What is it?
Roseola (also called exanthem subitum) is a viral illness caused by the human herpesvirus 6 (HHV-6). This type of herpesvirus is different from the herpesvirus responsible for cold sores or genital herpes infections. Roseola usually affects children about 6 months to 3 years old, with the highest number of cases occurring between ages 6 months and 12 months.
Roseola is a contagious illness, and outbreaks may occur throughout the year. Roseola virus probably spreads in the saliva of infected persons and possibly in other body fluids as well. Once a person recovers from a roseola infection, the HHV-6 virus may lie dormant (inactive) in the body for many years, possibly living inside certain blood cells or in cells of the salivary glands. This dormant virus may reactivate later in life, if immune defenses are weakened by illnesses or medicines that affect the immune system.
Although laboratory studies show that over 90 percent of children have been infected by HHV-6 by the time they are 2 years old, in about two thirds of these children the infection is asymptomatic (produces no symptoms). When symptoms do develop, they usually begin five days to 15 days after exposure to the virus.
What are the symptoms?
Characteristically, children with roseola have high fever and a rash that begins after the fever ends. Roseola can cause temperatures in the range of 102ºF to 105ºF. Fever may last for two days to five days, with three days being the average. During this time, the child may look and act well, or may seem just a little fussier or sleepier than usual. The child may also have any of the following symptoms: mild diarrhea, mild respiratory symptoms (cough or runny nose), or a sore throat with enlarged lymph nodes (swollen glands) in the neck.
Generally, on the third or fourth day of the illness, the temperature suddenly returns to normal just as the roseola rash appears. The rash looks like pink spots that blanch (turn white) when you touch them. Individual spots may have a lighter “halo” around them. The rash begins on the trunk and neck, then may spread to the arms, legs, and face. It may last for a few hours or up to one or two days. The high fever of roseola may trigger febrile seizures in about 10 percent of cases.
How is it treated?
Antibiotics are not effective in treating viral illnesses like roseola. Treatment of roseola is generally aimed at reducing a high fever and making the child more comfortable.
Treat fever using a nonaspirin fever-reducing medicine, such as acetaminophen (like Tylenol®) or ibuprofen (like Motrin®). Unless instructed by your child’s doctor, avoid giving aspirin to a child who has a viral illness, since the use of aspirin in certain viral infections has been associated with the development of Reye’s syndrome.
Encourage your child to drink plenty of fluids to help replace body water lost as the result of fever and sweating.
How long does it last?
Most children recover spontaneously from roseola within one week.
How can roseola be prevented?
There is no vaccine to prevent roseola. The only way of preventing it is by avoiding exposure to someone who already has the infection. As a practical matter, this is difficult to do since not everyone with the viral infection is aware of it. An episode of roseola in childhood usually provides lasting immunity to the illness.
When should the doctor be called?
There are many causes of fever in childhood. Call your doctor whenever your child has a high fever. Your doctor may investigate the reason for your child’s fever and may prescribe medicines to fight an infection, if one is present.
© Copyright 1998 American Medical Association
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