Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Pediatrics. 2010 Apr;125(4):e787-92. doi: 10.1542/peds.2009-1488. Epub 2010 Mar 1.
Human parvovirus B19 infection is associated not only with erythema infectiosum (fifth disease) but also, rarely, with purpuric or petechial rashes. Most reports of these atypical rashes describe sporadic cases with skin lesions that have distinctively focal distributions. During a community outbreak of fifth disease, we investigated a cluster of illnesses in children with generalized petechial rashes to determine whether parvovirus was the causative agent and, if so, to describe more fully the clinical spectrum of petechial rashes that are associated with this virus.
Systematic evaluation was conducted by general pediatricians of children with petechial rashes for evidence of acute parvovirus infection.
During the outbreak, acute parvovirus infection was confirmed in 13 (76%) of 17 children who were evaluated for petechial rash. Confirmed case patients typically had mild constitutional symptoms, and most (11 [85%] of 13) had fever. Petechiae were typically dense and widely distributed; sometimes accentuated in the distal extremities, axillae, or groin; and usually absent from the head/neck. Most case patients had leukopenia, and several had thrombocytopenia. Parvovirus immunoglobulin M was detected in 8 (73%) of 11 acute-phase serum specimens, and immunoglobulin G was detectable only in convalescent specimens. Parvovirus DNA was detected in all 7 tested serum specimens, including 2 acute-phase specimens that were immunoglobulin M-negative. All case patients had brief, uncomplicated illnesses, but 6 were briefly hospitalized and 1 underwent a bone marrow examination. Two case patients developed erythema infectiosum during convalescence.
During an outbreak of fifth disease, parvovirus proved to be a common cause of petechial rash in children, and this rash was typically more generalized than described in case reports. Associated clinical features, hematologic abnormalities, and serologic test results are consistent with a viremia-associated illness that is distinct from and occasionally followed by erythema infectiosum.
人类细小病毒 B19 感染不仅与传染性红斑（第五病）有关，而且很少与紫癜或瘀点性皮疹有关。大多数关于这些非典型皮疹的报告描述了具有明显局灶性分布的散发性病例。在第五病的社区暴发期间，我们调查了一组患有全身性瘀点性皮疹的儿童疾病，以确定细小病毒是否是致病因子，如果是，更全面地描述与该病毒相关的瘀点性皮疹的临床谱。
由普通儿科医生对患有瘀点性皮疹的儿童进行系统评估，以确定是否有急性细小病毒感染的证据。
在暴发期间，对 17 名患有瘀点性皮疹的儿童进行评估，确认有 13 名（76%）患有急性细小病毒感染。确诊病例患者通常有轻度全身症状，大多数（11 例[85%]）有发热。瘀点通常密集且广泛分布；有时在四肢末端、腋窝或腹股沟处加重；通常不发生在头部/颈部。大多数病例患者白细胞减少，少数血小板减少。在 11 份急性血清标本中检测到 8 份（73%）细小病毒免疫球蛋白 M，仅在恢复期标本中检测到免疫球蛋白 G。在所有 7 份测试血清标本中均检测到细小病毒 DNA，包括 2 份免疫球蛋白 M 阴性的急性标本。所有病例患者均有短暂、无并发症的疾病，但 6 例短暂住院，1 例进行骨髓检查。2 例病例患者在恢复期出现第五病。
在第五病暴发期间，细小病毒被证明是儿童瘀点性皮疹的常见原因，并且这种皮疹通常比病例报告中描述的更广泛。相关的临床特征、血液学异常和血清学检测结果与病毒血症相关的疾病一致，该疾病与第五病不同，偶尔继发于第五病。
