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Roseola Infantum

(Exanthem Subitum; Pseudorubella)

By Brenda L. Tesini, MD, Assistant Professor of Medicine and Pediatrics, Division of Infectious Diseases; Associate Hospital Epidemiology, University of Rochester School of Medicine and Dentistry; Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center

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Roseola infantum is an infection of infants or very young children caused by human herpesvirus 6B (HHV-6B) or, less commonly, HHV-7. The infection causes high fever and a rubelliform eruption that occurs during or after defervescence, but localizing symptoms or signs are absent. Diagnosis is clinical, and treatment is symptomatic.

Most viruses that infect humans can affect both adults and children and are discussed elsewhere in The Manual. Viruses with specific effects on neonates are discussed in see Infections in Neonates. This chapter covers viral infections that are typically acquired during childhood (although many may also affect adults).

Roseola infantum is the most well-described illness to result from HHV-6. HHV-6B may also cause CNS disease in immunocompromised patients (eg, hematopoietic stem cell transplant recipients). Roseola infantum occurs most often in the spring and fall. Minor local epidemics have been reported.

Symptoms and Signs

The incubation period is about 5 to 15 days. Fever of 39.5 to 40.5° C begins abruptly and persists 3 to 5 days without any localizing symptoms or signs. Despite the high fever, the child is usually alert and active, although febrile seizures may occur. Cervical and posterior auricular lymphadenopathy often develops. Encephalitis or hepatitis occurs rarely.

The fever usually falls rapidly on the 4th day, and when the fall occurs, a macular or maculopapular exanthem usually appears prominently on the chest and abdomen and, to a lesser extent, on the face and extremities; it lasts for a few hours to 2 days and may be unnoticed in mild cases. In 70% of HHV-6 infections, the classic exanthem does not occur.

Pearls & Pitfalls

  • In roseola infantum, the characteristic rash occurs with defervescence.

Diagnosis

  • Clinical evaluation

It may be suspected when a child aged 6 mo to 3 yr develops typical symptoms and signs. Testing is rarely needed, but diagnosis of roseola infantum can be confirmed by culture or serologic tests.

Molecular assays (eg, quantitative PCR) are available but are more commonly used to detect viral reactivation.

Treatment

  • Supportive care

Treatment of roseola infantum is generally symptomatic. Foscarnet or ganciclovir has been used to treat some immunosuppressed patients with severe disease, but controlled trials are lacking.

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