Exanthema subitum is a viral illness caused by human herpes virus 6 (HHV 6) and less commonly by HHV 7. The HHV 6 and HHV 7 are together referred as the Roseolovirus. A disease primarily of childhood, it is also known as roseola, roseola infantum, rose rash of infants, sixth disease, three-day fever and baby measles. The disease initially presents in childhood and the secondary infection is common in immunocompromised individuals.
Exanthema subitum occurs in children less than 2 years of age, with most patients presenting in infancy. After an incubation period of 5-15 days, the classical presentation is that of high-grade fever followed by the appearance of a morbilliform rash.
The fever usually lasts for 3-5 days, with temperatures ranging from 39.5-40.5 degrees celsius  . The baby is usually alert and active without any specific foci of infection . Febrile seizures may be seen in 15% of cases. Lymphadenopathy in the cervical and posterior auricular region may also be seen. Encephalitis and hepatitis are rare manifestations. During this phase, the examination may not reveal a lot of findings. Upper respiratory tract, gastrointestinal and CNS signs are rare at this stage.
The disappearance of fever coincides with the development of a mild morbilliform rash, seen most commonly on the chest and abdomen and rarely, on the face and extremities. The rash may vary in appearance from a small pink papule to a more generalized maculopapular exanthema. The rash usually lasts for a few hours to 2 days and may only be seen in 30% of cases infected with human herpes virus 6 .
Two-thirds of patients may show a characteristic enanthem (Nagayama's spots) on the soft palate and uvula. They usually take the form of erythematous papules and occur most commonly on the 4th day of illness.
HHV-6 often remains latent in patients with a well-functioning immune system. Immunocompromised patients, however, have a more abrupt onset of disease, with the disease spreading to the CNS and other organs  .
Hepatic dysfunction is rarely noted in patients. A few adults, with a past history of HHV-6 infection, may show reactivation of virus with clinical features of mononucleosis . Few patients have been reported with minimal signs and symptoms of the disease despite acquiring HHV-6 infection .
Entire Body System
[…] maculopapular) rash that appears within a few hours to a day after the fever has subsided. [medical-dictionary.thefreedictionary.com]
After an incubation period of 5-15 days, the classical presentation is that of high-grade fever followed by the appearance of a morbilliform rash. The fever usually lasts for 3-5 days, with temperatures ranging from 39.5-40.5 degrees celsius. [symptoma.com]
The convulsions previously thought to be the result of the associated fever of roseola infantum are proably caused by direct infection of the meninges with the HHV6. synonyms Exanthema Subitum, Roseola Infantum, Sixth Disease, Three-Day-Fever Exanthem [dermis.net]
A febrile fever usually last a few minutes and passes on its own without any long term health effects. When is Roseola contagious? The Roseola contagious period is from 2 days before the fever starts until the child is completely fever free. [baby-safety-concerns.com]
- High Fever
[…] translation and definition " exanthema subitum ", English-Polish Dictionary online exanthema subitum Type: noun; a viral disease of infants and young children; characterized by abrupt high fever and mild sore throat; a few days later there is a faint [glosbe.com]
A viral disease of infants and young children with sudden onset of high fever which lasts several days and then suddenly subsides leaving in its wake a fine red rash. [medicine.academic.ru]
Princeton's WordNet (0.00 / 0 votes) Rate this definition: exanthema subitum, roseola infantum, roseola infantilis, pseudorubella (noun) a viral disease of infants and young children; characterized by abrupt high fever and mild sore throat; a few days [definitions.net]
These are triggered by the high fevers of roseola and may be alarming when seen for the first time. [dermnetnz.org]
