Does roseola cause a runny nose?

Does Roseola Cause a Runny Nose?

Roseola infantum typically does not cause a runny nose as one of its primary symptoms. The classic presentation of roseola is high fever lasting 3-4 days followed by a characteristic rash that appears upon fever resolution 1.

Clinical Presentation of Roseola

Roseola infantum (exanthem subitum or sixth disease) is characterized by:

• High fever (typically 102-105°F) lasting 3-4 days
• Rose-pink macular or maculopapular rash appearing on the trunk as fever subsides
• Rash spreading to neck and proximal extremities
• Children often appearing well despite fever 1

Notable Absence of Respiratory Symptoms

Unlike common viral upper respiratory infections, roseola typically does not present with:

• Runny nose (rhinorrhea)
• Nasal congestion
• Cough or other respiratory symptoms 2, 1

Distinguishing Roseola from Other Childhood Illnesses

Roseola must be differentiated from other common childhood illnesses that do typically present with rhinorrhea:

1. Viral Upper Respiratory Infections (URIs):

   • Present with runny nose, often starting clear and becoming cloudy
   • Nasal congestion and cough are common
   • May have low-grade fever (unlike the high fever of roseola) 3

2. Acute Bacterial Sinusitis:

   • Persistent, severe, or worsening pattern of illness
   • Thick, colored nasal discharge
   • Daytime cough that may worsen at night 3

3. Allergic Rhinitis:

   • Clear nasal discharge
   • Sneezing and nasal obstruction
   • No fever (unlike roseola) 3

Causative Agent and Transmission

Roseola is caused by:

• Human herpesvirus 6 (HHV-6) in most cases
• Human herpesvirus 7 (HHV-7) less commonly 1

Transmission likely occurs through:

• Asymptomatic shedding of virus in saliva of caregivers or close contacts
• Not through respiratory droplets as with common cold viruses 1

Clinical Implications

The absence of respiratory symptoms in roseola is clinically significant because:

1. It helps differentiate roseola from common URIs in febrile children
2. Unnecessary antibiotic use can be avoided by recognizing the classic pattern of roseola
3. Parents can be reassured that despite high fever, the condition is generally benign and self-limiting 1

Laboratory Findings

Laboratory testing is generally not required for diagnosis, but when performed may show:

• Leukopenia (low white blood cell count) 4
• Positive HHV-6 PCR in blood during acute infection 4

Management Considerations

Since roseola does not typically present with rhinorrhea:

• Nasal decongestants and antihistamines are not indicated
• Supportive care with antipyretics for fever is the mainstay of treatment
• Parents should be educated about the expected clinical course 1

The absence of runny nose in a febrile child who later develops a characteristic rash upon fever resolution should increase clinical suspicion for roseola infantum rather than a common URI.