|Synonyms||Exanthema subitum, roseola infantum, sixth disease, baby measles, rose rash of infants, three-day fever|
|Roseola on a 21-month-old girl|
|Symptoms||Fever followed by rash|
|Usual onset||Before the age of three|
|Causes||Human herpesvirus 6 (HHV-6) or human herpesvirus 7 (HHV-7)|
|Diagnostic method||Typically based on symptoms|
|Differential diagnosis||Measles, rubella, scarlet fever|
Roseola is an infectious disease caused by certain types of virus. Most infections occur before the age of three. Symptoms vary from absent to the classic presentation of a fever of rapid onset followed by a rash. The fever generally lasts for three to five days. The rash is generally pink and lasts for less than three days. Complications may include febrile seizures, with serious complications being rare.
It is caused by either human herpesvirus 6 (HHV-6) or human herpesvirus 7 (HHV-7). Spread is usually through the saliva of those who are otherwise healthy. However, it may also spread from the mother to baby during pregnancy. Diagnosis is typically based on symptoms but can be confirmed with blood tests. Low numbers of white blood cells may also be present.
Treatment includes sufficient fluids and medications to treat the fever. Nearly all people are infected at some point in time. Males and females are affected equally often. The disease was first described in 1910 while the causal virus was determined in 1988. The disease may reactivate in those with a weakened immune system and may result in significant health problems.
Signs and symptoms
Roseola typically affects children between six months and two years of age, and begins with a sudden high fever (39–40 °C; 102.2-104 °F). In rare cases, this can cause febrile convulsions (also known as febrile seizures or "fever fits") due to the sudden rise in body temperature, but in many cases the child appears normal. After a few days the fever subsides, and just as the child appears to be recovering, a red rash appears. This usually begins on the trunk (torso) and then spreads to the arms, legs, and neck. The rash is not itchy and may last 1 to 2 days. In contrast, a child suffering from measles would usually appear sicker, with symptoms of conjunctivitis, cold-like symptoms, and a cough, and their rash would affect the face and last for several days. Liver dysfunction can occur in rare cases.
A small percentage of children acquire HHV-6 with few sign or symptoms of the disease. Exanthema subitum occurs in approximately 30% of children during primary HHV-6 infection. Others may show symptoms significant enough that other more serious infections, such as meningitis or measles should be ruled out. In case of febrile seizures, medical advice can be sought for reassurance. However, febrile seizures are not harmful, do not require treatment, and have no long term negative effects unless they last longer than five minutes.
Roseola is caused by two human herpesviruses, human herpesvirus 6 (HHV-6) and human herpesvirus 7 (HHV-7), which are sometimes referred to collectively as Roseolovirus. There are two variants of HHV-6 (HHV-6a and HHV-6b) and studies in the US, Europe, Dubai and Japan have shown that exanthema subitum is caused by HHV-6b. This form of HHV-6 infects over 90% of infants by age 2.
There is no specific vaccine against or treatment for exanthema subitum, and most children with the disease are not seriously ill.
John Zahorsky MD wrote extensively on this disease in the early 20th century, his first formal presentation was to the St Louis Pediatric society in 1909 where he described 15 young children with the illness. In a JAMA article published on Oct 18, 1913 he noted that "the name 'Roseola infantilis' had an important place in the medical terminology of writers on skin diseases" but that descriptions of the disease by previous writers tended to confuse it with many other diseases that produce febrile rashes. In this JAMA article Zahorsky reports on 29 more children with Roseola and notes that the only condition that should seriously be considered in the differential diagnosis is German Measles (rubella) but notes that the fever of rubella only lasts a few hours whereas the prodromal fever of Roseola lasts three to five days and disappears with the formation of a morbilliform rash.
