From the Guidelines
HHV-6 viral exanthem, also known as roseola infantum or sixth disease, typically presents with a high fever lasting 3-5 days, followed by a distinctive pink rash that appears as the fever breaks, primarily affecting children under two years of age. The presentation of HHV-6 viral exanthem is characterized by:
- A high fever, often above 102°F, lasting 3-5 days
- A distinctive pink rash that appears as the fever breaks, usually starting on the trunk and spreading to the neck, face, arms, and legs
- The rash lasts 1-2 days before fading This information is based on the guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents, which mentions that HHV-6B causes exanthem subitum (roseola), a common disease of childhood 1. Although more recent guidelines are available, such as the 2019 guidelines from the European Conference on Infections in Leukaemia for management of HHV-6 infection in patients with hematologic malignancies and after hematopoietic stem cell transplantation 1, the key characteristics of HHV-6 viral exanthem presentation remain consistent. Treatment is primarily supportive, focusing on fever management with acetaminophen or ibuprofen at age-appropriate doses, ensuring adequate hydration and rest during the illness. It is essential to note that while HHV-6 viral exanthem is typically mild, parents should seek medical attention if the child appears very ill, has a fever lasting more than 5 days, or shows signs of complications like excessive drowsiness or seizures.
From the Research
Presentation of Human Herpesvirus 6 (HHV6) Viral Exanthem
- The primary infection with HHV-6 usually presents as exanthem subitum, a common febrile illness in infants 2, 3.
- Exanthem subitum is characterized by a high fever followed by a rash 2, 4.
- In some cases, HHV-6 infection can present as febrile disease without an exanthem 4.
- In adults, an active HHV-6 infection can present as febrile illness, and may also include symptoms such as swelling of the lymph nodes and pancytopenia 4.
- Reactivation of HHV-6 can occur in immunocompromised patients, and may present with symptoms such as encephalitis, limbic encephalitis, and amnesia 3, 5.
Clinical Features
- The clinical features of HHV-6 infection can vary depending on the age and immune status of the individual 3, 5.
- In immunocompetent individuals, HHV-6 infection can cause fulminant hepatitis or meningoencephalitis, which can be severe and require early recognition and treatment 4.
- In immunocompromised patients, HHV-6 reactivation can cause severe encephalitis, particularly in hematopoietic stem cell transplant recipients 5.
Diagnosis and Treatment
- The diagnosis of HHV-6 infection is performed by both serologic and direct methods, including the quantification of viral DNA in blood, other body fluids, and organs by means of real-time PCR 5.
- The antiviral compounds ganciclovir, foscarnet, and cidofovir are effective against active HHV-6 infections, but the indications for treatment and conditions of drug administration are not formally approved to date 5, 6.