What are the other Names for this Condition? (Also known as/Synonyms)

• Erythema Subitum
• Rose Rash of Infants
• Sixth Disease

What is Roseola? (Definition/Background Information)

• Roseola is a common viral infection affecting infants and very young children. The condition is manifested as high fever for a few days followed by the appearance of widespread red skin rashes  on the body
• Roseola is known by a variety of names including Erythema Subitum and Sixth Disease. The virus causing Roseola belongs to the herpes simplex family of virus, specifically the human herpes virus types 6 and 7 (HHV-6 and HHV-7)
• The virus spreads through airborne dispersion of salivary and respiratory particulates from an infected child, when he/she sneezes or coughs. Roseola can also be transmitted via contaminated surfaces and direct physical contact such as by kissing
• A healthcare provider may diagnose the infection based on the clinical signs and symptoms, which includes the characteristic red skin rashes on the body. In many cases, no further laboratory tests are necessary to diagnose Roseola
• The condition is treated symptomatically using fever medication, adequate fluid intake, and rest. In a majority of children, Roseola has an excellent prognosis and a full recovery is ensured with adequate supportive treatment

Who gets Roseola? (Age and Sex Distribution)

• Roseola occurs in early childhood, between the ages of 6 months to 6 years. However, most cases are noted in children before they reach 3 years of age
• This primary form of infection is rare in adults; often, adults are affected on reactivation of the virus acquired earlier, due to an underlying disease or poor health (weak immune system)
• Both male and female genders are equally affected
• No particular racial, ethnic, or geographical preference is observed

What are the Risk Factors for Roseola? (Predisposing Factors)

The risk factors for Roseola may include:

• Exposure to saliva and respiratory fluids or mucus of infected individuals/children. The virus is present in the saliva and nasal fluids present in the mouth and respiratory tract. On coughing, sneezing, or even talking, these get expelled into air causing the spread of the virus
• Contact with an infected child, such as through hugging, shaking hands, or kissing can also lead to infection
• Sharing of items, such as a water bottle, toy, or towel, with an infected child can also lead to spread of the virus
• Contaminated surfaces and spaces, including doorknobs and water faucets
• School-going children and children at day care centers have a high risk of contracting Roseola
• Rarely, pregnant women can transmit the pathogen to the baby in the womb (called vertical transplacental transmission of infection)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Roseola? (Etiology)

• Roseola is caused by human herpes virus type 6 (HHV-6) in many cases. The infection can also be caused by human herpes virus type 7 (HHV-7) in some cases. Together, HHV-6 and HHV-7 viruses are known as ‘Roseola viruses’
• Human herpes virus 6 consists of two subtypes HHV-6A and HHV-6B; HHV-6A, rarely causes infection in infant children, while HHV-6B is the common cause of Roseola in children
• The virus spreads mostly through air (oral and respiratory secretions), contaminated materials, or direct physical contact with infected individuals

What are the Signs and Symptoms of Roseola?

The signs and symptoms of Roseola may be seen after an incubation period of 1-2 weeks i.e., time between viral exposure to presentation of symptoms. The human herpes virus type 6 infection can also be asymptomatic in some children.

The signs and symptoms of Roseola may be mild or severe and may include:

• Appearance of sudden high fever that may be about 102-105 degree F. The fever usually lasts for a period of 3-5 days
• Some children may also present runny nose, sore throat, and appetite loss
• Not uncommonly, the child may have seizures (febrile seizures) during the period of rapid fever increase
• During the fever phase, the child may appear otherwise healthy
• After the fever decreases, in 2-3 days, red (erythema) skin rashes appear on the body
• The rashes usually start from the chest/abdomen area and spreads to the upper limbs, lower limbs, and head and neck region
• The skin rashes typically last for 1-2 days and is not itchy
• The Roseola rash has a very classical appearance; it consists of discrete 2-5 mm slightly-elevated and pinkish-colored bumps
• No vesicles or fluid-filled blisters are seen
• Erythematous papules (Nakayama spots), which are red bumps, can be seen in the soft palate and uvula of the mouth in a majority of the children (65% of the cases)
• Sometimes, mild enlargement of lymph nodes of the head and neck region may be seen
• Rarely, diarrhea, headache, cough, may be observed

The infectious phase of the disease is reportedly during the incubation period and fever phase. And, it is important to note that the symptoms are often more severe, if the child is immunocompromised.

How is Roseola Diagnosed?

Diagnostic tests that may be performed for Roseola include:

• Complete physical examination with evaluation of medical history
• Assessment of the signs and symptoms
• Complete blood count (CBC)
• Blood test to detect for the presence of the human herpes virus
• Tests for detecting IgM and IgG antibodies against the virus
• Viral cultures of body fluids
• Molecular tests, such as PCR, on body fluids

In many cases, lab tests are not required; usually, a combination of the signs and symptoms is adequate for arriving at a diagnosis.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Roseola?

The complications of Roseola may include:

• 5-10% children have febrile convulsions with high fever
• Liver function may be affected in rare cases
• Rarely, the condition can cause inflammation of the brain or encephalitis
• Pneumonia or infection of the lungs
• Hemophagocytosis syndrome
• Occasionally, decreased white blood cell count (or leukopenia) is noted

How is Roseola Treated?

There is no specific medicine or drug to treat Roseola viral infection. Most cases of Roseola are self-limiting, implying that a healthy child usually recovers from the condition once the infection cycle is complete. The treatment measures are provided to address the symptoms and may involve:

• Symptomatic treatment of the disease such as the use of medication for fever and body aches
• Adequate rest
• Febrile seizures usually require monitoring, but no treatment may be necessary. However, if the seizures last more than 5 minutes, it may result in complications. Hence, the duration of the seizures should be noted and reported to the healthcare provider
• Fluid replacement
• Antiviral medication to treat encephalitis

If there are any other complications, then appropriate treatment may be provided by the healthcare provider based on the specific complications observed.

How can Roseola be Prevented?

Roseola is a viral infection that may not be typically prevented. Also, there is no vaccine currently available to prevent the disease. One may however lower or eliminate the risk for contracting Roseola, or its spread to others, through the following steps:

• Avoiding contact with infected individuals
• Washing hands regularly; avoiding touching eyes, mouth, or nose, with unclean hands
• Covering one’s mouth while sneezing or coughing
• Staying indoors and avoiding contact with others, if infected by Roseola
• Educating school teachers, caretakers, and parents on the symptoms of Roseola and on the mechanism of its spread

What is the Prognosis of Roseola? (Outcomes/Resolutions)

• In a majority of children, Roseola is a mild infection and no severe symptoms are noted
• Children with Roseola recover completely after the full course of the disease with adequate symptomatic treatment and the prognosis is generally excellent
• In rare cases, children are known to have developed complications that in the absence of suitable treatment has resulted in deaths

Once a child is affected, he/she does not have a recurrence of the viral infection later in life, in most of the cases.

Additional and Relevant Useful Information for Roseola:

Some of the other viral infections (presenting skin rashes) affecting young children include the following:

• Measles
• Fifth disease
• Rubella (German measles)
• Birth-acquired herpes