Erythema infectiosum: Symptoms, Diagnosis, and Treatment

Erythema infectiosum, also known as fifth disease, is a common childhood viral infection caused by parvovirus B19. This disease is characterized by a distinct rash that appears on the cheeks, giving them a “slapped” appearance. The rash may then spread to other parts of the body.

Children are most commonly affected by erythema infectiosum, although it can occur in individuals of any age. It is highly contagious and spreads through respiratory droplets, making it easily transmitted in schools and daycare settings. The virus can also be spread through blood transfusions and during pregnancy, potentially causing complications in unborn babies.

The symptoms of erythema infectiosum typically begin with a mild fever, headache, and runny nose. After a few days, the characteristic rash develops, starting on the cheeks and then spreading to the trunk, arms, and legs. The rash may appear lacy or reticular in pattern, which can vary in intensity. It usually resolves within two to three weeks without leaving any scars.

Diagnosis of erythema infectiosum is based on the characteristic clinical presentation and can be confirmed through blood tests that detect specific antibodies to the parvovirus. Treatment is generally supportive and aims to alleviate symptoms. Over-the-counter pain relievers may be recommended for fever and discomfort. It is important to note that there is no specific antiviral treatment for erythema infectiosum.

In conclusion, erythema infectiosum, or fifth disease, is a viral infection that primarily affects children and is characterized by a distinctive rash on the cheeks. It is caused by parvovirus B19 and spreads easily through respiratory droplets. While the disease is typically mild and self-limiting, it is important to take precautions to prevent its spread, especially in high-risk populations such as pregnant women and immunocompromised individuals.

Erythema Infectiosum

Erythema infectiosum, also known as fifth disease or slapped cheek disease, is a viral infection that primarily affects children. It is caused by the parvovirus B19 and is typically characterized by a distinctive rash on the cheeks and a low-grade fever.

The name “fifth disease” stems from its historical classification as the fifth childhood exanthem (rash-causing disease) that was identified. The characteristic rash begins as a bright red blush on both cheeks, giving the appearance of “slapped cheeks.” Over time, the rash spreads to the trunk and limbs, presenting as a lacy, pinkish-red discoloration.

Erythema infectiosum is highly contagious and can easily spread through respiratory droplets or by direct contact with an infected individual. It is most commonly contracted during school-age years or in community settings where close contact is common.

The initial symptoms of erythema infectiosum can resemble those of a common cold, with a runny nose, headache, and sore throat. Following this prodromal phase, the characteristic rash develops, accompanied by the low-grade fever. In some cases, joint pain and swelling may also occur, particularly in adults.

Diagnosis of erythema infectiosum is typically based on clinical presentation, with the characteristic rash being the main indicator. Laboratory tests, such as serology or polymerase chain reaction (PCR), can be used to confirm the presence of parvovirus B19 in cases where the diagnosis is uncertain.

Most cases of erythema infectiosum resolve on their own without the need for any specific treatment. Symptomatic relief can be achieved with over-the-counter pain relievers and antipyretics to alleviate fever and discomfort. It is important to ensure adequate hydration and rest during the course of the illness.

Complications are rare but can occur, especially in individuals with compromised immune systems or certain underlying conditions. Pregnant women who become infected with parvovirus B19 are at risk for fetal complications, such as anemia or miscarriage. It is important for pregnant women to seek medical attention promptly if they have been exposed to the virus or develop symptoms.

In conclusion, erythema infectiosum, or fifth disease, is a viral infection that primarily affects children. It is characterized by a distinctive rash on the cheeks, giving the appearance of “slapped cheeks.” The infection is caused by parvovirus B19 and is highly contagious. While most cases resolve on their own, it is important to monitor for complications in certain populations. Seeking medical attention promptly is crucial, especially for pregnant women.

Type of Rash

Erythema infectiosum, also known as fifth disease, is a common viral infection in children caused by parvovirus B19. One of the main symptoms of this disease is a characteristic rash. The rash in erythema infectiosum is often referred to as a “slapped cheeks” rash due to its appearance, which resembles the effects of getting slapped on the cheeks.

The rash usually begins on the cheeks and gives them a bright red, flushed appearance. It can then spread to other parts of the body, such as the arms, legs, and trunk. The rash may appear lacy or net-like in some cases.

