in children, it typically presents with a slapped-cheek rash that follows nonspecific prodromal symptoms (corresponding with viremia).  The virus is transmitted via respiratory droplets.

Most adults with parvovirus B19 infection are asymptomatic (or associated with nonspecific flulike symptoms or arthralgias); however, parvovirus B19 during pregnancy can have devastating fetal consequences due to viral cytotoxicity to fetal erythrocyte precursors.  With increasingly severe fetal anemia, the fetal heart tries to compensate for hypoxemia by increasing cardiac output.  However, eventually it cannot compensate, and high-output fetal heart failure develops.  As with other cases of heart failure, fetuses develop third spacing of fluid, resulting in ascites (ie, tense fluid-filled abdomen) and generalized skin edema (and subsequent peeling).  Other clinical features include pleural or pericardial effusions and placental edema.

<aside> 💡 Pregnant women should avoid infected individuals because the virus can cross the placenta and have devastating fetal consequences.

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