Definition

Roseola infantum (exanthem subitum or sixth disease) is a common illness of

infancy that is characterized by a high fever in a child who otherwise appears well
followed by a rash after the fever subsides. The causative agent was recently
identified as human herpesvirus 6 (HHV-6).
Epidemiology
Patients ranged in age from 3 weeks to 18 months, with a peak age of onset of 6 to
7 months. Ninety-four percent of cases occurred within the first year of life. Only
14% of patients had a prodrome of listlessness or irritability.
Clinical sign:
-Fever
-Morbiliform rash
-Other common findings were diarrhea (68% of patients), eyelid edema (30%),
erythematous papules on the soft palate and uvula (Nagayama's spots; 65%), mild
cough (50%), cervical adenopathy (31%), and bulging fontanelle (26%). Seizures
occurred in 13 of 173 patients evaluated, all during high fever.

Treatment
-Most children recover fully from roseola within a week of the onset of the fever.
acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others)-to reduce
fever
-Use caution when giving aspirin to children or teenagers. Children and teenagers
recovering from chickenpox or flu-like symptoms should never take aspirin
because aspirin has been linked to Reye's syndrome

-There's no specific treatment for roseola, although some doctors may prescribe the
antiviral medication ganciclovir (Cytovene) to treat the infection in people with
weakened immunity.
- Antibiotics AREN'T effective in treating viral illnesses, such as roseola.
Test and Diagnosis
-Doctors confirm a diagnosis of roseola by the telltale rash or, in some cases, by a
blood test to check for antibodies to roseola. The blood changes seem to be
important-they are a neutrophil leucopenia, appearing during the febrile stage and
falling to a total white-cell count as low as 2,000 per c.mm. This process is
reversed as soon as the rash appears, and the count returns to normal within a
week. The incubation period is 5 to 15 days.

Roseola Infantum
Synonyms of Roseola Infantum
Exanthem Subitum
Pseudorubella
Sixth Disease
General Discussion
Roseola Infantum is an acute infectious disorder of infants or very young children.
Characterized by high fever and the appearance of a red skin rash, this disorder
may resemble Rubella after the fever has disappeared. Seizures may
also occur.
Signs & Symptoms
The incubation period before symptoms of Roseola Infantum appear is
approximately 5 to 15 days. A high fever begins abruptly and usually lasts for 3 or
4 days without an obvious identifiable cause. Convulsions are common
during this period. Low levels of white blood cells (leukopenia) may occur by the
3rd day. The spleen may be slightly enlarged. The fever usually breaks on the 4th
day, and a characteristic rash of red spots or elevated (macular or maculopapular)
spots appears. This rash may cover the chest and abdomen, although it often
appears in a mild form on the face and extremities. Temperature returns to normal

at this stage, and the child usually feels and acts well. In some cases, the rash may
be so mild that it goes unnoticed.
Causes
In most affected infants and children, Roseola Infantum is caused by infection with
a herpesvirus known as human herpesvirus 6 (HHV-6). Less commonly, the
condition is thought to result from infection with human herpesvirus 7
(HHV-7). Although the infection is known to spread from person to person, the
specific mode of transmission remains unknown.
Affected Populations
Roseola Infantum most commonly affects infants and children between the ages of
six months and two years. The condition typically occurs during the spring and fall
months and, in some cases, has been reported in local outbreaks.
Related Disorders
Symptoms of the following disorders can be similar to those of Roseola Infantum.
Comparisons may be useful for a differential diagnosis:
Atypical Measles Syndrome (AMS) is most common among adolescents and
young adults. This disorder was usually associated with prior immunization
using the outdated killed measles vaccines, which are no longer in use.
However, inoculation with live measles vaccine has also been known to
precede development of AMS. Presumably, inactivated measles virus
vaccines do not prevent mild virus infection and can sensitize patients so
that disease expression is altered significantly. AMS may begin abruptly,
with high fever, headache, abdominal pain, and coughing. The rash may
appear one to two days after onset, often beginning on the extremities.
Swelling (edema) of the hands and feet may occur. Pneumonia is not
uncommon, and nodular dense areas in the lungs may persist for three
months or longer.
Measles (Rubeola; Morbilli) is a highly contagious viral disease occurring
primarily in children. The disease is characterized by fever, cough, acute
nasal membrane discharge (coryza), inflammation of the lining of the eyelids
(conjunctivitis), and eruption of small, irregular, bright red spots with a minute
bluish or white speck in the center (Kopliks spots) on the inner cheeks or lips and
a rash of elevated spots (maculopapular) spreading over the skin. Measles has
become rare in the United States since the introduction of Measles vaccines. (For
more information, use Measles as your search term in the Rare Disease
Database.) Rubella (German Measles) in children is a mild contagious viral disease

characterized by swelling of lymph glands and a rash beginning on the face and
neck which quickly spreads to the trunk and the extremities. If a woman
contracts Rubella during the early months of pregnancy, a spontaneous abortion,
stillbirth, or birth defects in the infant may result. (For more information, choose
Rubella as your search term in the Rare Disease Database.)
Scarlet Fever is an infection caused by bacteria that usually affects the
mouth/throat area (pharynx), but may also affect the skin or birth canal.
Patients may experience headache, abdominal pain, nausea, and a skin rash.
A reddish flush may be apparent on the face, chest and extremities,
accompanied by tiny red spots in some cases. The disease
is much milder now than in the past, and complications are rare with proper
treatment.
Standard Therapies
Roseola Infantum usually spontaneously resolves within a few days. Therefore,
treatment of the condition is primarily symptomatic and supportive. Such measures
may include providing certain medications to help reduce fever (antipyretics), such
as acetaminophen or ibuprofen. However, aspirin must be avoided, since there
appears to be an association between the onset of Reye Syndrome and the use of
aspirin in children or adolescents with certain viral illnesses. Reye Syndrome, a
rare but potentially life-threatening condition, is primarily characterized by
distinctive, fatty changes of the liver and sudden inflammation and swelling of the
brain (acute encephalopathy)
According to reports in the medical literature, if infants or children are prone to
experiencing convulsions, the administration of certain sedatives when there is a
sudden onset of fever may be helpful in preventing convulsive episodes in
association with Roseola Infantum.