eMedicine Specialties > Emergency Medicine > Pediatric

Pediatrics, Roseola Infantum: Differential Diagnoses & Workup

Author: Lisa S Lewis, MD, Consulting Staff, Division of Emergency Medicine, Children's Hospital Medical Center of Cincinnati
Contributor Information and Disclosures

Updated: Jul 14, 2009

Differential Diagnoses

Mononucleosis
Pediatrics, Otitis Media
Pediatrics, Febrile Seizures
Pediatrics, Pneumonia
Pediatrics, Fever
Pediatrics, Rubella
Pediatrics, Fifth Disease or Erythema Infectiosum
Pediatrics, Urinary Tract Infections and Pyelonephritis
Pediatrics, Measles
Pediatrics, Meningitis and Encephalitis

Other Problems to Be Considered

Sepsis
Drug eruption

Workup

Laboratory Studies

  • Given the benign nature and short duration of roseola infantum, laboratory studies generally are not obtained if the child presents with a classic history.
  • Diagnosis of primary HHV-6 can be confirmed by primary viral isolation from the peripheral blood.
  • Specific immunoglobulin M (IgM) serology or a rise in HHV-6-specific immunoglobulin G (IgG) and HHV-6 DNA polymerase chain reaction can document infection, even distinguishing between HHV-6a and 6b.3
  • If a complete blood count (CBC) is obtained, leukopenia may be noted. The white blood cell (WBC) count usually returns to reference ranges within a week.

More on Pediatrics, Roseola Infantum

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

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

  2. Stoeckle M. The spectrum of human herpesvirus 6 infection: from roseola infantum to adult disease. Annu Rev Med. 2000;51:423-430. [Medline].

  3. Boutolleau D, Duros C, Bonnafous P, Caiola D, Karras A, Castro ND, et al. Identification of human herpesvirus 6 variants A and B by primer-specific real-time PCR may help to revisit their respective role in pathology. J Clin Virol. Mar 2006;35(3):257-63. [Medline].

  4. Yoshikawa T, Asano Y. Central nervous system complications in human herpesvirus-6 infection. Brain Dev. Aug 2000;22(5):307-14. [Medline].

  5. American Academy of Pediatrics. Human herpesvirus 6 (including roseola) and 7. In: Pickering, LK, ed. Red Book: Report of the Committee on Infectious Diseases. 2003:357-359.

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

  7. Braun DK, Dominguez G, Pellett PE. Human herpesvirus 6. Clin Microbiol Rev. Jul 1997;10(3):521-67. [Medline].

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

  9. Cherry JD. Contemporary infectious exanthems. Clin Infect Dis. Feb 1993;16(2):199-205. [Medline].

  10. De Araujo T, Berman B, Weinstein A. Human herpesviruses 6 and 7. Dermatol Clin. Apr 2002;20(2):301-6. [Medline].

  11. Dockrell DH. Human herpesvirus 6: molecular biology and clinical features. J Med Microbiol. Jan 2003;52(Pt 1):5-18. [Medline].

  12. Drago F, Rebora A. The new herpesviruses: emerging pathogens of dermatological interest. Arch Dermatol. Jan 1999;135(1):71-5. [Medline].

  13. Frieden IJ, Resnick SD. Childhood exanthems. Old and new. Pediatr Clin North Am. Aug 1991;38(4):859-87. [Medline].

  14. Grossman KL, Rasmussen JE. Recent advances in pediatric infectious diseases and their impact on dermatology. J Am Acad Dermatol. Mar 1991;24(3):379-89. [Medline].

  15. Hukin J, Farrell K, MacWilliam LM, Colbourne M, Waida E, Tan R. Case-control study of primary human herpesvirus 6 infection in children with febrile seizures. Pediatrics. Feb 1998;101(2):E3. [Medline].

  16. Hurwitz S. Clinical Pediatric Dermatology. 2nd ed. WB Saunders Co; 1993:35.

  17. Jones CA, Isaacs D. Human herpesvirus-6 infections. Arch Dis Child. Feb 1996;74(2):98-100. [Medline].

  18. Leach CT. Human herpesvirus-6 and -7 infections in children: agents of roseola and other syndromes. Curr Opin Pediatr. Jun 2000;12(3):269-74. [Medline].

  19. Millichap JG, Millichap JJ. Role of viral infections in the etiology of febrile seizures. Pediatr Neurol. Sep 2006;35(3):165-72. [Medline].

  20. Okada K, Ueda K, Kusuhara K, Miyazaki C, Tokugawa K, Hirose M. Exanthema subitum and human herpesvirus 6 infection: clinical observations in fifty-seven cases. Pediatr Infect Dis J. Mar 1993;12(3):204-8. [Medline].

  21. Prober C. Sixth disease and the ubiquity of human herpesviruses. N Engl J Med. Feb 24 2005;352(8):753-5. [Medline].

  22. Ranger S, Patillaud S, Denis F, Himmich A, Sangare A, M'Boup S. Seroepidemiology of human herpesvirus-6 in pregnant women from different parts of the world. J Med Virol. Jul 1991;34(3):194-8. [Medline].

  23. Scott LA, Stone MS. Viral exanthems. Dermatol Online J. Aug 2003;9(3):4. [Medline].

  24. Suga S, Yoshikawa T, Asano Y, Yazaki T, Hirata S. Human herpesvirus-6 infection (exanthem subitum) without rash. Pediatrics. Jun 1989;83(6):1003-6. [Medline].

  25. 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].

  26. 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].

  27. Yamanishi K, Okuno T, Shiraki K, Takahashi M, Kondo T, Asano Y. Identification of human herpesvirus-6 as a causal agent for exanthem subitum. Lancet. May 14 1988;1(8594):1065-7. [Medline].

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Further Reading

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Keywords

roseola infantum, childhood exanthem, roseola, prodromal febrile illness, maculopapular rash, pink maculopapular rash, human herpesvirus type 6, HHV-6, hepatitis, encephalitis, hemophagocytic syndrome, mononucleosis-like illness, fulminant hepatitis, adult mononucleosislike illness, cell-associated viremia, febrile seizure, erythematous rash, bulging anterior fontanel, Nagayama spots, HHV-A, HHV6-B, palpebral edema, Herpesviridae, human herpesvirus type 7, HHV7, exanthem subitum, immunoglobulin M serology, IgM serology, HHV-6-specific immunoglobulin G, HHV-6-specific IgG

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Contributor Information and Disclosures

Author

Lisa S Lewis, MD, Consulting Staff, Division of Emergency Medicine, Children's Hospital Medical Center of Cincinnati
Lisa S Lewis, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Garry Wilkes, MBBS, FACEM, Director of Emergency Medicine, Bunbury Hospital, Western Australia; Medical Director, St John Ambulance, WA Ambulance Service; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia, Australia.
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

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.

CME Editor

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.

 
 
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