The first symptoms include: Eye redness Irritability Runny nose Sore throat High fever, that comes on quickly and may be as high as 105°F (40.5°C) and can last 3 to 7 days About 2 to 4 days after becoming sick, the child's fever lowers and a rash appears [nlm.nih.gov]
- Fever Followed by a Rash
The rash phase of roseola generally follows the disappearance of the fever. The rash is described as pale rose-pink spots and surrounded by a white halo. [southernnevadahealthdistrict.org]
Topic Resources Roseola infantum is a viral infection of infants or very young children that causes a high fever followed by a rash. Roseola infantum is caused by human herpesvirus-6. [merckmanuals.com]
It involves a pinkish-red skin rash and high fever. Roseola is an acute disease of infants and young children that is characterized by high fever followed by a rash that appears on trunk, limbs, neck and face. [mountsinai.org]
Roseola is a mild viral illness with a fever followed by a rash. Before the 20th century, children with roseola were lumped in with those with measles or rubella or scarlet fever. [drgreene.com]
C., a white female aged 31, was first seen on February 3, 1937, complaining of general malaise and weakness of one day's duration. [annals.org]
Irritability, malaise and runny nose may be present at this time. A red throat with small lesions on the palate and tonsils and swollen lymph glands may be the only other significant symptoms. [southernnevadahealthdistrict.org]
However, children may also have malaise, conjunctivitis, orbital edema, inflammation of the tympanic membranes, lymphadenopathy, irritability, anorexia, a bulging fontanelle, diarrhea, cough and other upper respiratory tract symptoms. [ncbi.nlm.nih.gov]
Secondary bacterial infections of the lesions can result in scarring. return to top Fifth Disease: Pruritus, low-grade fever, malaise, and sore throat precede the rash in approximately 10% of cases. Lymphadenopathy is absent. [atsu.edu]
- Skin Rash
rash pictures, pictures of roseola skin rash, roseola images, roseola photos, roseola pics, fotos, roseola photographs] [lib.uiowa.edu]
[…] a skin rash appears and the child becomes better---treated with meds that lower fever and stops the rash. [medical-dictionary.thefreedictionary.com]
38.7°C lasting 2.9 days, followed by a skin rash of 2.9 days’ duration. [dx.doi.org]
Some people confuse the roseola skin rash with the measles skin rash. However, these rashes are distinctly different. The measles rash is red or reddish-brown. [healthline.com]
- Febrile Seizures
In case of febrile seizures, medical advice can be sought for reassurance. However, febrile seizures are not harmful, do not require treatment, and have no long term negative effects unless they last longer than five minutes. [en.wikipedia.org]
Signs of a febrile seizure include: Loss of consciousness Jerking or twitching movements in the arms, legs or face for 2 to 3 minutes Wet or soiled pants in an unconscious, toilet-trained child Irritability These seizures are brief and not dangerous. [dermnetnz.org]
Febrile seizures occur when a child's temperature rises rapidly. While febrile seizures are generally not harmful, they can be very scary. Not every child with a high temperature is at risk for a febrile seizure. [vidanthealth.com]
Due to the high fever and the ability of the virus to cross the blood-brain barrier, 15% of children will also experience an acute febrile seizure during the febrile phase of the illness. [ncbi.nlm.nih.gov]
The diagnosis is usually clinical and a high degree of suspicion is to be held in children from 6 months-3 years with the classical clinical presentation. Further tests are rarely required. Confirmation of diagnosis may be done through serology or culture.
Routine blood tests, including a CBC, blood culture, cerebrospinal fluid (CSF) studies and urinalysis, may be done to rule out other causes of fever . Further testing to exclude other etiologies of seizures may be necessary for some patients.
Serological tests for herpes virus include virus isolation studies and detection of viral DNA from mononuclear blood cells. Antibodies to the different variants of human herpes virus 6 (HHV6A and HHV6B) may be detected by an immunoblot assay .
Histology of affected organs shows a characteristic ballooning of cells.
