in children 2 to 15 years of age, but it can be found in adults as well. Quick Fact – Fifth disease got its name because it was fifth in a list of historical classifications of common skin rash illnesses in children.

3. SYMPTOMS Symptoms at first are usually mild and nonspecific. Symptoms at first are usually mild and nonspecific. – They include: – LOW GRADE FEVER – RUNNY NOSE – HEADACHE – JOINT PAIN (in adults) After several days, an erythematous rash appears on the face-specifically the cheeks- of the infected child, giving them a “slapped cheek” presentation. After several days, an erythematous rash appears on the face-specifically the cheeks- of the infected child, giving them a “slapped cheek” presentation. Days later, the rash spreads and erythematous blotches appear on their chest, back, arms/legs, and buttocks. Days later, the rash spreads and erythematous blotches appear on their chest, back, arms/legs, and buttocks. The rash varies in intensity and comes and goes for several weeks. The rash varies in intensity and comes and goes for several weeks. The rash may be itchy (especially if the rash is on the soles of the feet). The rash may be itchy (especially if the rash is on the soles of the feet). It usually goes away in 7-10 days but can last for several weeks. It usually goes away in 7-10 days but can last for several weeks.

5. TRANSMISSION The virus spreads through respiratory secretions like saliva, mucous, and sputum.The virus spreads through respiratory secretions like saliva, mucous, and sputum. Once infected by the virus, an individual will usually get sick within 4-14 days. Once infected by the virus, an individual will usually get sick within 4-14 days. The individual is most contagious when they have the fever like symptoms (right before the rash appears). The individual is most contagious when they have the fever like symptoms (right before the rash appears). The virus can also spread through blood or blood products. The virus can also spread through blood or blood products. Pregnant women can also pass the virus to their baby. Pregnant women can also pass the virus to their baby. Once a person has had Fifth Disease, they will have developed immunity to it (they won’t get it again). Once a person has had Fifth Disease, they will have developed immunity to it (they won’t get it again).

6. Clinical Case Five year old, Caucasian, male Five year old, Caucasian, male Cultural considerations- Both parents present with child; sibling at home with grandma. Cultural considerations- Both parents present with child; sibling at home with grandma. Admitted for Fifth Disease Admitted for Fifth Disease Medical history of only a circumcision done at birth. Medical history of only a circumcision done at birth. No known allergies No known allergies Subjective findings: Subjective findings: – Mother states that patient had a fever of 101 a few days ago. – Patient states rashes itch. Objective findings: Objective findings: – Rash over cheeks and body – Patient is itching – BP: 90/55; heart rate: 88; respirations:22; temperature: 98.7 F; 02 sat 97% 02 sat 97%

7. What assessment data about this patient is particularly pertinent? -Fever/ flu-like symptoms that have lasted a few days. - Rash that appears first on the child’s cheeks and then spreads throughout the body after a few days of having these flu-like symptoms.

8. Is there additional data that you would like to obtain before you notify the physician about this patient? When exactly symptoms appeared, if anything was consumed to relieve symptoms, and the medical history of the patient especially those with sickle cell disease (high risk). - When exactly symptoms appeared, if anything was consumed to relieve symptoms, and the medical history of the patient especially those with sickle cell disease (high risk).

9. Role Play With The Doctor Nurse: Good morning doctor, I have a five year old Caucasian male who came in today with rashes over his cheeks and body. His parents say he did have a fever and other flu-like symptoms a few days ago. His parents are very concerned. Nurse: Good morning doctor, I have a five year old Caucasian male who came in today with rashes over his cheeks and body. His parents say he did have a fever and other flu-like symptoms a few days ago. His parents are very concerned. Doctor: Ok, I will come by and perform a physical exam. In the meantime, have blood work drawn to check for antibodies to the parovirus B19 virus. If IgM antibodies are seen, then the child may be in the middle of an infection or have had a recent infection of the parovirus B19 virus (depending on the stage they are at). Doctor: Ok, I will come by and perform a physical exam. In the meantime, have blood work drawn to check for antibodies to the parovirus B19 virus. If IgM antibodies are seen, then the child may be in the middle of an infection or have had a recent infection of the parovirus B19 virus (depending on the stage they are at). Nurse: Sounds good, Doc. I will get a blood sample of the patient. Nurse: Sounds good, Doc. I will get a blood sample of the patient.

10. What interventions would be appropriate for this patient? Which of these interventions are highest priority? - Treatment is symptomatic: pain relief pain relief fluids fluids rest rest good hand washing** good hand washing**

11. What potential problems or complications do you need to be prepared to handle? How would you do that? Are there other people that need to be involved to help? Consultations? This is usually just a mild rash that tends to go away within a couple weeks or so, however, if the patient is a high risk candidate (anemia) they should be closely monitored via blood test because it can lead to transient aplastic crisis, which is a rapid worsening of existing anemia lasting 7-10 days. These patients will become very sick (fever, lethargy, rapid HR, and rapid breathing). This is usually just a mild rash that tends to go away within a couple weeks or so, however, if the patient is a high risk candidate (anemia) they should be closely monitored via blood test because it can lead to transient aplastic crisis, which is a rapid worsening of existing anemia lasting 7-10 days. These patients will become very sick (fever, lethargy, rapid HR, and rapid breathing). If iron levels are low, iron supplements can be used. If iron levels are low, iron supplements can be used. Parents should be involved to make sure treatment is followed. The Primary Doctor should also be involved to confirm viral illness is resolving. Parents should be involved to make sure treatment is followed. The Primary Doctor should also be involved to confirm viral illness is resolving.

