Roseola
Roseola, also known as sixth disease, is an infectious disease caused by certain types of virus.[2] Most infections occur before the age of three.[1] Symptoms vary from absent to the classic presentation of a fever of rapid onset followed by a rash.[1][2] The fever generally lasts for three to five days.[1] The rash is generally pink and lasts for less than three days.[1] Complications may include febrile seizures, with serious complications being rare.[1][2]
| Roseola | |
|---|---|
| Other names | Exanthema subitum,[1] roseola infantum,[1] sixth disease,[1] baby measles, rose rash of infants, three-day fever |
 | |
| Roseola on a 21-month-old girl | |
| Specialty | Infectious disease |
| Symptoms | Fever followed by rash[1] |
| Complications | Febrile seizures[1] |
| Usual onset | Before the age of three[1] |
| Duration | Few days[2] |
| Causes | Human herpesvirus 6 (HHV-6) or human herpesvirus 7 (HHV-7)[1] |
| Diagnostic method | Typically based on symptoms[1] |
| Differential diagnosis | Measles, rubella, scarlet fever[1] |
| Treatment | Supportive care[1] |
| Prognosis | Generally good[1] |
It is caused by either human herpesvirus 6 (HHV-6) or human herpesvirus 7 (HHV-7).[1] Spread is usually through the saliva of those who are otherwise healthy.[1][2] However, it may also spread from the mother to baby during pregnancy.[1] Diagnosis is typically based on symptoms but can be confirmed with blood tests.[1] Low numbers of white blood cells may also be present.[1]
Treatment includes sufficient fluids and medications to treat the fever.[1] Nearly all people are infected at some point in time.[2] Males and females are affected equally often.[1] The disease was first described in 1910 while the causal virus was determined in 1988.[1] The disease may reactivate in those with a weakened immune system and may result in significant health problems.[2]
Signs and symptoms
Roseola classically presents with two phases: fever and rash.
Fever
The virus begins with a three to six day febrile illness.[3][4] During this time, temperatures can peak above 104 °F and children can experience increased irritability with general malaise.[4] However, many children in the febrile phase feel well, engaged, and alert. For these patients, fever is usually diagnosed incidentally.[4]
The most common complication (10-15% of children between 6 and 18 months) and most common cause of hospitalization in children with primary infection of HHV-6B is febrile seizures which can precipitate status epilepticus due to the sudden rise in body temperature.[5]
Rash
Once the febrile phase subsides, a rash develops. In some cases, the rash can present after one or two days after the fever resolves.[4] The rash is classically described as an erythematous morbilliform exanthem[3] and presents as a distribution of soft pink, discrete, and slightly raised lesions each with a 2-5mm diameter.[3][4][5] It classically begins on the trunk (torso) and spreads outward to the neck, extremities, and face. This pattern is referred to as a centrifugal spread.[3] Usually, peeling and itching are not characteristic of this rash.[4] This phase can last anywhere from several hours to 2 days.[3][4][5][6]
Other symptoms
Children with HHV-6 infection can also present with miringitis (inflammation of the tympanic membranes),[3] upper respiratory symptoms,[5][7] diarrhea, and a bulging fontanelle.[5] In addition, children can experience pharyngitis with lymphoid hyperplasia seen on the soft palate and swelling of the eyelids.[4] These symptoms usually present during the febrile phase of roseola.[5] Cervical and postocciptal lymphadenopathy can also be seen, but this generally presents 2–4 days after the onset of the febrile phase.[5][8]
In contrast, a child suffering from measles would usually appear sicker, with symptoms of conjunctivitis, cold-like symptoms, and a cough, and their rash would affect the face and last for several days. Liver dysfunction can occur in rare cases.
A small percentage of children acquire HHV-6 with few signs or symptoms of the disease. Exanthema subitum occurs in approximately 30% of children during primary HHV-6 infection.[9] Others may show symptoms significant enough that other more serious infections, such as meningitis or measles should be ruled out. In case of febrile seizures, medical advice can be sought for reassurance.
In rare cases, HHV-6 can become active in an adult previously infected during childhood and can show signs of mononucleosis.[10]
Cause
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Roseola is caused by two human herpesviruses, human herpesvirus 6 (HHV-6) and human herpesvirus 7 (HHV-7), which are sometimes referred to collectively as Roseolovirus. There are two variants of HHV-6 (HHV-6a and HHV-6b) and studies in the US, Europe, Dubai and Japan have shown that exanthema subitum is caused by HHV-6b. This form of HHV-6 infects over 90% of infants by age 2.
There are nine known human herpesviruses. Of these, roseola has been linked to two: HHV-6 and HHV-7.[5] These viruses are of the Herpesviridae family and the Betaherpesvirinae subfamily, underwhich Cytomegalovirus is also classified.[5] HHV-6 has been further classified into HHV-6A and HHV-6B, two distinct viruses which share 88% of the same RNA makeup.[3][11]
Prevention
There is no specific vaccine against or treatment for exanthema subitum, and most children with the disease are not seriously ill.
Treatment
Most cases of HHV-6 infection get better on their own.[12] If encephalitis occurs ganciclovir or foscarnet may be useful.[13]
Epidemiology
Roseola typically affects children between six months and two years of age. However, between the two, HHV-6B has been detected much more frequently in hosts.[11] HHV-6B has been shown to affect about 90% of children before the age of 3.[14] Out of these, 20% develop symptoms of Roseola, also known as Exanthem Subitum.[14] Out of all emergency department visits for children between the ages of 6 months and 12 months who have fever, twenty percent of these are due to HHV-6.[5]
History
John Zahorsky MD wrote extensively on this disease in the early 20th century, his first formal presentation was to the St Louis Pediatric society in 1909 where he described 15 young children with the illness. In a JAMA article published on Oct 18, 1913 he noted that "the name 'Roseola infantilis' had an important place in the medical terminology of writers on skin diseases" but that descriptions of the disease by previous writers tended to confuse it with many other diseases that produce febrile rashes. In this JAMA article Zahorsky reports on 29 more children with Roseola and notes that the only condition that should seriously be considered in the differential diagnosis is German Measles (rubella) but notes that the fever of rubella only lasts a few hours whereas the prodromal fever of Roseola lasts three to five days and disappears with the formation of a morbilliform rash.[15]
Names
| Country | Local name (language) | Translated name |
| Belgium | Driedagenkoorts (Dutch) Zesde ziekte (Dutch) Roséole (French) |
"three-day fever" "sixth disease" - |
| China (PRC) | 急疹 (Mandarin) jí zhěn (pinyin) | "fast rash" |
| Czech republic | Šestá nemoc (Czech) | "sixth disease" |
| Denmark | Tredagsfeber (Danish) | "three day fever" |
| Estonia | Roseool, kolme päeva palavik | Roseola/three day fever |
| Finland | Vauvarokko (Finnish) | "baby measles" |
| France | Roséole | "Roseola" |
| Germany | Drei-Tage-Fieber (German) | "three-day fever" |
| Greece | Αιφνίδιο εξάνθημα (Greek) | "sudden rash" |
| Hungary | Háromnapos láz (Hungarian) Hatodik betegség (Hungarian) |
"three-day fever" "sixth disease" |
| Iceland | Mislingabróðir (Icelandic) | "measles' brother" |
| Israel | Tifrachat vrooda תפרחת ורודה (Hebrew) | "rose/pink rash" |
| Italy | Sesta malattia (Italian) | "sixth disease" |
| Japan | 突発性発疹 (Japanese) toppatsuseihasshin | "fast/sudden rash" |
| Korea (South) | 돌발진 (Korean) Dolbaljin | "fast/sudden rash" |
| Malaysia | Campak halus (Malay) | "small/tiny measles" |
| Netherlands | Zesde ziekte (Dutch) | "sixth disease" |
| Norway | Fjerde barnesykdom (Norwegian)[16] | "fourth disease" |
| Philippines | Tigdas Hangin (Tagalog) | "wind measles" |
| Poland | Gorączka trzydniowa (Polish) | "three-day fever" |
| Romanian | Roseola eruptia subita |
Roseola |
| Russia | Розеола (Russian) шестая болезнь (Russian) |
Roseola "sixth disease" |
| Singapore | Jiǎ má 假麻 (Chinese) | "false measles" |
| Slovakia | Šiesta (detská) choroba (Slovak) | "sixth disease" |
| Slovenia | Šesta bolezen (Slovenian) | "sixth disease" |
| South Africa | Roseola (English) | "Roseola" |
| Sweden | Tredagarsfeber Sjätte sjukan (Swedish) |
"three-day fever" Sixth disease |
| Taiwan | Méiguī zhěn 玫瑰疹 (Chinese) | "rose rash" |
| Turkey | Altıncı hastalık (Turkish) | "sixth disease" |
| Vietnam | Sốt phát ban (Vietnamese) | "baby rash" |
Research
HHV-6 has been tentatively linked with neurodegenerative disease.[17]
See also
- Fifth disease
References
- Stone, RC; Micali, GA; Schwartz, RA (April 2014). "Roseola infantum and its causal human herpesviruses". International Journal of Dermatology. 53 (4): 397–403. doi:10.1111/ijd.12310. PMID 24673253.
