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

  Acetaminophen (Tylenol) and cool sponge baths can help reduce the fever. Some children may have seizures when they get a high fever. If this occurs, call your health care provider or go to the closest emergency room. [medlineplus.gov]

  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]

• High Fever

  These are triggered by the high fevers of roseola and may be alarming when seen for the first time. [dermnetnz.org]

  […] 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]

  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 [medlineplus.gov]

• Asymptomatic

  Primary infection with HHV-7 is milder and most often asymptomatic, although some cases of roseola-like illness have been linked to it. [genome.jp]

  The most likely method is by transmission in saliva after asymptomatic reactivation in a parent or sibling. [cancertherapyadvisor.com]

  Primary infection with HHV-6 may be asymptomatic, or it may cause the exanthem subitum/roseola syndrome. [8] Within that complex, otitis, gastroenteritis, respiratory distress, and seizures may occur. [emedicine.com]

• Infectious Mononucleosis

  Abstract Postinfectious thrombocytopenic purpura in children is well known, and several viral infections have been incriminated, including rubella, measles, measles vaccination, chickenpox, mumps, smallpox vaccination, infectious mononucleosis, hepatitis [pediatrics.aappublications.org]

  Acute encephalitis, hepatitis, myocarditis, haemophagocytic syndrome and infectious mononucleosis-like illness occur only very rarely. [dermnetnz.org]

• 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. [msdmanuals.com]

  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]

  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]

• Pneumonia

  Children who have weakened immune systems due to cancer, autoimmune disease or other conditions may be at risk for pneumonia or other complications. Once infected, children develop an immunity to the virus, so they are unlikely to get it again. [my.clevelandclinic.org]

  Reactivation of HHV-6 in immune suppressed patients or in association with drug hypersensitivity syndrome results in fever, rash, pneumonia, hepatitis, bone marrow suppression and encephalitis. See smartphone apps to check your skin. [dermnetnz.org]

  They have a higher risk of developing potentially serious complications from the infection, such as pneumonia or encephalitis. [southerncross.co.nz]

  In very rare cases, the illness can lead to serious complications, such as: encephalitis pneumonia meningitis hepatitis Most kids develop antibodies to roseola by the time they reach school age, which makes them immune to a repeat infection. [healthline.com]

• Nasal Congestion

  Typically the patient presents with an acutely onset high degree of fever of 3 – 5 days. [1,2,3,4,5] Nasal congestion Upper respiratory symptoms such as sore throat, cough, runny nose or congestion are not uncommon. [2,3,4] Irritability Patient looks [explainmedicine.com]

• Hypertension

  Trauma and cardiovascular diseases such as hypertension are associated with a loss of cerebrovascular control. [doi.org]

• Skin Rash

  rash pictures, pictures of roseola skin rash, roseola images, roseola photos, roseola pics, fotos, roseola photographs] [lib.uiowa.edu]

  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]

  38.7°C lasting 2.9 days, followed by a skin rash of 2.9 days’ duration. [dx.doi.org]

  It involves a pinkish-red skin rash and high fever. Roseola is common in children ages 3 months to 4 years, and most common in those ages 6 months to 1 year. [medlineplus.gov]

• Papule

  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. [symptoma.com]

  Two-thirds of patients with roseola also have Nagayama spots which are erythematous papules found on the soft palate and uvula. Diagnosis is usually made by a thorough history and physical exam. [aocd.org]

  Upon rapid defervescence of the fever around days three to five, small, rose-pink or red 2 mm to 5mm papules and macules will develop. A pale halo can occur around the macules and papules in some cases. [ncbi.nlm.nih.gov]

  Exanthema subitum with rose-pink macules and papules. Medical dictionary. 2011. [medicine.academic.ru]

• Withdrawn

  The patient’s condition improved (with a drop in GAD antibody titers and stabilization of psychotic symptoms) in response to three weeks of antiviral therapy but relapsed when antiviral therapy was withdrawn. [hhv-6foundation.org]

• Febrile Seizures

  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]

  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]

  Febrile seizures are generally not harmful. But they can be very scary. Not every child with a high temperature is at risk for a febrile seizure. Febrile seizures occur in about 3 in 100 children under the age of 5. [stlouischildrens.org]

  Seizure. This is generally a febrile seizure, or a seizure that is brought on by a quick rise in body temperature. This type of seizure is rarely harmful. [my.clevelandclinic.org]

• Excitement

  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]

  This would be particularly exciting, considering that no therapies are yet approved to target endogenous remyelination in MS patients. [doi.org]

• Stroke

  Click on the brush button to enter characters just by drawing them with the correct stroke order. Stroke order animation. Sample. [yellowbridge.com]

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.

Treatment Most cases of roseola require only supportive treatment. As the condition is caused by a virus, antibiotics will be of no benefit in combating it. [southerncross.co.nz]

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]

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]

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]

The disease prognosis was unexpectedly poor. Publication type, MeSH terms, Substance Publication type Research Support, Non-U.S. [ncbi.nlm.nih.gov]

Outlook / Prognosis What is the prognosis (outlook) for people with roseola? Most children recover from roseola without any long-term health issues. [my.clevelandclinic.org]

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]

Manifestation code identifies conditions for which it is important to record both the etiology and the symptom of the disease. [books.google.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.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: [1] [2] 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.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.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 ... [arjournals.annualreviews.org]

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]

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 How can I prevent roseola? There is not a vaccine to prevent roseola. Good hygiene is the best way to keep others from getting the virus. You can lower infection risk by: Avoiding close contact with someone who is infected. [my.clevelandclinic.org]

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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.
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