Roseola infantum is an infection of infants or very young children caused by human herpesvirus 6 (HHV-6) 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.

Roseola infantum is the most well-described illness to result from HHV-6. HHV-6 may also cause visceral disease in immunocompromised patients (eg, organ 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.

Diagnosis

If roseola is known to be in the community, it may be suspected when a child aged 6 mo to 3 yr develops typical symptoms and signs. Testing is rarely needed, but diagnosis can be confirmed by culture, PCR, or serologic tests.

Treatment

Treatment is generally symptomatic. Foscarnet or ganciclovir have been used to treat some immunosuppressed patients with severe disease, although controlled trials are lacking. Foscarnet is more consistently active than ganciclovir against HHV-6.

Last full review/revision December 2009 by Kenneth M. Kaye, MD