Roseola infantum (exanthem subitum)
- Cécile Tremblay, MD
Cécile Tremblay, MD
- Associate Professor
- University of Montreal, Canada
- Michael T Brady, MD
Michael T Brady, MD
- Professor and Chair of Pediatrics
- Ohio State University College of Medicine
- Nationwide Children's Hospital
- Section Editors
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
- Moise L Levy, MD
Moise L Levy, MD
- Section Editor — Pediatric Dermatology
- Clinical Professor of Dermatology and Pediatrics
- Baylor College of Medicine
- Professor of Pediatrics and Medicine
- Dell Medical School/University of Texas, Austin
Roseola infantum (also known as exanthem subitum, sixth disease, pseudorubella, exanthem criticum, and three-day fever) is a clinical syndrome characterized by three to five days of high fever (may exceed 40ºC [104ºF]) that resolves abruptly and is followed by development of a rash (picture 1) [1,2]. Roseola usually is caused by human herpesvirus 6 (HHV-6) .
The clinical manifestations, diagnosis, and treatment of roseola infantum will be reviewed here. The virology, pathogenesis, epidemiology, and other clinical manifestations of HHV-6 in children are discussed separately. (See "Virology, pathogenesis, and epidemiology of human herpesvirus 6 infection" and "Human herpesvirus 6 infection in children: Clinical manifestations; diagnosis; and treatment".)
Human herpesvirus 6 (HHV-6) is the most frequent cause of roseola . Other causes include HHV-7, enteroviruses (coxsackieviruses A and B, echoviruses), adenoviruses, and parainfluenza virus type 1 [2,4,5].
The pathogenesis of roseola is not known . In a prospective study of 38 children with roseola, human herpesvirus 6 (HHV-6) viremia was detected in all of the children during the first two days of illness (before the onset of the rash) . By days 5 to 7, only 7 percent of children were viremic. HHV-6 antibody was first detected on day 3 of illness, and present in all patients by day 8 of illness. This pattern of viremia preceding rash, and rash coincident with development of antibody, suggests that the rash may result from antigen-antibody complexes .
- Hall CB. Herpes and the rash of roses: a new virus, HHV-6, as a cause of an old childhood disease, roseola. Pediatr Ann 1990; 19:517.
- Cherry JD. Roseola infantum (exanthem subitum). In: Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 7th ed, Cherry JD, Harrison GJ, Kaplan SL, et al (Eds), Elsevier Saunders, Philadelphia 2014. p.768.
- Asano Y, Yoshikawa T, Suga S, et al. Viremia and neutralizing antibody response in infants with exanthem subitum. J Pediatr 1989; 114:535.
- Jenista JA. Human herpesvirus-6 and human herpesvirus-7 infections. In: Textbook of Pediatric Care, McInerny TK (Ed), American Academy of Pediatrics, Elk Grove Village, IL 2009.
- Tanaka K, Kondo T, Torigoe S, et al. Human herpesvirus 7: another causal agent for roseola (exanthem subitum). J Pediatr 1994; 125:1.
- 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.
- Breese BB. Roseola infantum (exanthem subitum). N Y State J Med 1941; 41:1854.
- Barenberg LH, Greenspan L. Exanthema subitum (roseola infantum). Am J Dis Child 1939; 58:983.
- American Academy of Pediatrics. Human herpesvirus 6 (including roseola) and 7. In: Red Book: 2015 Report of the Committee on Infectious Diseases, Kimberlin DW, Brady MT, Jackson MA, Long SS. (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.449.
- Harnett GB, Farr TJ, Pietroboni GR, Bucens MR. Frequent shedding of human herpesvirus 6 in saliva. J Med Virol 1990; 30:128.
- Asano Y, Yoshikawa T, Suga S, et al. Clinical features of infants with primary human herpesvirus 6 infection (exanthem subitum, roseola infantum). Pediatrics 1994; 93:104.
- Stoeckle MY. The spectrum of human herpesvirus 6 infection: from roseola infantum to adult disease. Annu Rev Med 2000; 51:423.
- Clemens HH. Exanthem subitum (roseola infantum): report of 80 cases. J Pediatr 1945; 26:66.
- BERLINER BC. A physical sign useful in diagnosis of roseola infantum before the rash. Pediatrics 1960; 25:1034.
- Huang CT, Lin LH. Differentiating roseola infantum with pyuria from urinary tract infection. Pediatr Int 2013; 55:214.
- McEnery JT. Postoccipital lymphadenopathy as a diagnostic sign in roseola infantum (exanthem subitum). Clin Pediatr (Phila) 1970; 9:512.
- Pruksananonda P, Hall CB, Insel RA, et al. Primary human herpesvirus 6 infection in young children. N Engl J Med 1992; 326:1445.
- BERENBERG W, WRIGHT S, JANEWAY CA. Roseola infantum (exanthem subitum). N Engl J Med 1949; 241:253.
- 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.
- LETCHNER A. Roseola infantum; a review of fifty cases. Lancet 1955; 269:1163.
- Hashimoto H, Maruyama H, Fujimoto K, et al. Hematologic findings associated with thrombocytopenia during the acute phase of exanthem subitum confirmed by primary human herpesvirus-6 infection. J Pediatr Hematol Oncol 2002; 24:211.
- Greenthal RM. Roseola infantum (exanthum subitum). Wisc Med J 1941; 40:27.
- Shaikh N, Morone NE, Lopez J, et al. Does this child have a urinary tract infection? JAMA 2007; 298:2895.
- Richardson M, Elliman D, Maguire H, et al. Evidence base of incubation periods, periods of infectiousness and exclusion policies for the control of communicable diseases in schools and preschools. Pediatr Infect Dis J 2001; 20:380.
- CLINICAL FEATURES
- Epidemiologic features
- Clinical course
- - Febrile phase
- - Rash
- Laboratory features
- DIFFERENTIAL DIAGNOSIS
- Infectious exanthems
- Drug allergy
- Fever and pyuria
- Child care
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS