Roseola is a common febrile viral illness of early childhood; it is usually caused by human herpesvirus (HHV)-6B and occasionally by HHV-7.
Roseola is characterised by 3 to 7 days of fever, often high grade (>39.5°C [103.0°F]), followed by onset of a diffuse morbilliform rash that appears with defervescence of fever. The lesions are discrete 3- to 5-mm pink-red macules and papules that commonly begin on the neck and trunk and spread to the extremities.
Roseola is usually a benign self-limited illness that has been associated with febrile seizures.
Roseola (also called exanthem subitum or sixth disease for the sixth classic paediatric exanthem) is a common early childhood febrile illness, characterised by 3 to 7 days of high fever followed by onset of rash that appears with resolution of fever. The rash consists of asymptomatic pink-red macules and papules. Febrile seizures may occur. Roseola is most commonly caused by human herpesvirus (HHV)-6B, but occasionally by HHV-7 and rarely by other viruses. HHV-6A (associated with thyroiditis), HHV-6B (roseola), and HHV-7 (roseola) are lymphotropic viruses within the Herpesviridaefamily andBetaherpesvirinae subfamily, and all establish latency. HHV-6A, HHV-6B, and HHV-7 can occasionally integrate into the host chromosome. Reactivation of the roseola viruses may occur with immunosuppression.
History and exam
Key diagnostic factors
- age under 2 years
- high fever
Other diagnostic factors
- abdominal pain
- Nagayama's spots
- tympanic membrane inflammation
- upper respiratory symptoms
- peri-orbital oedema
- bulging anterior fontanelle
- cervical, occipital, or post-auricular lymphadenopathy
- age under 2 years
1st investigations to order
- no initial test
Investigations to consider
- viral culture
- antibody detection
- polymerase chain reaction (PCR)
- Epstein-Barr virus
- Viral exanthems
- Human herpesvirus 6 (including roseola) and 7
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer