ROSEOLA

Roseola, also known as roseola infantum or sixth disease, is a common viral illness that primarily affects infants and young children below the age of 2. Typically, it poses no significant concern as children tend to recover on their own.

Causes

Roseola is typically caused by the human herpesvirus 6 (HHV-6) or, less commonly, human herpesvirus 7 (HHV-7). These viruses belong to the herpes family and are highly contagious. Roseola spreads through respiratory secretions, such as saliva and nasal discharge, as well as through close contact with an infected individual.

Roseola Rash

Within 24 hours of the fever breaking, your child may develop a rash. On lighter skin tones, it appears as pinkish-red spots, while on darker skin tones, it may be less noticeable. The rash can be flat or have both flat and raised areas. Pressing on the spots will cause them to fade or turn white.
Initially, the rash typically appears on the chest, back, and abdomen, then spreads to the face, neck, arms, and legs. Although seeing a rash spread over your baby’s body can be concerning, remember that a roseola rash does not cause itching or discomfort and usually resolves within two to four days.
Unlike some other rashes, a key characteristic of a roseola rash is that it only emerges after the child’s fever has subsided.

Is Roseola Contagious?

Yes, roseola is contagious and spreads through saliva and respiratory droplets, particularly from coughing or sneezing, of individuals who have a fever or are asymptomatic carriers. Symptoms typically appear 5 to 15 days after exposure to the virus.
A child with roseola can transmit the virus to others while experiencing a fever and for 24 hours after the fever subsides. A fever is considered a temperature of 100.4 degrees F (38 degrees C) or higher. Even if the child appears alert and well, it’s advisable to refrain from sending them to daycare or play dates until their temperature has remained normal for at least 24 hours. It’s important to note that the child cannot spread roseola solely through the rash.
If uncertain about whether it’s safe for a child to be around others, consulting a pediatrician is recommended. This caution is particularly crucial when avoiding contact with children who have compromised immune systems, as roseola can lead to more severe complications for them.

Can You Get Roseola Twice?

While it’s possible to contract roseola more than once, it’s rare. Typically, individuals develop immunity to roseola after experiencing it, reducing the likelihood of reinfection. However, immunocompromised children or adults may be susceptible to multiple episodes of roseola.

Symptoms

The primary symptom of this viral illness is a sudden and high fever, typically ranging from 103 to 105 degrees Fahrenheit (39.5 to 40.5 degrees Celsius).

Following the fever’s resolution, a rash may emerge all over the child’s body.

Additional Symptoms and Signs:

Before the onset of the roseola rash, some children may experience:
Vomiting.
Diarrhea.
Loss of appetite.
Cough.
Sore throat.
Runny nose.
Pink eye.
Swelling of the eyelids or the area around the eyes.
Swollen lymph nodes in the neck or the back of the head.
Small pink or red spots along the throat.

Risk Factors

Children between the ages of 6 months and 3 years are most susceptible to sixth disease due to their immature immune systems. Additionally, exposure to an infected individual increases the risk of contracting the virus.

Prevalence

Roseola is highly prevalent, affecting nearly all children by the time they reach their second birthday. In the United States, roseola accounts for up to 45% of all fevers in infants. Additionally, approximately 12% of infants requiring care for a fever in an emergency room (ER) are diagnosed with roseola. Although roseola can potentially affect individuals of any age, it primarily occurs in babies and toddlers. Instances of roseola in older children or adults are rare.

Diagnosis

Healthcare providers diagnose sixth disease through a combination of discussing your child’s symptoms and conducting a physical examination. Laboratory tests, such as blood tests or viral cultures, may be conducted to confirm the presence of HHV-6 or HHV-7, although these are typically not necessary for diagnosis.

Your pediatrician will typically rule out other potential causes of your child’s symptoms, including:

Allergic reaction to medication.
Ear infection.
Measles.
Rubella.
Scarlet fever.

Your pediatrician will provide guidance on managing your child’s fever and advise when to seek medical attention if necessary.

Treatments

No Specific Treatment: Healthcare providers do not have a specific treatment for roseola. Since roseola is a viral infection, antibiotics are ineffective as they only treat bacterial infections.
Fever Management: The focus of treatment is on managing symptoms at home. Your pediatrician may recommend children’s acetaminophen or ibuprofen to reduce your child’s fever. However, aspirin should not be given to children under 17 due to the risk of Reye’s syndrome.
Rash Management: Typically, the rash associated with roseola does not cause itching or pain, so it does not require treatment.
Special Considerations: If your child is taking immunosuppressant medication, consult your pediatrician to determine if any special treatment is needed.
Seeking Guidance: If you have any questions or concerns about managing roseola, don’t hesitate to talk to your pediatrician. They are available to answer your questions and provide guidance on how best to care for your child.

Complications of Roseola

Most children experience no complications from this viral illness. However, for those who do, the most common complication is a febrile seizure. Approximately 10% to 15% of children aged 6 to 18 months with roseola may experience febrile seizures, typically occurring on the first day of fever.

Febrile seizures typically last less than 15 minutes and do not cause lasting harm to the child. The key signs of a febrile seizure include:

The child’s body shakes, stiffens, or tenses up.
Loss of consciousness, or the eyes rolling back in the head.
Loss of control over basic bodily functions, such as vomiting, drooling, urination, or defecation.

If a child displays these signs and has never experienced a febrile seizure before, it’s essential to call 911 or the local emergency number immediately. Attempting to treat a first-time febrile seizure at home is not advisable, as the child requires immediate medical attention to rule out more serious types of seizures.

For children who have had febrile seizures before, pediatricians provide guidance on how to manage future occurrences. It’s crucial to follow these guidelines closely, and when in doubt, seek emergency assistance.

It’s important not to exceed recommended doses and frequencies of acetaminophen or ibuprofen in an attempt to prevent febrile seizures. Excessive use of these medications can lead to liver damage or failure (with acetaminophen) or kidney damage and stomach problems (with ibuprofen).

While rare, more severe complications can occur, especially in children with weakened immune systems due to conditions such as cancer or autoimmune diseases. Potential complications include:

Infection and inflammation in the lungs, leading to pneumonia.
Inflammation of the delicate tissue surrounding the brain and spinal cord, known as aseptic meningitis.
Inflammation of the brain itself, termed encephalitis.
Other conditions affecting the central nervous system, which comprises the brain and spinal cord.

Home Care Remedies

To ease symptoms at home, encourage rest and provide a cool, comfortable environment. Dress the child in lightweight clothing and offer lukewarm baths to help reduce fever. Use a humidifier to moisten the air and soothe respiratory symptoms.

Expectations if Your Child Has Roseola:

Variability in Symptoms: Symptoms of this viral illness can vary among children. Some may remain alert, playful, and exhibit their usual behavior, while others may experience restlessness or irritability, particularly during periods of high fever.
Recovery Time: Most babies and children with roseola recover within about one week and typically do not experience any complications.
Possible Complication: It’s important to be aware that febrile seizures are a potential complication of roseola. While these seizures usually last for a short duration and do not cause lasting harm, they can be alarming. If your child has a medical condition that weakens their immune system, discuss with your pediatrician what steps to take if they develop a fever.
Guidance from Pediatrician: Your pediatrician will guide recognizing signs of complications and when to seek medical assistance. It’s essential to follow their advice closely and communicate any concerns or changes in your child’s condition promptly.
Possibility of Unnoticed Roseola: Yes, it is possible to have this viral illness without being aware of it. Many children may have experienced a virus that causes roseola without displaying noticeable symptoms. Since children can develop fevers for various reasons, if a child does not manifest the characteristic roseola rash, the fever may be attributed to another illness, and the presence of roseola may go unrecognized.

Prevention

Preventing the spread of this viral illness involves practicing good hygiene, such as frequent handwashing with soap and water, especially after coughing, sneezing, or caring for a sick child. Additionally, avoiding close contact with individuals who have symptoms of roseola can help prevent transmission.

Comparison with Measles Rash

Both roseola and measles can result in a rash, but there are notable differences between them:
Color of the Spots: A roseola rash is typically pink-red, while a measles rash tends to be red or red-brown. Additionally, a measles rash may have small, raised white spots atop the red spots.
Connectivity of Spots: Roseola rash spots are usually separate and do not merge, whereas measles rash spots are more likely to join together.
Location of Rash Onset: Roseola rash starts on the chest, back, and abdomen, spreading outward. In contrast, a measles rash begins on the face and moves downward to cover the body.
Skin Peeling During Resolution: A roseola rash does not cause skin flaking or peeling, whereas a measles rash does.

If there are concerns about measles, contacting a pediatrician promptly is crucial, as measles is a more serious illness than roseola and can lead to severe complications. Measles is highly contagious and spreads through the air.

Preventive Measures Against Measles:

Protection against measles can be achieved by administering either the Measles, Mumps, Rubella (MMR) vaccine or the Measles, Mumps, Rubella, Varicella (MMRV) vaccine.

When to See a Doctor

While roseola is typically a mild, self-limiting illness, it’s essential to consult a doctor if a child develops a high fever or rash. Seek medical attention if the child shows signs of dehydration, difficulty breathing, or other concerning symptoms.

Outlook/Prognosis

In most cases, roseola resolves on its own without complications within a week. Once the fever breaks and the rash fades, the child is no longer contagious. However, complications such as febrile seizures can occur in rare cases. Overall, the prognosis for roseola is excellent, and most children recover fully with supportive care.

Sources

American Academy of Pediatrics. (2018). Roseola. In Red Book: 2018 Report of the Committee on Infectious Diseases (31st ed.).
Centers for Disease Control and Prevention. (2021). Roseola (Human Herpesvirus 6 and 7).
National Health Service (U.K.). Roseola
Mayo Clinic. (2022). Roseola.
UpToDate. (2022). Clinical features and diagnosis of roseola infantum (exanthem subitum).
Emerging Infectious Diseases: “Human Herpesvirus 6: An Emerging Pathogen.”
HealthyChildren.org: “Roseola Infantum.”
Children’s National Health System: “Pediatric Viral Exanthems (Rashes).”
American Osteopathic College of Dermatology. Roseola Infantum
Canadian Paediatric Society. Roseola
Merck Manual (Consumer Version). Roseola Infantum