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Generalized petechial rashes linked to parvovirus
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Petechial rashes caused by human parvovirus B19 during an outbreak of erythema infectiosum were more common than previous research suggested, according to study results.
Researchers from the University of Wisconsin in Madison notified general pediatricians in the University of Wisconsin Health network to watch for patients presenting with petechial rash of unknown cause after the start of an outbreak in the Madison area in 2007. They used lab or clinical evidence to confirm parvovirus infection.
Overall, 17 suspected cases of parvovirus-associated petechial rash were reported by network pediatricians in the Madison area between February and November 2007. The researchers confirmed acute parvovirus infection in 13 children with lab or clinical evidence, with only two sisters having known common household or school exposure.
The researchers said that 11 children experienced fever that just preceded or coincided with emergence of petechial rashes — which were generally described as dense; broadly distributed; occasionally concentrated in the distal extremities, axillae or groin; and usually absent from the head or neck.
Blood counts from 12 children indicated the following:
- 10 had leukopenia;
- two had isolated neutropenia;
- five had isolated lymphopenia;
- five had both isolated neutropenia and lymphopenia;
- four had thrombocytopenia.
Lab results showed detection of parvovirus immunoglobulin M in eight of 11 acute-phase serum specimens, according to the researchers. IgG, however, was only detectable in convalescent specimens. Seven cases tested by polymerase chain reaction detected parvovirus DNA, including two cases that tested negative for IgM.
The researchers also reported that six of the 13 children with lab- or clinically-confirmed infection were hospitalized, although stays only ranged from two to three days. One patient, however, underwent a bone marrow biopsy to evaluate neutropenia and thrombocytopenia.
Two patients also developed erythema infectiosum after their petechial rash resolved. These cases involved the appearance of a second rash two to three weeks after the first rash was discovered. – by Melissa Foster
Edmonson MB. Pediatrics. 2010;125:e787-e792.
This is an interesting article that documents generalized petechial rashes seen during an outbreak of parvovirus B19. While petechial rashes are known to be associated with parvo B19, this study is the first to document a community outbreak of petechial eruptions associated with the virus, with six of 13 affected children hospitalized. Most of the patients had only mild constitutional symptoms, while most had fever and leukopenia. The petechiae were generalized in most patients, with lesions common on the trunk and extremities but rarely on the head and neck. The serologic data and clinical presentation argue for the petechial eruption being part of the viremic phase of parvo B19 infection and distinct from the slapped cheek and reticular erythema of erythema infectiosum (also known as fifth disease), which occurs in a subset of parvovirus-infected children after viremia. The authors believe that petechial rashes with parvo B19 may be more common than previously appreciated.
– Lawrence F. Eichenfield, MD
Infectious Diseases in Children Editorial Board