What is roseola?

From the Guidelines

Roseola is a common viral infection caused by human herpesvirus 6 (HHV-6) that primarily affects infants and young children, typically between 6 months and 2 years of age, characterized by a sudden high fever followed by a distinctive rose-pink rash. The illness usually begins with a high fever that lasts for 3-5 days, followed by a rash that appears as the fever breaks, typically starting on the trunk and spreading to the neck, face, arms, and legs, lasting for a few hours to a few days [ 1 ]. Other symptoms may include irritability, decreased appetite, mild diarrhea, swollen eyelids, and swollen lymph nodes in the neck.

Key Characteristics of Roseola

• Caused by human herpesvirus 6 (HHV-6) or occasionally human herpesvirus 7 (HHV-7)
• Affects infants and young children, typically between 6 months and 2 years of age
• Characterized by a sudden high fever followed by a distinctive rose-pink rash
• Rash typically starts on the trunk and spreads to the neck, face, arms, and legs
• Other symptoms may include irritability, decreased appetite, mild diarrhea, swollen eyelids, and swollen lymph nodes in the neck

Treatment and Management

Treatment for roseola is supportive and focuses on managing fever with acetaminophen or ibuprofen (following age-appropriate dosing), ensuring adequate hydration, and rest [ 1 ]. Most children recover completely within a week without complications. The virus spreads through respiratory droplets and saliva, making it contagious before symptoms appear, which explains why outbreaks can occur in childcare settings. Roseola rarely requires medical intervention unless the fever is extremely high or persists longer than expected.

Prevention

Given that roseola is caused by a virus, prevention measures are largely focused on reducing the spread of the virus, such as practicing good hygiene, including frequent handwashing, and avoiding close contact with individuals who are infected [ 1 ]. However, because the virus can be contagious before symptoms appear, preventing outbreaks can be challenging.

Complications

While roseola is generally a mild illness, there can be complications, particularly in cases where the fever is extremely high or persists longer than expected [ 1 ]. It is essential for parents and caregivers to monitor the child's condition closely and seek medical attention if there are any concerns.

In terms of morbidity, mortality, and quality of life, the most critical aspect of managing roseola is ensuring that the child remains comfortable and hydrated, as the illness is typically self-limiting [ 1 ]. Given the potential for roseola to cause significant distress due to high fever and rash, prompt recognition and management of symptoms are crucial to minimize the impact on the child's quality of life.

From the Research

Definition and Characteristics of Roseola

• Roseola is a common viral disease that occurs during childhood worldwide, characterized by high fever that lasts 3 to 4 days, followed by the sudden appearance of rash at defervescence 2.
• The disease occurs most frequently in children between 6 months and 2 years of age 2.
• Human herpesvirus-6 (HHV-6) is the major cause of roseola infantum, followed by HHV-7 2.
• The rash is discrete, rose-pink in color, circular or elliptical, macular or maculopapular, measuring 2 to 3 mm in diameter, and typically appears on the trunk before spreading to the neck and proximal extremities 2.

Clinical Presentation and Diagnosis

• The diagnosis of roseola is mainly clinical, based on the characteristic presentation of high fever followed by a rash 2.
• Febrile seizures occur in 10 to 15% of children with roseola infantum during the febrile period 2.
• Serious complications are rare and occur more often in individuals who are immunocompromised 2.
• The clinical presentation of roseola can be differentiated from other childhood rashes by the appearance and location of the rash, the clinical course, and associated symptoms such as pruritus or fever 3.

Transmission and Treatment

• Transmission of the infection most likely results from the asymptomatic shedding of the virus in the saliva of caregivers or other close contacts 2.
• There is no specific treatment for roseola, but an antipyretic may be used to reduce fever and discomfort 2.
• Roseola is generally a benign and self-limited disease, and failure to recognize this condition may result in undue parental fear, unnecessary investigations, and misuse of healthcare expenditure 2.

Epidemiology and Virology

• The natural contamination of HHV-6 is intense, with 60-75% of children acquiring the infection in infancy, and most infections are clinically silent or develop without an exanthema 4.
• The prognosis of roseola is good, but the disease can be a special challenge for ambulatorily acting physicians due to its nonspecific symptoms and potential for differential diagnostic considerations 4.
• Coinfections with other viruses, such as HIV-1, have been reported, and the role of HHV-6 in roseola infantum is not always confirmed 5.