Roseola Infantum in Emergency Medicine Clinical Presentation

  • Author: Lisa S Lewis, MD; Chief Editor: Richard G Bachur, MD   more...
 
Updated: May 17, 2012
 

History

Symptoms of roseola infantum include the following:

  • Roseola is typically characterized by a history of high fever followed by rapid defervescence and a characteristic rash.
  • Fever (often up to 40°C and of 3-7 days' duration)
  • Rash (fades within a few hours to 2 d)
    • Maculopapular or erythematous
    • Typically beginning on the trunk and may spread to involve the neck and extremities
    • Nonpruritic
    • Blanches on pressure
  • Seizures (6-15%)
  • Diarrhea (68%)
  • Prodromal symptoms (14%)
    • Listlessness
    • Irritability
  • Cough (50%)
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Physical

Physical examination findings of roseola infantum include the following:

  • Alert, nontoxic appearance
  • Fever (98%)
  • Rash (98%)
    • Rose pink macules or maculopapules approximately 2-5 mm in diameter are present.Discrete rose-pink macules/maculopapules characterDiscrete rose-pink macules/maculopapules characteristic of roseola infantum.
    • Lesions are characteristically discrete, rarely coalesce, and fade with blanching of the skin surface.
    • Typically, roseola infantum involves the trunk or back with minimal facial or proximal extremity involvement.
    • Some lesions may be surrounded by a halo of pale skin.
    • The rash typically evolves over 12 hours with a duration of 1-2 days.[3]
  • Bulging anterior fontanel (26%)
  • Nagayama spots (erythematous papules on the soft palate and uvula) (65%)
  • Periorbital edema, most common in the preexanthematous stage (30%); palpebral edema also common
  • Cervical, postauricular, and postoccipital lymphadenopathy (31%)
  • Splenomegaly
  • Encephalopathy
  • Conjunctival erythema
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Causes

  • HHV-6 was identified as the etiologic agent of roseola infantum in 1988.
    • This large, double-stranded deoxyribonucleic acid (DNA) virus is a member of the Herpesviridae family.
    • Two major strains, variants A and B, of this virus exist. HHV-6A appears to be more cytolytic and potentially more virulent. Strain B is responsible for most of the exanthem subitum infections in children.
    • The incubation period is approximately 9 days (range, 5-15 d).
    • Approximately 21% of primary infections will exhibit the classic clinical presentation of roseola infantum.[4]
  • HHV-6B is not believed to be the only causative agent of exanthem subitum. Primary infection with human herpesvirus type 7 (HHV-7) has also been implicated in exanthem subitum, but it is typically asymptomatic.
  • Transmission is usually horizontal via person-to-person oral secretions. Adult family members or older siblings appear to be the infective source. The virus has been found in the saliva of healthy adults. Although rare, vertical transmission has been reported with chromosomally integrated HHV-6 DNA.[5]
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Contributor Information and Disclosures
Author

Lisa S Lewis, MD  Attending Physician, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center

Lisa S Lewis, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Garry Wilkes, MBBS, FACEM  Director of Emergency Medicine, Calvary Hospital, Canberra, ACT; Adjunct Associate Professor, Edith Cowan University, Western Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Grace M Young, MD  Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

References

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Discrete rose-pink macules/maculopapules characteristic of roseola infantum.
 
 
 
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