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Exanthema Subitum

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.


Presentation

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 [1] [2]. The baby is usually alert and active without any specific foci of infection [3]. 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 [4].

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 [5] [6].

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 [7]. Few patients have been reported with minimal signs and symptoms of the disease despite acquiring HHV-6 infection [8].

Fever
  • 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]
  • […] maculopapular) rash that appears within a few hours to a day after the fever has subsided.[medical-dictionary.thefreedictionary.com]
  • 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]
  • […] very tired, irritable and ill due to the high fever. [1,3,5] Fits Very rarely the rapid rise of fever predisposes the patient to febrile fits.[explainmedicine.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]
  • Without any treatment, they may fade within a few hours or persist for as long as 2-3 days. [1,2,3] At risk population Exanthema subitum typically occurs in children between six months and two years of age who present with high fever. [1,3,5][explainmedicine.com]
  • 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]
  • Patient discussion about exanthema subitum Q. roseola high fever A. roseola; any rose colored eruption of the skin--roseola is a viral infection of young children producing a fever which last three or four days after which temperatures drops to normal[medical-dictionary.thefreedictionary.com]
Fever Followed by a Rash
  • Roseola infantum (or roseola) is an infection that can cause a high fever followed by a rash. It usually occurs in babies and children between 6 months and 2 years. It lasts about 3 to 5 days and can make your child feel feverish and unwell.[healthdirect.gov.au]
  • followed by a rash.[merckmanuals.com]
  • 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. A thermometer is a useful aid used to measure body temperature.[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]
Malaise
  • 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]
  • ., 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]
  • 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]
Varicella-Zoster Virus Infection
  • zoster virus infections 1F01 Roseola infantum H00369 Exanthema subitum Pathogen Human herpesvirus 6B [GN: T40075 ] Human herpesvirus 7 [GN: T40076 ] Other DBs ICD-11: 1F01 ICD-10: B08.2 MeSH: D019349 D005077 MedlinePlus: 000968 Reference PMID: 21120721[genome.jp]
  • zoster virus infections 1F01 Roseola infantum H00369 突発性発疹 感染症法による感染症分類 [ jp08406.html ] H00369 病原体 Human herpesvirus 6B [GN: T40075 ] Human herpesvirus 7 [GN: T40076 ] リンク ICD-11: 1F01 ICD-10: B08.2 MeSH: D019349 D005077 MedlinePlus: 000968 文献 PMID:[genome.jp]
Exanthema
  • To evaluate the role of HHV-6 as the causal agent in clinically diagnosed exanthema subitum, we tested for HHV-6 antibody in 57 infants with clinical exanthema subitum and exanthema subitum-like rash without fever.[ncbi.nlm.nih.gov]
  • These findings suggest that the pathogeneses of the brain lesions related to exanthema subitum are variable.[ncbi.nlm.nih.gov]
  • Abstract Twenty-two infants with exanthema subitum and their mothers were studied for human herpesvirus 6 (HHV-6) infection.[ncbi.nlm.nih.gov]
  • It is concluded that if the clinical diagnosis of exanthema subitum is deemed doubtful, HHV-6 infection is verifiable in about 75% of the cases by serology.[ncbi.nlm.nih.gov]
  • Exanthema subitum occurs in children less than 2 years of age, with most patients presenting in infancy.[symptoma.com]
Febrile Convulsions
  • […] first febrile convulsion episode (table 2 ).[doi.org]
  • To begin with, the status diagnostically unclear and high-febrile for several days, the central-nervous excitability occurring in many cases, and in some children the appearing of dramatic febrile convulsions, as well as gastroenteric symptoms perpetually[ncbi.nlm.nih.gov]
  • RESULTS —Primary infection with HHV-6 was seen in 21 of 105 patients with febrile convulsions (3 upper respiratory infection, 1 lower respiratory infection, and 17 exanthem subitum). 13 of 23 patients 1 year, 19 of 79 patients with first febrile convulsion[ncbi.nlm.nih.gov]
  • convulsions. ( 13354383 ) MOLLER K.L. 1956 22 Infectious nature of exanthema subitum (roseola infantum). ( 14777168 ) SHAW E.B....SILVER H.K. 1950 23 Roseola infantum (exanthema subitum). ( 18135038 ) Jackson D.C. 1949[malacards.org]
  • In summary, we have identified three infants with febrile convulsions associated with primary HHV-7 infection.[dx.doi.org]
Neglect
  • Identify and manage the psychosocial issues surrounding pediatric patients, including major depression and suicidality, sexual and physical abuse, child neglect, and violence.[books.google.com]

Workup

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 [9]. 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 [10].

Histology of affected organs shows a characteristic ballooning of cells.

Human Herpesvirus 6
  • Roseola infantum is most commonly caused by human herpesvirus 6 and less commonly, human herpesvirus 7. Human herpesvirus 6 has two variants: A and B. The primary variant that causes roseola infantum is HHV-6B.[ncbi.nlm.nih.gov]
  • Abstract Twenty-two infants with exanthema subitum and their mothers were studied for human herpesvirus 6 (HHV-6) infection.[ncbi.nlm.nih.gov]
  • ( 1649431 ) Kusuhara K....Yamanishi K. 1991 19 Roseola infantum caused by human herpesvirus-6: report of 7 cases with emphasis on complications. ( 1681005 ) Huang LM...Kuo T 1991 20 Role of human herpesvirus 6 infection in infants with exanthema subitum[malacards.org]
  • ) Linnavuori K....Hovi T. 1992 12 Liver dysfunction, anaemia, and granulocytopenia after exanthema subitum. ( 1359341 ) Takikawa T....Shiraki K. 1992 13 Do second attacks of exanthema subitum result from human herpesvirus 6 reactivation or reinfection[malacards.org]
  • Abstract Twenty-five patients with clinical exanthema subitum (roseola infantum) were enrolled into a study, where acute-phase and convalescent sera were examined for antibodies to human herpesvirus 6 (HHV-6), several other viruses, and other microbes[ncbi.nlm.nih.gov]
Brain Edema
  • The neuroradiologic findings of the brain lesions in eight infants with exanthema subitum were normal in three, suspected vascular lesions in two, and symmetric thalamic lesions with or without diffuse brain edema in the other three.[ncbi.nlm.nih.gov]

Treatment

  • What is the treatment? At this time there is no specific treatment. What are the complications associated with roseola? Symptoms are generally mild and most children are alert and playful despite high fever.[southernnevadahealthdistrict.org]
  • 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]
  • Without any treatment, they may fade within a few hours or persist for as long as 2-3 days. [1,2,3] At risk population Exanthema subitum typically occurs in children between six months and two years of age who present with high fever. [1,3,5][explainmedicine.com]
  • Treatment / Management There is no specific treatment for roseola infantum. The majority of cases of roseola infantum are mild and self-limited.[ncbi.nlm.nih.gov]
  • For most viral infections, treatments can only help with symptoms while you wait for your immune system to fight off the virus. Antibiotics do not work for viral infections. There are antiviral medicines to treat some viral infections.[icdlist.com]

Prognosis

  • The prognosis of the exanthema subitum is in force to be good; the disease is the special field of activity for ambulatorily acting physicians (paediatrist, general practitioner).[ncbi.nlm.nih.gov]
  • 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]
  • In a Brazilian study, 75% of HHV-6 infections occurred in children aged 6-17 months. [7] Prognosis Practically all patients who are immunocompetent survive roseola infantum without sequelae.[emedicine.medscape.com]

Etiology

  • 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]
  • 13163404 ) NEVA FA...ENDERS JF 1954 44 Experimental inoculation of roseola infantum. ( 14837736 ) HELLSTROM B...VAHLQUIST B 1951 45 Infectious nature of exanthema subitum (roseola infantum). ( 14777168 ) SHAW E.B....SILVER H.K. 1950 46 Studies on the etiology[malacards.org]
  • Furthermore, disease that HHV6-A and HHV6-B may be connected with etiology includes multiple sclerosis. In addition, unlike HHV6-B, HHV6-A does not multiply with salivary gland of patient.[translate-en.city.yokohama.lg.jp]
  • 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]

Epidemiology

  • Contact your physician or the Southern Nevada Health District, Office of Epidemiology at (702) 759-1300.[southernnevadahealthdistrict.org]
  • 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: [1] [2] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • Regarding Roseolovirus primary infection epidemiological data, several authors have proposed that HHV-7 infection usually occurs later than HHV-6 infection (Wyatt et al. 1991, Torigoe et al. 1995, Tanaka-Taya et al. 1996, Ward et al. 2001).[scielo.br]
  • Epidemiology Human herpesvirus 6 has been found to be the cause of febrile illness in 10% to 45% of infants in the United States.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Effective strategies to prevent and treat AD remain elusive despite major efforts to understand its basic biology and clinical pathophysiology. Significant investments in therapeutic ...[dx.doi.org]
  • 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]

Prevention

  • Vaccines can help prevent you from getting many viral diseases.[icdlist.com]
  • What can be done to prevent the spread of roseola? There is no vaccine available for roseola. Measures to effectively control roseola have not been developed.[southernnevadahealthdistrict.org]
  • It is ... for the prevention There is no Vaccinations (vaccine) of exanthema subitum. Because case that baby starts is most, in the United States of America, it is called "baby measles" (baby measles) commonly.[translate-en.city.yokohama.lg.jp]
  • 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]

References

Article

  1. Juretic M. Exanthema subitum a review of 243 cases. Helv Paediatr Acta 1963; 18:80.
  2. Meade RH 3rd. Exanthem subitum (roseola infantum). Clin Dermatol 1989; 7:92.
  3. 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.
  4. Berenberg W, Wright S, Janeway CA. Roseola infantum (exanthem subitum). N Engl J Med 1949; 241:253.
  5. 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.
  6. Abdel Massih RC, Razonable RR. Human herpesvirus 6 infections after liver transplantation. World J Gastroenterol. 2009 Jun 7. 15(21):2561-9.
  7. Stoeckle MY.The spectrum of human herpesvirus 6 infection: from roseola infantum to adult disease". Annu. Rev. Med. 2000;51: 423–30.
  8. 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.
  9. 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.
  10. 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.

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Last updated: 2019-07-11 21:32