eMedicine Specialties > Dermatology > Viral Infections

Roseola Infantum: Follow-up

Author: Stephen W White, MD, Clinical Assistant Professor, Department of Dermatology, George Washington University Hospital; Chief, Sub-section of Dermatology, Suburban Hospital
Coauthor(s): Christopher R Gorman, MD, Bethesda Dermatology, private practice
Contributor Information and Disclosures

Updated: Nov 13, 2009

Follow-up

Further Inpatient Care

  • Inpatient care for roseola infantum consists of support with antipyretics and treatment of gastroenterologic, respiratory, hematologic, or CNS complications.

Inpatient & Outpatient Medications

  • Antipyretics and attention to hydration are important supportive measures in the care of a young child with high fever.

Deterrence/Prevention

  • Because seroconversion in the United States is nearly 100%, isolation is not indicated. The infection is spread through saliva in both the acute phase and the chronic phase.

Complications

  • In roseola infantum, complications are rare. Given that seroconversion is practically universal, finding any of the complications that have been reported in the gastrointestinal, central nervous, pulmonary, and hematopoietic systems is rare.
  • Children who have seizures with roseola are not expected to have further febrile or nonfebrile seizures.

Prognosis

  • Practically all patients who are immunocompetent survive roseola infantum without sequelae.
  • In patients who are immunosuppressed, multisystem complications are not unusual. Infection may be chronic, leading to viral progression and death.

Patient Education

  • In the case of an otherwise healthy infant with roseola infantum, educating the parents is important to alleviate anxiety about the hyperpyrexia and possible associated seizure.
  • In patients who are immunocompromised, the complexity of overlapping signs and symptoms with other viral syndromes and parasitic and fungal infections must be explained.
  • For excellent patient education resources, visit eMedicine's Children's Health Center. Also, see eMedicine's patient education article Skin Rashes in Children.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider roseola infantum in the differential diagnosis of a febrile child may lead to unnecessary tests, treatments, and admission to the hospital.
  • In 2005, Ward suggested testing for human herpesvirus (HHV)–6 and HHV-7 primary infection when serious neurological disease/encephalitis is temporally related to immunization, lest the condition be misdiagnosed as a vaccine reaction.6,7

Special Concerns

  • No risk appears to be present to pregnant women exposed to roseola. Care must be taken to distinguish this from rubella. No reports of infection or complications following exposure exist. This is probably because of the nearly universal seroconversion and latent infection. No sequelae of intrauterine infection are known. Isolation is not indicated.
  • In patients who are immunosuppressed, infection may be from latent infection in most if not all cases. The many and severe complications are special concerns.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.



More on Roseola Infantum

Overview: Roseola Infantum
Differential Diagnoses & Workup: Roseola Infantum
Treatment & Medication: Roseola Infantum
Follow-up: Roseola Infantum
References
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References

  1. Vinnard C, Barton T, Jerud E, Blumberg E. A report of human herpesvirus 6-associated encephalitis in a solid organ transplant recipient and a review of previously published cases. Liver Transpl. Oct 2009;15(10):1242-6. [Medline].

  2. Abdel Massih RC, Razonable RR. Human herpesvirus 6 infections after liver transplantation. World J Gastroenterol. Jun 7 2009;15(21):2561-9. [Medline].

  3. Zerr DM, Meier AS, Selke SS, et al. A population-based study of primary human herpesvirus 6 infection. N Engl J Med. Feb 24 2005;352(8):768-76. [Medline].

  4. Vianna RA, de Oliveira SA, Camacho LA, et al. Role of human herpesvirus 6 infection in young Brazilian children with rash illnesses. Pediatr Infect Dis J. Jun 2008;27(6):533-7. [Medline].

  5. Rapaport D, Engelhard D, Tagger G, Or R, Frenkel N. Antiviral prophylaxis may prevent human herpesvirus-6 reactivation in bone marrow transplant recipients. Transpl Infect Dis. Mar 2002;4(1):10-6. [Medline].

  6. Ward KN. The natural history and laboratory diagnosis of human herpesviruses-6 and -7 infections in the immunocompetent. J Clin Virol. Mar 2005;32(3):183-93. [Medline].

  7. Ward KN, Andrews NJ, Verity CM, Miller E, Ross EM. Human herpesviruses-6 and -7 each cause significant neurological morbidity in Britain and Ireland. Arch Dis Child. Jun 2005;90(6):619-23. [Medline].

  8. Asano Y, Suga S, Yoshikawa T, Urisu A, Yazaki T. Human herpesvirus type 6 infection (exanthem subitum) without fever. J Pediatr. Aug 1989;115(2):264-5. [Medline].

  9. Asano Y, Yoshikawa T, Suga S, et al. Clinical features of infants with primary human herpesvirus 6 infection (exanthem subitum, roseola infantum). Pediatrics. Jan 1994;93(1):104-8. [Medline].

  10. Campadelli-Fiume G, Mirandola P, Menotti L. Human herpesvirus 6: An emerging pathogen. Emerg Infect Dis. May-Jun 1999;5(3):353-66. [Medline].

  11. Dockrell DH. Human herpesvirus 6: molecular biology and clinical features. J Med Microbiol. Jan 2003;52:5-18. [Medline].

  12. Hall CB, Long CE, Schnabel KC, et al. Human herpesvirus-6 infection in children. A prospective study of complications and reactivation. N Engl J Med. Aug 18 1994;331(7):432-8. [Medline].

  13. Wang FZ, Linde A, Hagglund H, Testa M, Locasciulli A, Ljungman P. Human herpesvirus 6 DNA in cerebrospinal fluid specimens from allogeneic bone marrow transplant patients: does it have clinical significance?. Clin Infect Dis. Mar 1999;28(3):562-8. [Medline].

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Further Reading

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Keywords

roseola infantum, roseola exanthem subitum, sixth disease, herpes virus, human herpesvirus 6, HHV-6, human herpesvirus 7, HHV-7, herpes, human herpes virus, herpetic infection

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Contributor Information and Disclosures

Author

Stephen W White, MD, Clinical Assistant Professor, Department of Dermatology, George Washington University Hospital; Chief, Sub-section of Dermatology, Suburban Hospital
Stephen W White, MD is a member of the following medical societies: American Academy of Dermatology, International Society of Dermatology, Society for Investigative Dermatology, and Society for Pediatric Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Christopher R Gorman, MD, Bethesda Dermatology, private practice
Christopher R Gorman, MD is a member of the following medical societies: Alpha Omega Alpha
Disclosure: Nothing to disclose.

Medical Editor

Franklin Flowers, MD, Chief, Division of Dermatology, Professor, Department of Medicine and Otolaryngology, University of Florida College of Medicine
Franklin Flowers, MD is a member of the following medical societies: American College of Mohs Micrographic Surgery and Cutaneous Oncology
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Paul Krusinski, MD, Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont
Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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