What is roseola (exanthema subitum)?

From the Guidelines

Roseola is a common viral infection that primarily affects infants and young children, typically between 6 months and 2 years of age, caused by human herpesvirus 6 (HHV-6) or occasionally human herpesvirus 7 (HHV-7), and is characterized by a high fever followed by a distinctive pinkish-red rash. The condition is often associated with a spectrum of neurologic diseases, including encephalitis and febrile seizure, as noted in a study published in 2009 1. Key characteristics of roseola include:

• A high fever that lasts for 3-5 days
• A distinctive pinkish-red rash that appears as the fever breaks
• Age range typically between 6 months and 2 years
• Caused by HHV-6 or occasionally HHV-7

Treatment for roseola is primarily supportive care, focusing on:

• Managing fever with acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) for children over 6 months
• Ensuring the child stays well-hydrated by offering frequent small amounts of fluids
• Monitoring for complications such as febrile seizures, which are a main concern in children with roseola, as highlighted by the study 1. It is essential to contact a healthcare provider if the child experiences seizures, if the fever lasts more than 7 days, or if the child appears unusually ill. Most children recover completely without complications, and infection typically confers lifelong immunity.

From the Research

Definition and Characteristics of Roseola

• Roseola infantum is a common viral disease that occurs during childhood worldwide 2
• It is 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

Transmission and Symptoms

• Transmission of the infection most likely results from the asymptomatic shedding of the virus in the saliva of the caregivers or other close contacts 2
• 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
• Typically, the rash blanches on pressure and subsides in 2 to 4 days without sequelae 2

Diagnosis and Treatment

• The diagnosis 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, but an antipyretic may be used to reduce fever and discomfort 2
• Studies have shown that antipyretics such as ibuprofen and acetaminophen can be effective in reducing fever in children with febrile seizures 3, 4

Febrile Seizures

• Febrile seizures are classified as simple or complex, with complex seizures lasting 15 minutes or more, or recurring within 24 hours 5
• Children who have a simple febrile seizure and are well-appearing do not require routine diagnostic testing 5
• The use of antiepileptics is not indicated for febrile seizures due to their benign nature 5
• A systematic review and meta-analysis found limited support for the use of antipyretics in preventing febrile seizure recurrence within the same fever episode, and no evidence for its use in distant fever episodes 6