- Campadelli-Fiume, Gabriella (1999). "Human Herpesvirus 6: An Emerging Pathogen". Emerging Infectious Diseases. 5 (3): 353–366. doi:10.3201/eid0503.990306. PMC 2640789. PMID 10341172.
- Arango, Carlos A.; Jones, Ross (October 2017). "8 viral exanthems of childhood". The Journal of Family Practice. 66 (10): 598–606. ISSN 1533-7294. PMID 28991936.
- Cherry, James D. (2019). "Roseola Infantum (Exanthem Subitum)". Feigin and Cherry's Textbook of Pediatric Infectious Diseases. pp. 559–561. ISBN 978-0-323-37692-1.
- "Human Herpesvirus 6 (Including Roseola) and 7 | Red Book® 2018 | Red Book Online | AAP Point-of-Care-Solutions". redbook.solutions.aap.org. Retrieved 2020-04-22.
- Roseola – Topic Overview Archived 2008-07-27 at the Wayback Machine, webmd.com
- Zerr, Danielle M.; Meier, Amalia S.; Selke, Stacy S.; Frenkel, Lisa M.; Huang, Meei-Li; Wald, Anna; Rhoads, Margaret P.; Nguy, Long; Bornemann, Rena; Morrow, Rhoda Ashley; Corey, Lawrence (2005-02-24). "A Population-Based Study of Primary Human Herpesvirus 6 Infection". New England Journal of Medicine. 352 (8): 768–776. doi:10.1056/NEJMoa042207. ISSN 0028-4793. PMID 15728809.
- Asano, Y.; Yoshikawa, T.; Suga, S.; Kobayashi, I.; Nakashima, T.; Yazaki, T.; Kajita, Y.; Ozaki, T. (January 1994). "Clinical features of infants with primary human herpesvirus 6 infection (exanthem subitum, roseola infantum)". Pediatrics. 93 (1): 104–108. ISSN 0031-4005. PMID 8265302.
- Zerr, D. M.; Meier, A. S.; Selke, S. S.; Frenkel, L. M.; Huang, M. L.; Wald, A.; Rhoads, M. P.; Nguy, L.; Bornemann, R.; Morrow, R. A.; Corey, L. (2005). "A Population-Based Study of Primary Human Herpesvirus 6 Infection". New England Journal of Medicine. 352 (8): 768–776. doi:10.1056/NEJMoa042207. PMID 15728809.
- Stoeckle MY (2000). "The spectrum of human herpesvirus 6 infection: from roseola infantum to adult disease". Annu. Rev. Med. 51: 423–30. doi:10.1146/annurev.med.51.1.423. PMID 10774474.
- Strausbaugh, Larry J.; Caserta, Mary T.; Mock, David J.; Dewhurst, Stephen (2001-09-15). "Human Herpesvirus 6". Clinical Infectious Diseases. 33 (6): 829–833. doi:10.1086/322691. ISSN 1058-4838.
- Tesini, BL; Epstein, LG; Caserta, MT (December 2014). "Clinical impact of primary infection with roseoloviruses". Current Opinion in Virology. 9: 91–6. doi:10.1016/j.coviro.2014.09.013. PMC 4267952. PMID 25462439.
- Ongrádi, J; Ablashi, DV; Yoshikawa, T; Stercz, B; Ogata, M (February 2017). "Roseolovirus-associated encephalitis in immunocompetent and immunocompromised individuals". Journal of NeuroVirology. 23 (1): 1–19. doi:10.1007/s13365-016-0473-0. PMC 5329081. PMID 27538995.
- "HHV-6 & Rash/Roseola | HHV-6 Foundation | HHV-6 Disease Information for Patients, Clinicians, and Researchers | Apply for a Grant". hhv-6foundation.org. Retrieved 2020-04-22.
- John Zahorsky. Roseola Infantum. Journal of the American Medical Association. Oct 18, 1913 pages 1446-1450
- Nylander, Gro (2009) "Lille venn, hva nå?"
- Hogestyn, JM; Mock, DJ; Mayer-Proschel, M (February 2018). "Contributions of neurotropic human herpesviruses herpes simplex virus 1 and human herpesvirus 6 to neurodegenerative disease pathology". Neural Regeneration Research. 13 (2): 211–221. doi:10.4103/1673-5374.226380. PMC 5879884. PMID 29557362.