What is the treatment of roseola? There is no specific treatment for roseola. The disease is usually mild and self-limiting. Rest, maintaining fluid intake and paracetamol for fever is all that is usually required. [dermnetnz.org]
Diagnosis and treatment A GP or pediatrician can easily diagnose roseola with a physical exam and prescribe a specific treatment for your child based on their age and medical history. This treatment will help reduce discomfort. [thechildren.com]
What are the adverse effects associated with each treatment option? Ganciclovir treatment can lead to serious side effects. Ganciclovir can cause bone marrow suppression and renal damage. [cancertherapyadvisor.com]
Treatment for Roseola Roseola is a benign child hood disease that usually resolves on its own within a week without any special Roseola treatment. If necessary you can give your child some fever reducers like Tylenol or ibuprofen. [baby-safety-concerns.com]
Treatment Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. Antibiotics are not used to treat this illness. The goal of treatment is to help reduce symptoms. [stlouischildrens.org]
The disease prognosis was unexpectedly poor. Publication type, MeSH terms, Substance Publication type Research Support, Non-U.S. [ncbi.nlm.nih.gov]
Source MeSH Antiviral Agents Diagnosis, Differential Exanthema Subitum Female Herpesvirus 6, Human Humans Infant Molecular Diagnostic Techniques Pregnancy Prognosis Serologic Tests Pub Type(s) Journal Article Review Language jpn PubMed ID 12722211 TY [unboundmedicine.com]
Further testing to exclude other etiologies of seizures may be necessary for some patients. Serological tests for herpes virus include virus isolation studies and detection of viral DNA from mononuclear blood cells. [symptoma.com]
Etiology Pathogen HHV-6 ; (and in rare cases HHV-7 ) Humans are the sole hosts. [amboss.com]
Consequently, our knowledge of etiology and pathogenesis of HHV-6 associated diseases can only come from the combined efforts of clinicians, virologists, molecular biologists and pathologists. [books.google.ro]
Since identification of the etiologic agent human herpesvirus type 6 (HHV-6), infection has been documented without the characteristic fever or rash. [emedicine.medscape.com]
Exanthema Subitum/epidemiology* Exanthema Subitum/pathology Female Herpesvirus 6, Human/genetics Herpesvirus 6, Human/isolation & purification Humans Infant Japan/epidemiology Leukocytosis/cerebrospinal fluid Leukocytosis/epidemiology Leukocytosis/pathology [ncbi.nlm.nih.gov]
Epidemiology Most frequent in infants and young children Peak incidence : 6 months to 2 years References:   Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
Contact your physician or the Southern Nevada Health District, Office of Epidemiology at (702) 759-1300. [southernnevadahealthdistrict.org]
Epidemiology Frequency United States Serologic tests indicate that human herpesvirus 6 (HHV-6) infection is nearly universal. In emergency clinics, HHV-6 has been reported to be responsible for 10-45% of cases of febrile illness in infants. [emedicine.medscape.com]
Pathophysiology Respiratory secretions of asymptomatic individuals likely transmit the virus. The child is most likely to spread the infection during the febrile and viremic phase of the illness. [emedicine.medscape.com]
Effective strategies to prevent and treat AD remain elusive despite major efforts to understand its basic biology and clinical pathophysiology. Significant investments in therapeutic ... [doi.org]
How can it be prevented? There is no clear way to prevent roseola. There is no reason to exclude children with the roseola rash from daycare. Related concepts: Exanthem subitum, Human herpesvirus 6, HHV-6, Sixth disease. [drgreene.com]
Prevention Exclusion from childcare, preschool, school or work is not necessary follow good hand washing procedures dispose of soiled tissues appropriately there is no vaccine available to prevent this infection. [sahealth.sa.gov.au]
Prevention Careful handwashing can help prevent the spread of the viruses that cause roseola. References Caserta MT. Roseola (human herpesviruses 6 and 7). In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. [mountsinai.org]
- Juretic M. Exanthema subitum a review of 243 cases. Helv Paediatr Acta 1963; 18:80.
- Meade RH 3rd. Exanthem subitum (roseola infantum). Clin Dermatol 1989; 7:92.
- Cherry JD. Roseola infantum (Exanthem subitum).. In: Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 6th ed, Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL (Eds), Saunders, Philadelphia 2009. p.780.
- Berenberg W, Wright S, Janeway CA. Roseola infantum (exanthem subitum). N Engl J Med 1949; 241:253.
- Vinnard C, Barton T, Jerud E, Blumberg E. A report of human herpesvirus 6-associated encephalitis in a solid organ transplant recipient and a review of previously published cases. Liver Transpl. 2009 Oct. 15(10):1242-6.
- Abdel Massih RC, Razonable RR. Human herpesvirus 6 infections after liver transplantation. World J Gastroenterol. 2009 Jun 7. 15(21):2561-9.
- Stoeckle MY.The spectrum of human herpesvirus 6 infection: from roseola infantum to adult disease". Annu. Rev. Med. 2000;51: 423–30.
- Zerr D M, Meier AS, Selke SS, et al. A Population-Based Study of Primary Human Herpesvirus 6 Infection. New England Journal of Medicine. 2000;352(8): 768–776.
- Caserta MT, Hall CB, Schnabel K, et al. Primary human herpesvirus 7 infection: a comparison of human herpesvirus 7 and human herpesvirus 6 infections in children. J Pediatr. 1998; 133:386.
- Higashimoto Y, Ohta A, Nishiyama Y, et al. Development of a human herpesvirus 6 species-specific immunoblotting assay. J Clin Microbiol. 2012 Apr. 50(4):1245-51.