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
- Professor of Pediatrics and Medicine (Dermatology)
- Dell Medical School, University of Texas, Austin
- Clinical Professor of Dermatology and Pediatrics
- Baylor College of Medicine
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 40°C [104°F]) 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 .
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- 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