The onset of the rash typically occurs after several days of flu-like symptoms, such as fever, headache, and body aches. As the infection progresses, the rash may become more prominent and can last for several weeks. It may also come and go in different stages.

Although the rash in fifth disease is usually not itchy or painful, it can cause discomfort for some individuals. It is important to note that the rash is not contagious and does not pose a risk to others.

In conclusion, the rash associated with erythema infectiosum, or fifth disease, is a distinct symptom characterized by a “slapped cheeks” appearance. Understanding the type of rash can help in the diagnosis and treatment of this infection in children.

Causes and Transmission

Erythema infectiosum, also known as fifth disease, is a viral infection caused by the parvovirus B19. It mainly affects children, particularly those between the ages of 5 and 15.

The primary mode of transmission is through respiratory droplets. When an infected individual sneezes or coughs, tiny droplets containing the virus can be inhaled by others, leading to infection. Additionally, the virus can also be spread through direct contact with infected respiratory secretions or blood.

Once infected, individuals typically develop a characteristic “slapped cheek” rash, along with flu-like symptoms such as fever, headache, and fatigue. The rash may then spread to the trunk and extremities, taking on a lacy or reticular appearance.

It is important to note that the virus typically affects individuals who have not previously been infected and have not received a vaccination against it. However, in most cases, the infection is mild and resolves on its own without any specific treatment.

Symptoms and Signs

When a person is infected with the parvovirus, it can lead to a disease called erythema infectiosum, also known as fifth disease. This disease is characterized by a distinctive rash on the cheeks, giving the appearance of being slapped.

The most common symptom of erythema infectiosum is a low-grade fever, which may precede the appearance of the rash. The rash usually begins on the cheeks and spreads to other parts of the body, such as the arms, trunk, and legs. It can last for several days to a few weeks.

Other symptoms that may accompany the rash include headache, sore throat, runny nose, and fatigue. In some cases, joint pain and swelling may also occur.

Early Symptoms:

Low-grade fever
Headache
Sore throat
Runny nose
Fatigue

Rash Symptoms:

Rash on the cheeks
Rash on other parts of the body
Appearance of being slapped

If you or your child experiences these symptoms, it is important to consult a healthcare provider for proper diagnosis and treatment.

Incubation Period

The incubation period for erythema infectiosum, also known as slap cheek or fifth disease, is typically 4 to 14 days after exposure to the parvovirus B19. This period can vary depending on the individual, but it is generally around 7 to 10 days.

During the incubation period, children may not show any symptoms of the infection. However, they can still spread the virus to others, even before the onset of symptoms.

Once the infection starts to manifest, the first symptom is usually a low-grade fever, followed by a distinctive rash. The rash begins as red patches on the cheeks, giving the appearance of being slapped, hence the nickname “slap cheek”.

From the cheeks, the rash can spread to other parts of the body, including the arms, legs, trunk, and buttocks. It typically lasts for about 1 to 3 weeks, but can come and go in cycles or worsen with exposure to sunlight or heat.

While the rash may be itchy, it usually does not cause significant discomfort. Some children may also experience mild flu-like symptoms, such as a runny nose, headache, or sore throat, but these symptoms are not always present.

If a child develops the characteristic rash on the cheeks, it is important to seek medical attention for an accurate diagnosis. The doctor may confirm the infection through a blood test or by evaluating the clinical signs and symptoms.

Treatment for erythema infectiosum is primarily focused on managing the symptoms. This may include over-the-counter pain relievers, antipyretics, and plenty of rest and fluids. In most cases, the infection resolves on its own without complications.

It is important to note that erythema infectiosum is most contagious during the incubation period and until the rash appears. Once the rash is present, the risk of transmission is significantly reduced. However, it is still advisable to take precautions, such as practicing good hygiene and avoiding contact with individuals who may be at risk, particularly pregnant women and individuals with compromised immune systems.

Diagnosis Methods

The diagnosis of erythema infectiosum, commonly known as fifth disease, is primarily based on the characteristic symptoms and physical examination. In most cases, the distinctive rash on the cheeks, often referred to as the “slapped cheeks” appearance, is enough to make a diagnosis. However, additional diagnostic methods may be used to confirm the presence of the parvovirus B19 infection:

Antibody testing: Blood tests can be performed to detect the presence of antibodies to the parvovirus B19. Specific IgM antibodies are typically detected during the early stages of the infection, while IgG antibodies may indicate a past infection or immunity.
PCR testing: Polymerase chain reaction (PCR) testing can be used to directly detect and identify the genetic material of the parvovirus B19 in blood samples. This method is highly specific and sensitive, providing a definitive diagnosis.
Serology testing: Serologic tests can be conducted to measure the levels of specific antibodies in the blood. This can help determine the stage of the infection and assess the immune response.