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|Country||Local name (language)||Translated name|
Zesde ziekte (Dutch)
|China (PRC)||急疹 (Mandarin) jí zhěn (pinyin)||"fast rash"|
|Czech republic||Šestá nemoc (Czech)||"sixth disease"|
|Denmark||Tredagsfeber (Danish)||"three day fever"|
|Estonia||Roseool, kolme päeva palavik||Roseola/three day fever|
|Finland||Vauvarokko (Finnish)||"baby measles"|
|Germany||Drei-Tage-Fieber (German)||"three-day fever"|
|Greece||Αιφνίδιο εξάνθημα (Greek)||"sudden rash"|
|Hungary||Háromnapos láz (Hungarian)
Hatodik betegség (Hungarian)
|Iceland||Mislingabróðir (Icelandic)||"measles' brother"|
|Israel||Tifrachat vrooda תפרחת ורודה (Hebrew)||"rose/pink rash"|
|Italy||Sesta malattia (Italian)||"sixth disease"|
|Japan||突発性発疹 (Japanese) toppatsuseihosshin||"fast/sudden rash"|
|Korea (South)||돌발진 (Korean) Dolbaljin||"fast/sudden rash"|
|Malaysia||Campak halus (Malay)||"small/tiny measles"|
|Netherlands||Zesde ziekte (Dutch)||"sixth disease"|
|Norway||Fjerde barnesykdom (Norwegian)||"fourth disease"|
|Philippines||Tigdas Hangin (Tagalog)||"wind measles"|
|Poland||Gorączka trzydniowa (Polish)||"three-day fever"|
шестая болезнь (Russian)
|Singapore||Jiǎ má 假麻 (Chinese)||"false measles"|
|Slovakia||Šiesta (detská) choroba (Slovak)||"sixth disease"|
|Slovenia||Šesta bolezen (Slovenian)||"sixth disease"|
|South Africa||Roseola (English)||"Roseola"|
Sjätte sjukan (Swedish)
|Taiwan||Méiguī zhěn 玫瑰疹 (Chinese)||"rose rash"|
|Turkey||Altıncı hastalık (Turkish)||"sixth disease"|
|Vietnam||Sốt phát ban (Vietnamese)||"baby rash"|
- Stone, RC; Micali, GA; Schwartz, RA (April 2014). "Roseola infantum and its causal human herpesviruses". International Journal of Dermatology. 53 (4): 397–403. doi:10.1111/ijd.12310. PMID 24673253.
- Campadelli-Fiume, Gabriella. "Human Herpesvirus 6: An Emerging Pathogen". Emerging Infectious Diseases. pp. 353–366. doi:10.3201/eid0503.990306. Archived from the original on 26 September 2017. Retrieved 26 September 2017.
- Roseola – Topic Overview Archived 2008-07-27 at the Wayback Machine., webmd.com
- Zerr, D. M.; Meier, A. S.; Selke, S. S.; Frenkel, L. M.; Huang, M. L.; Wald, A.; Rhoads, M. P.; Nguy, L.; Bornemann, R.; Morrow, R. A.; Corey, L. (2005). "A Population-Based Study of Primary Human Herpesvirus 6 Infection". New England Journal of Medicine. 352 (8): 768–776. doi:10.1056/NEJMoa042207. PMID 15728809.
- Stoeckle MY (2000). "The spectrum of human herpesvirus 6 infection: from roseola infantum to adult disease". Annu. Rev. Med. 51: 423–30. doi:10.1146/annurev.med.51.1.423. PMID 10774474.
- Tesini, BL; Epstein, LG; Caserta, MT (December 2014). "Clinical impact of primary infection with roseoloviruses". Current Opinion in Virology. 9: 91–6. doi:10.1016/j.coviro.2014.09.013. PMC 4267952. PMID 25462439.
- Ongrádi, J; Ablashi, DV; Yoshikawa, T; Stercz, B; Ogata, M (February 2017). "Roseolovirus-associated encephalitis in immunocompetent and immunocompromised individuals". Journal of NeuroVirology. 23 (1): 1–19. doi:10.1007/s13365-016-0473-0. PMC 5329081. PMID 27538995.
- John Zahorsky. Roseola Infantum. Journal of the American Medical Association. Oct 18, 1913 pages 1446-1450
- Nylander, Gro (2009) "Lille venn, hva nå?"
- Hogestyn, JM; Mock, DJ; Mayer-Proschel, M (February 2018). "Contributions of neurotropic human herpesviruses herpes simplex virus 1 and human herpesvirus 6 to neurodegenerative disease pathology". Neural regeneration research. 13 (2): 211–221. doi:10.4103/1673-5374.226380. PMID 29557362.