Slapped cheek syndrome

SLAPPED cheek syndrome, also known as ‘fifth disease’ or erytherma infectiosum, is a viral infection caused by the Parvovirus B19 virus. Although it affects anyone at any age, it is more commonly seen in children and can have adverse effects on pregnant women and their foetuses.

“The condition, which spreads in a way similar to the common cold, is transmitted by hand-to-hand contact, by exchange of respiratory secretions through coughing, sneezing, and exposure to respiratory secretions. The virus can spread from mother to foetus and through blood transfusions,” explained Dr Keisha Buchanan, obstetrician-gynaecologist at ICON Medical Centre.

In expectant mothers, the condition can cause serious complications. The name originates from the appearance of rashes on the cheeks of the person in the later stages of the illness when the patient is no longer infectious.

“Slapped cheek syndrome can trigger a number of complications in pregnancy, such as miscarriage. It can also cause severe foetal and maternal complications in pregnant women who have sickle cell disease or who have a weakened immune system,” Dr Buchanan underscored.

She said that the time of exposure to the infection to the onset of the illness can extend from four to 14 days, and rashes that may develop can recur several weeks to months after the initial infection.

But this is not the case for approximately 30 per cent of infected parties, who Dr Buchanan says show no signs or symptoms of the condition.

“Children with slapped cheek syndrome may have a fever, a rash on the cheeks, a generalised lacy skin rash, a rash that tends to recur with exercise, warm baths, and when the person is emotionally upset. The symptoms may be more severe in adults and in pregnant women, and may present as high fever, joint pain, headache, muscle pain, or abdominal pain,” she shared.

According to Dr Buchanan, the condition is dangerous for certain groups of pregnant women for a number of reasons. Below, she outlines the breakdown of each category and how they are affected.

1. Pregnant women who were not previously exposed.

Approximately 50-60 per cent of the adult population are immune to Parvovirus B19 from prior exposure. If the pregnant mother was infected with Parvovirus B19 prior to her pregnancy, the infection is unlikely to cause any problems in the pregnancy as she would most likely be immune to the virus. “However, if the pregnant woman has no prior exposure and no immunity to the virus, and especially if she is exposed to the virus in the first half of the pregnancy, there is an increased risk of the foetus developing a complication called Hydrops Fetalis in which severe foetal anaemia develops, followed by heart failure, and ultimately death,” Dr Buchanan warned. She explained that the rate of foetal death is lower in medical centres equipped to offer blood transfusion to the foetus. “Parvovirus can also cause infection of the foetal meninges (the membrane covering the spinal cord and brain), meningitis, encephalitis (brain infection), inflammation of the foetal heart, growth restriction and premature delivery,” Dr Buchanan noted. On the bright side, she pointed out that Parvovirus does not cause birth defects or long-standing problems in the baby.

2. Pregnant women with sickle cell disease

Pregnant women who have sickle cell disease are at high risk of going into a sickle cell crisis marked by worsening anaemia, joint pain, severe respiratory difficulties and the need for early delivery and blood transfusion. “An aplastic crisis can occur in pregnant women who have abnormalities of their haemoglobin such as sickle cell disease and hereditary spherocytosis. An aplastic crisis is marked by severe anaemia, low platelets that predispose to increased risk of bleeding problems, and low white blood cells that put both mother and foetus at risk of severe infections,” Dr Buchanan explained. She said that there is higher risk of foetal and maternal death with an aplastic crisis. In addition, since sickle cell disease results in a rapid breakdown of the red cells, the woman should be closely monitored for severe worsening of the red cell count and for falling white blood cells by serial blood count monitoring.

3. Pregnant women with compromised immune systems

Pregnant women who are immunocompromised such as those who have AIDS, severe diabetes or are on immunosuppressive treatments, for example renal transplant patients, are at greater risk of prolonged illness and have a higher chance of complications such as severe anaemia, meningitis, brain infection and poor pregnancy outcome, foetal growth restriction with smaller babies, and premature delivery.

Dr Buchanan advised expectant mothers exposed to the virus for the first time in the first or early second trimester — even in the absence of any other pre-existing factors — that close follow-up will be required.

“This usually takes the form of weekly ultrasounds to assess the foetus for signs of heart failure, such as fluid accumulating around the foetal heart and in the foetal lung. In fact, in some countries, a foetal blood transfusion can be done to correct severe anaemia and prevent heart failure and hydrops from occurring, and so decrease the mortality rate. These women will need to be monitored by their obstetricians and co-managed with haematologists (doctors who treat blood conditions) and infectious disease specialists,” Dr Buchanan said.

While these disclosures could easily put fear into the hearts of pregnant women as well as those planning to get pregnant, Dr Buchanan said that most women who get slapped cheek syndrome in pregnancy will not have complications; however, she advised that medical attention must be sought if this or any other infections are noted during pregnancy.

She added that this illness can be avoided if good hygiene is practised and if infected individuals exercise good conscience.

“All that is required is for you to practise simple hygiene methods such as handwashing, covering the mouth when coughing, avoiding the workplace when there is an outbreak, avoiding persons who are having an acute infection, and screening blood for the infection prior to transfusion.” She also encouraged parents to keep their infected children out of school and day care and to avoid public spaces in general.

Dr Buchanan again stressed practising simple hygiene procedures, because to date there is no vaccine available to prevent the Parvovirus B19 infection.