It is important to note that laboratory tests may not be necessary in all cases of erythema infectiosum, as the clinical presentation is often sufficient for diagnosis. However, these diagnostic methods can be helpful in confirming the presence of the parvovirus B19 infection, especially in atypical or complicated cases.

Differential Diagnosis

When a child presents with a fever and a rash, several diseases may be considered in the differential diagnosis. Erythema infectiosum, also known as fifth disease, is caused by the parvovirus B19 infection and is characterized by a “slapped cheek” rash. However, other conditions can present with similar symptoms and should be ruled out:

Rubella: Rubella, also known as German measles, can cause a rash similar to that of erythema infectiosum. A key difference is that rubella typically presents with swollen lymph nodes and can cause more serious complications in pregnant women.
Scarlet fever: Scarlet fever is a bacterial infection that can cause a rash similar to that of erythema infectiosum. However, scarlet fever is usually accompanied by a sore throat, swollen glands, and a strawberry tongue.
Measles: Measles, also known as rubeola, can cause a rash similar to that of fifth disease. However, measles generally presents with a high fever, cough, and runny nose, in addition to the rash.
Drug reaction: Some medications can cause rashes that may resemble the rash of erythema infectiosum. It is important to consider any recent changes in medication or exposure to new medications.

In order to make an accurate diagnosis, healthcare providers may need to perform laboratory tests to confirm the presence of parvovirus B19 or rule out other infections. Clinical evaluation, medical history, and physical examination are also important in determining the correct diagnosis.

It is crucial to consider these differential diagnoses when evaluating a child with a fever and rash, as the appropriate treatment and management of these conditions may vary.

Treatment and Management

There is no specific treatment for fifth disease, also known as erythema infectiosum, as it is a viral infection. Most children with this disease recover on their own without any complications. Treatment typically focuses on managing the symptoms and providing comfort to the child.

Managing Fever

One common symptom of fifth disease is a mild fever. To manage the fever, it is recommended to give the child over-the-counter pain relievers, such as acetaminophen or ibuprofen, as directed by a healthcare provider. These medications can help reduce fever and relieve any associated discomfort.

Providing Comfort

Symptoms of fifth disease can include general discomfort, body aches, and headache. It is important to ensure that the child gets plenty of rest and stays hydrated. Offering fluids and encouraging the child to drink water or other clear liquids can help prevent dehydration and reduce symptoms.

Additionally, applying cool compresses to the child’s forehead or using a fan to create a gentle breeze can help alleviate any discomfort caused by fever. It is also important to dress the child in light, comfortable clothing to prevent overheating.

In some cases, if the child experiences joint pain as a result of fifth disease, a healthcare provider may recommend over-the-counter pain relievers or anti-inflammatory medications to manage the pain.

It is important to note that children with fifth disease should avoid contact with pregnant women, as the infection can be harmful to unborn babies. If a pregnant woman is exposed to fifth disease, it is crucial to seek medical advice to assess the risk and determine appropriate management.

In conclusion, treatment for fifth disease focuses on managing symptoms and providing comfort to the child. Most children recover without any complications, and the infection typically resolves on its own. If you suspect your child has fifth disease, it is advisable to consult a healthcare provider for an accurate diagnosis and appropriate management.

Complications and Risks

Erythema infectiosum, also known as fifth disease, is a common infection among children caused by parvovirus B19. While generally mild, this viral infection can sometimes lead to complications and pose certain risks.

One of the most common complications of erythema infectiosum is the appearance of a rash on the cheeks. This rash, often referred to as a “slapped cheek” rash, is typically bright red in color and can be accompanied by a lacy rash on the body. While the rash is not usually itchy or painful, it can cause embarrassment and discomfort for some individuals.

In addition to the rash, some individuals with erythema infectiosum may experience other symptoms such as fever, headache, sore throat, and joint pain. These symptoms are generally mild and resolve on their own without treatment.

