What is roseola (exanthema subitum)?

From the Guidelines

Sixth disease, caused by human herpesvirus 6 (HHV-6), is a common and typically self-limiting viral infection in infants and young children, characterized by a high fever followed by a distinctive rash, and its management should focus on supportive care to alleviate symptoms and prevent complications, as stated in the guidelines from reputable health organizations 1. The disease usually starts with a high fever that can last for 3-5 days, and then a rash appears as the fever subsides.

• The rash is characterized by small pink spots or patches that typically start on the trunk and may spread to other parts of the body.
• Treatment is primarily supportive, aiming to manage symptoms such as fever and discomfort with medications like acetaminophen or ibuprofen at appropriate doses for the child's age.
• It is crucial to ensure the child stays hydrated by encouraging adequate fluid intake.
• The infection is usually spread through respiratory droplets or direct contact with an infected individual, with an incubation period of approximately 5-15 days.
• Most children recover fully from sixth disease without any long-term complications, as noted in studies on the condition 1.
• The virus can also cause other diseases, including encephalitis and febrile seizures, especially in immunocompromised patients, although it is not identified as a major opportunistic pathogen in HIV-infected patients 1.

From the Research

Definition and Causes of Sixth Disease

• Sixth disease, also known as roseola infantum or exanthem subitum, is a common viral disease that occurs during childhood worldwide 2.
• The disease is caused by human herpesvirus-6 (HHV-6) and human herpesvirus-7 (HHV-7) 2, 3.
• Transmission of the infection most likely results from the asymptomatic shedding of the virus in the saliva of caregivers or other close contacts 2.

Clinical Manifestations

• Roseola infantum is characterized by high fever that lasts 3 to 4 days, followed by the sudden appearance of a rash at defervescence 2, 4.
• The rash is discrete, rose-pink in color, circular or elliptical, macular or maculopapular, measuring 2 to 3 mm in diameter 2.
• The eruption is first seen on the trunk, then spreads to the neck and proximal extremities 2.
• Most children look well otherwise and appear to be happy, active, alert, and playful 2.

Diagnosis and Treatment

• The diagnosis of roseola infantum is mainly clinical 2.
• Febrile seizures occur in 10 to 15% of children with roseola infantum during the febrile period 2.
• There is no specific treatment for roseola infantum, but an antipyretic may be used to reduce fever and discomfort 2.
• Serious complications are rare and occur more often in individuals who are immunocompromised 2, 3, 5.

Prognosis and Complications

• Roseola infantum is generally a benign and self-limited disease 2, 3.
• Failure to recognize this condition may result in undue parental fear, unnecessary investigations, and delay in treatment for conditions that mimic roseola infantum 2.
• HHV-6/7 can reactivate in immunocompetent as well as immunocompromised individuals with severe systemic consequences 3, 5.