12. How often should the nurse reassess the patient? Monitor Q2h (if hospitalized) Monitor Q2h (if hospitalized) Educate parents and make sure they understand the disease process Educate parents and make sure they understand the disease process

13. Appropriate Patient/Family Teaching Handwashing is key Handwashing is key Teach parents that this is a mild illness that will resolve Teach parents that this is a mild illness that will resolve Once the rashes appear, child is able to return to school because it will not be contagious anymore (it’s most contagious during fever). Once the rashes appear, child is able to return to school because it will not be contagious anymore (it’s most contagious during fever).

14. Problems Acute Pain Acute Pain Knowledge Deficit Knowledge Deficit Fatigue Fatigue Body image disturbance Body image disturbance Priority Nursing Diagnosis: Priority Nursing Diagnosis: – Acute pain related to rashes as evidenced by verbal statements of discomfort from patient.

15. Goals Short term goals Short term goals – Patient will rate pain 0/10 by the end of my shift. – Patient will stop itching by the end of my shift. Long term goals Long term goals – Patient will not be in pain through discharge.

16. Developmental Stage and Milestones Preschool (3-5 years of age) Preschool (3-5 years of age) – Initiative vs Guilt Children need to begin asserting control and power over the environment. Success in this stage leads to a sense of purpose. Children who try to exert too much power experience disapproval, resulting in a sense of guilt. Children need to begin asserting control and power over the environment. Success in this stage leads to a sense of purpose. Children who try to exert too much power experience disapproval, resulting in a sense of guilt. Milestones Milestones – Hops, skips, jumps, balances on one foot – Vocabulary of 2,100 words; uses sentences – Expresses through play and story-telling; imagination – Gender aware – Mood swings& dramatic behavior

17. Family Structure/Support System Both parents at the bedside of child Both parents at the bedside of child – Open to healthcare advice Sibling at home with grandma Sibling at home with grandma Approach to Invasive Procedures Approach to Invasive Procedures Standard Precautions Standard Precautions Good Hygiene/Handwashing Good Hygiene/Handwashing Gloves Gloves

18. Treatment Treatment is symptomatic:Treatment is symptomatic: pain reliefpain relief fluidsfluids restrest good hand washinggood hand washing Child can go to school once rash is present. Child can go to school once rash is present.

19. Documentation Temperature Temperature Flu-like symptoms Flu-like symptoms Location of rashes Location of rashes OLDCART OLDCART Patient/family education. Patient/family education.

20. Epidemiological and clinical features of erythema infectiosum in children in Novi Sad from 2000 to 2009 The reason for this study was to analyze the epidemiological (population) and clinical characteristics of erythema infectiosum (EI) in children. There were 88 children observed in the study that lasted from January 2000-December 2009 in Vojvodina, in Novi Sad(Serbia). The clinical characteristics were compared during and after the outbreak of EI and the results detected that 88 (44 boys, 44 girls) out of the 41,345 children had EI. The average age of children getting infected were 7.59 +/- 3.339. The most common signs were rashes on the cheeks and limbs, though no children had serious complications. The reason for this study was to analyze the epidemiological (population) and clinical characteristics of erythema infectiosum (EI) in children. There were 88 children observed in the study that lasted from January 2000-December 2009 in Vojvodina, in Novi Sad(Serbia). The clinical characteristics were compared during and after the outbreak of EI and the results detected that 88 (44 boys, 44 girls) out of the 41,345 children had EI. The average age of children getting infected were 7.59 +/- 3.339. The most common signs were rashes on the cheeks and limbs, though no children had serious complications.

21. Infectious diseases in children Fifth disease (Slapped cheek disease) This article describes Fifth Disease, explains why it is important and analyzes the characteristics of the viral outbreak it can resemble. This article describes Fifth Disease, explains why it is important and analyzes the characteristics of the viral outbreak it can resemble.

22. References Lowth, M. (2013). Infectious diseases in children Fifth disease (Slapped cheek disease). Practice Nurse, 43(10), 32-35. Lowth, M. (2013). Infectious diseases in children Fifth disease (Slapped cheek disease). Practice Nurse, 43(10), 32-35. Prćić, S., Gajinov, Z., Zrnić, B., Radulović, A., Matić, M., & Djuran, V. (2013). Epidemiological and clinical features of erythema infectiosum in children in Novi Sad from 2000 to 2009. Vojnosanitetski Pregled: Military Medical & Pharmaceutical Journal Of Serbia & Montenegro, 70(12), 1081-1084. doi:10.2298/VSP110607026P Prćić, S., Gajinov, Z., Zrnić, B., Radulović, A., Matić, M., & Djuran, V. (2013). Epidemiological and clinical features of erythema infectiosum in children in Novi Sad from 2000 to 2009. Vojnosanitetski Pregled: Military Medical & Pharmaceutical Journal Of Serbia & Montenegro, 70(12), 1081-1084. doi:10.2298/VSP110607026P