Herpesvirus 6 Infection Clinical Presentation

  • Author: Ruchir Agrawal, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Mar 21, 2012
 

History

Human herpesvirus 6 (HHV-6) is the single most common cause of hospital visits in infants with fever.

Roseola is characterized by an initial febrile phase of 3-5 days, with temperatures reaching 40°C.

With the fever, some children exhibit bilateral periorbital edema in the prodrome.

At or near the period of defervescence, a maculopapular rash is observed on the infant's trunk and neck; however, this rash is found in the minority of patients (10%).

Children can contract primary human herpesvirus 6 without manifesting a rash.

Human herpesvirus 6 can be isolated from the blood for the first 5 days and later is found intermittently or persistently in saliva, stool, and, rarely, urine.

Complications of febrile seizures (10%)[8] and, rarely, encephalitis may occur.[9]

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Physical

High-grade fever higher than 39.5°C (103°F) persists for 3-5 days and then resolves abruptly.

Rash appears after 12-24 hours of resolution of fever. In many incidents of human herpesvirus 6, rash appears during defervescence or within a few hours.

Rash of roseola is erythematous, nonpruritic, mildly elevated, and consists of rosepink papules (roseola meaning pink-colored rash). The rash blanches on pressure and mainly is distributed on the trunk, arms, and neck.

The rash fades in 1-2 days.

Most children are playful despite high-grade fever; however, anorexia, irritability, and listlessness may be the presenting signs.

Undifferentiated febrile illness without rash or localizing signs is possible.

Acute febrile illnesses with cervical and postoccipital lymphadenopathy, GI or respiratory tract signs, and inflamed tympanic membranes may occur.

Febrile seizures occur in 10-15% of primary infections.

See the images below.

A 9-month-old infant boy presented with a 1-day hiA 9-month-old infant boy presented with a 1-day history of high-grade fever and irritability. In the emergency department, the patient had a septic workup including lumbar puncture (adhesive bandage) with normal cerebrospinal fluid analysis results. He was admitted to the hospital. A 9-month-old infant boy presented with a 1-day hiA 9-month-old infant boy presented with a 1-day history of high-grade fever and irritability. In the emergency department, the patient had a septic workup including lumbar puncture with normal cerebrospinal fluid analysis results. He was admitted to the hospital. High-grade fever abruptly resolved on the third day of hospitalization. Within a few hours, an erythematous, pink papular (roseola), nonpruritic rash appeared, mainly on the trunk. A 9-month-old infant boy presented with a 1-day hiA 9-month-old infant boy presented with a 1-day history of high-grade fever and irritability. In the emergency department, the patient had septic workup including lumbar puncture with normal cerebrospinal fluid analysis results. He was admitted to the hospital. High-grade fever abruptly resolved on the third day of hospitalization. Within a few hours, an erythematous, pink papular (roseola), nonpruritic rash appeared mainly on the trunk. Patient was playful after supportive therapy. Antibiotics discontinued after 2 days of negative culture. Rash is distributed mainly over the trunk.
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Contributor Information and Disclosures
Author

Ruchir Agrawal, MD  Chief, Allergy and Immunology, Aurora Sheboygan Clinic

Ruchir Agrawal, MD, is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Allergy, Asthma and Immunology, and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Leonard R Krilov, MD  Chief of Pediatric Infectious Diseases and International Adoption, Vice Chair, Department of Pediatrics, Professor of Pediatrics, Winthrop University Hospital

Leonard R Krilov, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Medimmune Grant/research funds Cliinical trials; Medimmune Honoraria Speaking and teaching; Medimmune Consulting fee Consulting

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.

Larry I Lutwick, MD  Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Sue Jue, MD, to the development and writing of this article.

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A 9-month-old infant boy presented with a 1-day history of high-grade fever and irritability. In the emergency department, the patient had a septic workup including lumbar puncture (adhesive bandage) with normal cerebrospinal fluid analysis results. He was admitted to the hospital.
A 9-month-old infant boy presented with a 1-day history of high-grade fever and irritability. In the emergency department, the patient had a septic workup including lumbar puncture with normal cerebrospinal fluid analysis results. He was admitted to the hospital. High-grade fever abruptly resolved on the third day of hospitalization. Within a few hours, an erythematous, pink papular (roseola), nonpruritic rash appeared, mainly on the trunk.
A 9-month-old infant boy presented with a 1-day history of high-grade fever and irritability. In the emergency department, the patient had septic workup including lumbar puncture with normal cerebrospinal fluid analysis results. He was admitted to the hospital. High-grade fever abruptly resolved on the third day of hospitalization. Within a few hours, an erythematous, pink papular (roseola), nonpruritic rash appeared mainly on the trunk. Patient was playful after supportive therapy. Antibiotics discontinued after 2 days of negative culture. Rash is distributed mainly over the trunk.
 
 
 
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