Roseola Infantum in Emergency Medicine Clinical Presentation

Updated: Mar 05, 2018
  • Author: Lisa S Lewis, MD; Chief Editor: Kirsten A Bechtel, MD  more...
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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%)



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 character Discrete 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%) [4]

  • 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



See the list below:

  • 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. [5]

  • 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. [6]