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Roseola, Pediatric

Basics

Description

- Rash - Erythematous, blanching, maculopapular - First appears on trunk, spreads to face and extremities - Appears for 1 " “2 days after fever resolves

- Other findings: - Lymphadenopathy - Eyelid edema - Bulging fontanelle can occur occasionally.

Roseola infantum is a common illness in preschool-aged children characterized by fever lasting 3 " “7 days followed by rapid defervescence and the appearance of a blanching maculopapular rash (usually on the 4th day of illness) lasting only 1 " “2 days. ‚

Epidemiology

  • Roseola affects children from 3 months to 4 years of age. The peak age is 7 " “13 months.
  • 90% of cases occur in the first 2 years of life.
  • No gender predilection
  • Roseola can occur throughout the year; outbreaks have occurred in all seasons.

General Prevention

  • The virus that causes roseola infantum is usually transmitted via respiratory secretions or fecal " “oral spread. Good hand hygiene is recommended.
  • Outbreaks in hospitals have been reported, and standard infection control precautions are recommended.

Pathophysiology

  • Incubation period is 5 " “15 days.
  • The typical pattern of rash that appears as the fever disappears may represent virus neutralization in the skin.

Etiology

  • A major cause of roseola is human herpesvirus 6 and 7 (HHV-6 and HHV-7).HHV-6 was first associated with roseola infantum in 1988.HHV-6 and HHV-7 account for 20 " “40% of unexplained febrile illness in emergency department visits by febrile infants 6 months to 2 years of age.Almost all children will acquire a primary infection and be seropositive for HHV-6 by the age of 4 years. ¢ ˆ ¼30% of children infected with HHV-6 will present with the classic manifestations of roseola.
  • Roseola-like illnesses have been associated with a number of different viruses, including enterovirus (coxsackievirus A and B, echoviruses), adenoviruses (types 1, 2, 3), parainfluenza virus, and measles vaccine virus.

Diagnosis

History

  • Diagnosis is clinical, based on classic features.
  • Affected children generally do not look sick.
  • Fever, typically >39.5 ‚ °C, lasting 3 " “7 days
  • Mild cough and acute rhinitis may be present.

Physical Examination

  • RashErythematous, blanching, maculopapularFirst appears on trunk, spreads to face and extremitiesAppears for 1 " “2 days after fever resolves
  • Other findings:LymphadenopathyEyelid edemaBulging fontanelle can occur occasionally.

Diagnostic Tests & Interpretation

Lab

  • Not helpful in diagnosisPolymerase chain reaction (PCR) tests are available for detecting HHV-6 and HHV-7 but generally not needed.
  • CBCOccasionally, leukopenia with lymphocytosis is noted.Thrombocytopenia is likely secondary to viral bone marrow suppression.

Differential Diagnosis

  • Roseola has a distinctive presentation but does resemble other viral exanthems.
  • Antibiotic-associated rash in a child taking oral antibiotics when rash develops after defervescence
  • Rubella and enteroviral infections
  • Viral exanthems in preschool-aged children are sometimes called roseola even when fever is concomitant with rash.

Ongoing Care

Prognosis

Most children with roseola infantum recover without sequelae. ‚

Complications

  • SeizuresMost common complication of roseolaBetween 10 and 15% of children have a generalized tonic " “clonic seizure associated with fever.
  • Aseptic meningitis with <200 cells, primarily mononuclear cells, have been reported.
  • Encephalitis
  • Thrombocytopenic purpura

Additional Reading

  • American Academy of Pediatrics. Human herpesvirus 6 (including roseola) and 7. In: Pickering ‚ LK, Baker ‚ CJ, Kimberlin ‚ DW, et al, eds. Red Book: 2012 Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012.
  • Jackson ‚ MA, Sommerauer ‚ JF. Human herpesviruses 6 and 7. Pediatr Infect Dis J. 2002;21(6):565 " “566. ‚ [View Abstract]
  • Leach ‚ CT. Human herpesvirus-6 and -7 infections in children: agents of roseola and other syndromes. Curr Opin Pediatr. 2000;12(3):269 " “274. ‚ [View Abstract]
  • Stoeckle ‚ MY. The spectrum of human herpesvirus 6 infection: from roseola infantum to adult disease. Annu Rev Med. 2000;51:423 " “430. ‚ [View Abstract]
  • Vianna ‚ RA, de Oliveira ‚ SA, Camacho ‚ LA, et al. Role of human herpesvirus 6 infection in young Brazilian children with rash illnesses. Pediatr Infect Dis J. 2008;27(6):533 " “537. ‚ [View Abstract]

Codes

ICD09

  • 058.10 Roseola infantum, unspecified
  • 058.11 Roseola infantum due to human herpesvirus 6
  • 058.12 Roseola infantum due to human herpesvirus 7
  • 057.8 Other specified viral exanthemata

ICD10

  • B08.20 Exanthema subitum [sixth disease], unspecified
  • B08.21 Exanthema subitum [sixth disease] due to human herpesvirus 6
  • B08.22 Exanthema subitum [sixth disease] due to human herpesvirus 7
  • B09 Unsp viral infection with skin and mucous membrane lesions

SNOMED

  • 54385001 Exanthema subitum
  • 402902002 Roseola infantum (HHV 6)
  • 402903007 Roseola infantum (HHV 7)
  • 402419007 Roseolar erythema

FAQ

  • Q: When can a child with roseola return to day care?
  • A: As soon as fever subsides; there is no infectious risk of spread afterward. The child may return to day care even with the rash visible.
  • Q: Will there be long-term sequelae in the child who has a seizure associated with roseola?
  • A: In general, these seizures are typical febrile seizures that hold only a slightly higher risk than the general population for long-term neurologic sequelae (e.g., epilepsy).