However, in rare cases, complications can occur, particularly in individuals with weakened immune systems or certain underlying health conditions. These complications may include anemia, especially in individuals with underlying red blood cell disorders, and joint pain that can last for several weeks or months.

In pregnant women, erythema infectiosum can pose a risk to the unborn baby. If a pregnant woman becomes infected with parvovirus B19, there is a small risk of the virus causing complications such as fetal anemia or miscarriage. However, the overall risk of these complications is low.

It is important to note that most individuals with erythema infectiosum recover without any complications or long-term risks. However, if you or your child experience unusual or severe symptoms, it is important to seek medical attention for a proper diagnosis and appropriate treatment.

Common Complications and Risks:
– Slapped cheek rash
– Lacy rash on the body
– Mild symptoms such as fever, headache, sore throat, and joint pain
– Anemia (in rare cases, especially in individuals with underlying red blood cell disorders)
– Prolonged joint pain
– Risk to unborn baby in pregnant women (small risk of complications such as fetal anemia or miscarriage)

Prevention Strategies

Currently, there is no specific vaccine available for the prevention of erythema infectiosum caused by parvovirus B19. However, there are several general prevention strategies that can be followed to reduce the risk of infection and the spread of the disease.

Social Distancing

One of the key prevention strategies is to maintain proper social distancing, especially during an outbreak of the disease. This involves avoiding close contact with individuals who are known to have the infection, as well as minimizing contact with large crowds and public places where the infection may be more prevalent.

Hand Hygiene

Regular and thorough hand hygiene is essential in preventing the spread of parvovirus B19. This includes washing hands with soap and water for at least 20 seconds, especially after coming into contact with someone who has the infection or their belongings. If soap and water are not readily available, alcohol-based hand sanitizers can be used instead.

Covering Coughs and Sneezes

Coughing and sneezing can release infectious droplets into the air, increasing the risk of transmission. It is important to cover the mouth and nose with a tissue or the elbow when coughing or sneezing. Used tissues should be immediately disposed of and hands should be washed afterwards.

Cleaning and Disinfecting

Frequently touched surfaces, such as doorknobs, light switches, and countertops, should be regularly cleaned and disinfected to reduce the risk of infection. This can be done using household disinfectants that are effective against viruses, following the instructions on the product label.

Stay Home When Sick

If you or your child is experiencing symptoms of erythema infectiosum, such as fever and rash on the cheeks that resemble a slapped cheek, it is important to stay home and avoid close contact with others. This can help prevent the spread of the disease to others who may be more susceptible to complications.

By following these prevention strategies, the risk of contracting and spreading erythema infectiosum, also known as fifth disease, can be significantly reduced.

Epidemiology and Prevalence

Erythema infectiosum, also known as Fifth disease, is a common viral infection that primarily affects children. It is caused by the parvovirus B19, which is highly contagious and easily spreads from person to person. The disease is most prevalent during the late winter and early spring months.

The hallmark symptom of Erythema infectiosum is the distinctive “slapped cheek” rash, which presents as bright red cheeks. This rash usually appears a few days after the initial infection and may spread to the arms, legs, and trunk. In addition to the rash, affected individuals may also experience mild flu-like symptoms such as fever, headache, and fatigue.

Erythema infectiosum is more common in children, especially those aged 5 to 15 years. This is because they have not yet developed immunity to the parvovirus B19. In older individuals, the infection is less severe and may present as joint pain or swelling, particularly in the hands, wrists, knees, and ankles.

The parvovirus B19 is transmitted through respiratory droplets, such as when an infected individual coughs or sneezes. It can also be spread through contact with contaminated objects or surfaces. Once a person is infected, they can spread the virus to others for several days before the rash appears, making it difficult to control the spread of the disease.

Overall, Erythema infectiosum is a common childhood infection that usually resolves on its own without treatment. However, in some cases, particularly in individuals with weakened immune systems or certain underlying conditions, complications may arise. Therefore, it is important to consult a healthcare provider for a proper diagnosis and appropriate management if symptoms occur.

Impact on Children

Erythema infectiosum, also known as fifth disease, is a common viral illness that primarily affects children. It is caused by the parvovirus B19 and is known for its distinctive rash, which often appears as a “slapped cheek” appearance.

