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| |    Roseola by Lynn Cates, M.D., F.A.A.P. reviewed by Laura Jana, M.D., F.A.A.P. Roseola is one of the most common-and memorable--of all childhood infections. Classically, a child suddenly develops a high fever, but he doesn't have any other symptoms and he doesn't look very sick. The fever lasts for three or four days and, just when his parents are worried sick about the fever, it breaks--and then he develops a rose-colored rash. Because roseola is known to cause a child's temperature to rise rapidly, about 10 to 15 percent of children will develop febrile seizures (or fever-related seizures) early in the disease. Despite the drama of the high fever, and even the possibility of seizures, roseola only rarely causes any serious complications. What causes roseola? Roseola is caused by human herpesvirus 6 (HHV-6) and, less commonly, HHV-7 or other viruses. You may have also heard it called roseola infantum, exanthem subitum, or sixth disease. The name "sixth disease" simply comes from the fact that it was the sixth of the common children's diseases that cause rashes to be listed in a particular classification scheme. The other five are measles, scarlet fever, rubella, a variant of scarlet fever that is no longer recognized, and fifth disease. Who gets roseola? Roseola most commonly occurs in children between six and 24 months, and the vast majority of children get it between three months and three years of age. Studies have shown that almost all two-year olds have antibodies to HHV-6--indicating that, whether or not they have had a full-blown classical case of roseola, they have had an HHV-6 infection at some point in time. How is roseola spread? Children (and adults) can carry the viruses that cause roseola for months without having any symptoms (that is, they are asymptomatic), but they are capable of transmitting the infection to others who may happen to come in contact with their respiratory secretions. Thus, children can get roseola from close contact with asymptomatic adults such as family members, or from other children with roseola. To date, the only natural host for either virus appears to be humans. The time between when a child is exposed to the roseola virus and when he actually starts to look sick or develop fever is generally nine to ten days. This period of time is known as the incubation period. Roseola can occur any time of the year and doesn't seem to be more common during any particular season. Although cases don't usually occur in clusters, some roseola outbreaks have been reported. When should you suspect roseola? You should suspect roseola if your infant or toddler develops a persistently high fever with no other symptoms, and he doesn't look very sick. He may not be quite as active as usual, he might be slightly irritable, and his appetite may be a little off, but he looks remarkably alert and active considering his 103 to 105 degree fever. One of the signs that your child might have roseola is his ability to continue to run around and play despite his high fever. While the fact that your child looks well can be reassuring, you should always discuss a fever this high with your child's healthcare provider. The fever usually will last three or four days, but may persist up to seven days. Just as the fever goes away, he will break out in a pink rash that starts on his trunk and spreads to his arms and neck--and sometimes to his face and legs. The rash may be slightly raised. It lasts a few hours to a couple of days. Other, less common symptoms that can accompany roseola include cough, runny nose, stomachache, headache, vomiting, diarrhea, and swollen lymph nodes and eyelids. However, if your child has any of these symptoms with his fever, it is less likely he has roseola. Uncommon problems caused by HHV-6 and 7 Most children with HHV-6 infection do not develop the full-blown roseola syndrome--they have the fever alone without the typical rash. Occasionally children will develop encephalopathy. The virus also has been known to cause pneumonia, hepatitis, encephalitis, and inability to produce blood cells in individuals with decreased immunity to infections (e.g., individuals who are receiving chemotherapy for cancer). For the most part, HHV-7 infections cause either very mild symptoms, or no symptoms at all. The role of the healthcare provider in roseola The problem with roseola-from the vantage point of both parents and pediatricians-is that the definitive cause of the high fever only becomes apparent after the fever breaks and the characteristic rash appears. That can mean several days of worry, careful observation, and evaluation by parents and doctors alike. You should always consult your child's healthcare provider just as you would any time he has a high fever. This is important because more serious causes of fever such as ear infections and urinary tract infections also can cause high fevers without any other symptoms, but these conditions need antibiotic treatment to prevent potentially serious complications. Most children with roseola have a normal physical examination except for their fever. Some will have inflamed throats or eardrums, swollen lymph nodes or eyelids, or the soft spot on infants' heads (the anterior fontanelle) may be bulge. How is roseola diagnosed? Currently, no laboratory tests are available to help make the diagnosis of roseola in a timely fashion in the routine practitioner's office setting. That means the diagnosis can be made only after the rash appears. Treatment The only treatment that is needed is fever management, since children with roseola don't usually look very sick. You should consult with your healthcare provider about your child's high fever, and you should contact her immediately if he develops a seizure.
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