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Roseola infantum (exanthem subitum)

Cécile Tremblay, MD
Michael T Brady, MD
Section Editors
Morven S Edwards, MD
Moise L Levy, MD
Deputy Editor
Mary M Torchia, MD


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) [3].

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 [2]. 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 [2]. 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) [3]. 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 [1].


Most cases of roseola occur sporadically, without known exposure [2,6,7]. However, secondary cases and horizontal transmission have been reported [2,8,9].

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Literature review current through: Nov 2017. | This topic last updated: Sep 01, 2017.
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