Children are particularly susceptible to the virus and are more likely to develop symptoms than adults. The disease is most commonly seen in school-aged children, typically between the ages of 5 and 15.

Symptoms in Children

When infected with parvovirus B19, children may initially experience a mild fever, sore throat, and headache. After a few days, the characteristic rash appears, with bright red cheeks that look like they have been slapped. This rash may extend to the trunk, arms, and legs, often in a lace-like pattern.

In addition to the rash, children may also experience joint pain and swelling, which typically resolve within a week or two. However, these symptoms can be more severe in adults, particularly women who are pregnant or individuals with certain underlying medical conditions.

Diagnosis and Treatment

To diagnose erythema infectiosum, a healthcare provider may perform a physical examination and inquire about the characteristic symptoms and rash. Blood tests can also be done to detect the presence of parvovirus B19 antibodies.

Most cases of fifth disease do not require specific treatment and resolve on their own within a few weeks. However, symptomatic relief can be achieved through over-the-counter pain relievers and ample rest. It is important for children to stay hydrated and avoid potential triggers, such as excessive sunlight and heat.

In some cases, particularly for individuals with weakened immune systems, additional medical intervention may be necessary to manage symptoms and complications associated with erythema infectiosum.

Adult Infection Risks

Although erythema infectiosum, commonly known as fifth disease, is primarily seen in children, adults can also become infected with the virus. Adults who are exposed to the virus may develop the disease, especially if they have not been previously infected and have not developed immunity.

The virus is highly contagious and can be transmitted through respiratory droplets, such as when an infected person coughs or sneezes. Therefore, adults who work closely with children, such as teachers or daycare workers, are at an increased risk of infection.

Adults who contract erythema infectiosum may experience similar symptoms to those seen in children, although the severity may vary. These symptoms typically include:

Fever: Adults with erythema infectiosum may develop a low-grade fever, usually around 100.4°F (38°C) or slightly higher.
Rash: The hallmark symptom of erythema infectiosum is the appearance of a characteristic rash. The rash usually starts on the cheeks and is described as a “slapped cheek” rash. It may then spread to the arms, legs, and trunk.

In some cases, adults may experience joint pain and swelling, which is less commonly seen in children with erythema infectiosum. These symptoms usually resolve on their own within a few weeks.

Diagnosing and Treating Adult Infections

Diagnosing erythema infectiosum in adults can be challenging, as the rash and symptoms are similar to other viral infections. A blood test may be used to detect antibodies to the virus and confirm the diagnosis.

There is no specific treatment for erythema infectiosum. For adults with mild symptoms, symptomatic relief such as taking over-the-counter pain relievers and staying hydrated may be sufficient. Bed rest may also be beneficial.

In some cases, adults with severe symptoms or complications may require medical intervention. This may include antiviral medications or treatment for joint pain and swelling.

If you suspect you or a loved one may have erythema infectiosum, it is important to seek medical advice for an accurate diagnosis and appropriate treatment.

Management in Pregnancy

Erythema infectiosum, also known as fifth disease or slapped cheek disease, is a viral infection that commonly affects children. It is caused by parvovirus B19, which is highly contagious and spreads through respiratory droplets.

When a pregnant woman is exposed to the parvovirus B19, there is a risk of transmission to the fetus. The virus can cross the placenta and cause complications, especially in the first half of pregnancy.

If a pregnant woman develops symptoms of erythema infectiosum, such as rash and fever, it is important to seek medical attention. The healthcare provider may perform tests to confirm the diagnosis and evaluate the potential impact on the fetus.

The management of erythema infectiosum in pregnancy involves monitoring the mother and the fetus closely. This may include regular ultrasounds to check for any signs of fetal anemia or hydrops, which are potential complications of the infection.

If fetal complications are detected, the healthcare provider may recommend further interventions such as intrauterine blood transfusion to treat severe anemia.

It is important for pregnant women to take preventive measures to reduce the risk of exposure to parvovirus B19. This includes avoiding close contact with infected individuals, practicing good hand hygiene, and ensuring that children with the infection are kept away from pregnant women.

In conclusion, the management of erythema infectiosum in pregnancy involves close monitoring and prompt medical attention. By taking preventive measures, pregnant women can reduce the risk of infection and protect the health of their fetus.

Infection in Immunocompromised Patients

Infection with parvovirus B19, the causative agent of erythema infectiosum or fifth disease, is typically a mild and self-limiting illness that occurs primarily in children. However, in immunocompromised patients, such as those with weakened immune systems due to medical conditions or medications, the infection can cause more severe symptoms and complications.

Immunocompromised individuals may experience a prolonged and more severe rash compared to children with normal immune function. The characteristic “slapped cheeks” rash seen in children may be less pronounced or absent in these patients. Instead, they may develop a generalized rash that can spread to the trunk, limbs, and even the palms and soles of the feet.

In addition to the rash, immunocompromised patients may develop other symptoms, such as joint pain, arthritis, and fever. These symptoms can persist for a longer duration and may require more aggressive treatment.

Given the increased risk for complications in immunocompromised patients, it is important to promptly diagnose and treat parvovirus infection in this population. Laboratory testing, such as antibody assays or PCR, can be used to confirm the diagnosis. Treatment options may include antiviral medications, immune system support, and symptom management.

Infection in Immunocompromised Patients:
– Prolonged and more severe rash
– Absence or less pronounced “slapped cheeks” rash
– Generalized rash spreading to trunk, limbs, and palms/soles
– Joint pain, arthritis, and fever
– Prompt diagnosis and treatment

In conclusion, while erythema infectiosum is usually a mild condition in children, it can pose more serious risks for immunocompromised patients. Close monitoring and appropriate management are essential to ensure optimal outcomes for these individuals.

Prognosis and Recovery Time

The prognosis for children with erythema infectiosum, also known as fifth disease or slapped cheek disease, is generally excellent. Most children recover completely without any complications.

The duration of the disease can vary, but the typical recovery time for erythema infectiosum is around one to two weeks.

Symptoms

The most characteristic symptom of erythema infectiosum is a rash on the cheeks that gives the appearance of being slapped. This rash is usually followed by a lacy or reticular rash on the trunk and extremities. Other common symptoms include fever, headache, and fatigue.

Diagnosis

Erythema infectiosum is usually diagnosed based on clinical symptoms and physical examination. A blood test may be done to confirm the presence of parvovirus B19, the virus responsible for causing fifth disease.

It is important to note that erythema infectiosum is most contagious before the rash appears. Therefore, diagnosis based solely on the presence of a rash may not be accurate.

If you suspect that your child has erythema infectiosum, it is recommended to consult a healthcare provider for a proper diagnosis and guidance on treatment options.

Research and Current Studies

Researchers are continually studying the parvovirus that causes erythema infectiosum in children. They are trying to understand the disease better and develop more effective treatment options.

One aspect of research focuses on the rash that appears on the cheeks, often referred to as “slapped cheeks.” Scientists are studying the exact cause of this distinctive rash and how it develops in the body.

Another area of research is aimed at determining the best methods for diagnosing erythema infectiosum. Currently, doctors rely on the characteristic symptoms of the disease, such as the rash and fever, to make a diagnosis. However, researchers are investigating more accurate diagnostic techniques, such as blood tests, to identify the presence of the parvovirus.

Additionally, researchers are exploring potential treatments for erythema infectiosum. Currently, there is no specific treatment for the infection, as it usually resolves on its own within a few weeks. However, scientists are investigating antiviral medications and other therapies that may help alleviate symptoms and shorten the duration of the illness.

Overall, ongoing research and current studies on erythema infectiosum aim to enhance our understanding of the disease and improve the management and outcome for affected children.

Q&A:

What is erythema infectiosum?

Erythema infectiosum is a viral infection that causes a rash on the skin.

What are the symptoms of erythema infectiosum?

The symptoms of erythema infectiosum include a rash on the cheeks, arms, and legs, fever, headache, and runny nose.

How is erythema infectiosum diagnosed?

Erythema infectiosum is typically diagnosed based on the characteristic rash and symptoms. A blood test may also be done to detect the presence of the virus.

Is erythema infectiosum contagious?

Yes, erythema infectiosum is highly contagious. It can be spread through respiratory droplets, direct contact with infected individuals, or contact with contaminated surfaces.

What is the treatment for erythema infectiosum?

There is no specific treatment for erythema infectiosum. The infection usually resolves on its own within a couple of weeks. Treatment typically focuses on relieving symptoms, such as fever and rash, with over-the-counter medications. Rest and plenty of fluids are also important.