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Roseola infantum

Last updated: August 3, 2020

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Roseola infantum (exanthem subitum, three-day fever) is a viral exanthematous infection caused by the human herpes virus 6 (HHV-6; in rare cases, HHV-7) that mainly affects infants and toddlers. Infection is characterized by high fever, which ends abruptly after three to five days, followed by the sudden appearance of a maculopapular rash. The rash generally appears mainly on the trunk, but sometimes spreads to the face and extremities, and fades within two days. Roseola infantum is a self-limiting condition that is only treated symptomatically. Febrile seizures are a possible complication of infection; however, most patients recover from these seizures without any adverse outcome.

  • Most frequent in infants and young children
  • Peak incidence: 6 months to 2 years

References:[1][2]

Epidemiological data refers to the US, unless otherwise specified.

  • Pathogen
    • HHV-6 (and in rare cases HHV-7)
    • Humans are the sole hosts.
  • Route of transmission: droplet infection (e.g., saliva)
  • Incubation period: 5–15 days

References:[1][3]

Febrile phase

Exanthem phase

  • Duration: 1–3 days
  • Characteristic presentation: subsequent sudden decrease in temperature and development of a patchy, maculopapular exanthem
    • Rose-pink in color; blanches upon pressure
    • Nonpruritic (in contrast to the drug allergy rash)
    • Originates on the trunk; ; sometimes spreads to the face and extremities

The names of the disease reflect its two phases: Three-day fever refers to 3 days of high fever; exanthem subitum (from Latin: "subitus" = sudden) describes a "sudden exanthem" (upon fever cessation).

References:[1][4][5][6][7][8]

References:[7]

References:[7]

The differential diagnoses listed here are not exhaustive.

References:[7]

References:[5]

We list the most important complications. The selection is not exhaustive.

  • Very good prognosis; self-limiting disease
  • The virus persists lifelong in its host, and reactivation of latent virus or reinfection may occur later in life (especially if individuals become immunocompromised)

References:[5]

  1. Marcdante K, Kliegman RM. Nelson Essentials of Pediatrics E-Book. Elsevier Health Sciences ; 2018
  2. Tesini BL, Epstein LG, Caserta MT. Clinical impact of primary infection with roseoloviruses. Curr Opin Virol. 2014; 9 : p.91-96. doi: 10.1016/j.coviro.2014.09.013 . | Open in Read by QxMD
  3. Tremblay C. Virology, Pathogenesis, and Epidemiology of Human Herpesvirus 6 Infection. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/virology-pathogenesis-and-epidemiology-of-human-herpesvirus-6-infection.Last updated: November 14, 2016. Accessed: March 19, 2018.
  4. Goljan EF. Rapid Review Pathology. Elsevier Saunders ; 2013
  5. Gorman CR. Roseola Infantum. In: James WD, Roseola Infantum. New York, NY: WebMD. http://emedicine.medscape.com/article/1133023. Updated: June 2, 2016. Accessed: March 19, 2017.
  6. McKinnon HD, Howard T. Evaluating the febrile patient with a rash. Am Fam Physician. 2000; 62 (4): p.804-816.
  7. Tremblay C, Brady MT. Roseola Infantum (Exanthem Subitum). In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. http://www.uptodate.com/contents/roseola-infantum-exanthem-subitum.Last updated: October 12, 2015. Accessed: March 19, 2017.
  8. Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. Elsevier Health Sciences ; 2014