Summary
Definition
History and exam
Key diagnostic factors
- age under 2 years
- immunosuppression
- high fever
- exanthem
Other diagnostic factors
- gastrointestinal symptoms
- abdominal pain
- Nagayama spots
- tympanic membrane inflammation
- upper respiratory symptoms
- seizures
- periorbital edema
- bulging anterior fontanelle
- cervical, occipital, or postauricular lymphadenopathy
Risk factors
- age under 2 years
- immunosuppression
Diagnostic tests
1st tests to order
- clinical diagnosis
Tests to consider
- Human herpesvirus-6- or human herpesvirus-7-specific IgG detection
- polymerase chain reaction
- viral culture
- immunohistochemistry
Treatment algorithm
all patients
Contributors
Authors
Henry M. Feder, Jr., MD
Professor of Pediatrics and Family Medicine
University of Connecticut Medical Center and Connecticut Children’s
Farmington, CT
Disclosures
HMF declares that he has no competing interests.
Hassan El Chebib, MD, FAAP
Attending Physician in the Division of Infectious Diseases and Immunology
Connecticut Children’s
Assistant Professor of Pediatrics
Pediatrics, Infectious Diseases and Immunology
University of Connecticut School of Medicine
Hartford, CT
Disclosures
HEC declares that he has no competing interests.
Ashley C. Howard, DO
Attending Physician in the Division of Infectious Diseases and Immunology
Connecticut Children’s
Assistant Professor of Pediatrics
Pediatrics, Infectious Diseases and Immunology
University of Connecticut School of Medicine
Hartford, CT
Disclosures
ACH declares that she has no competing interests.
Acknowledgements
Dr Henry M. Feder, Dr Hassan El Chebib, and Dr Ashley C. Howard would like to gratefully acknowledge Dr Edward C. Kim, Dr Nicholas Bennett, Dr James Azim, Dr Margie C. Andreae, Dr Jon Dyer, and Dr Jennifer Holman, the previous contributors to this topic.
Disclosures
ECK, NB, JA, MCA, JD, and JH declare that they have no competing interests.
Peer reviewers
Helen Goodyear, MBChB, MRCP, FRCPCH, MD, MMed
Consultant Paediatrician
Heartlands Hospital
Birmingham
UK
Disclosures
HG declares that she has no competing interests.
Mary T. Caserta, MD
Associate Professor of Pediatrics
Department of Pediatrics
Division of Infectious Diseases
University of Rochester Medical Center
Rochester, NY
Disclosures
MTC declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Hall CB, Long CE, Schnabel KC, et al. Human herpesvirus-6 infection in children: a prospective study of complications and reactivation. N Engl J Med. 1994 Aug 18;331(7):432-8.Full text Abstract
Leung AK, Lam JM, Barankin B, et al. Roseola infantum: an updated review. Curr Pediatr Rev. 2024;20(2):119-28. Abstract
Asano Y, Yoshikawa T, Suga S, et al. Clinical features of infants with primary human herpesvirus 6 infection (exanthem subitum, roseola infantum). Pediatrics. 1994;93:104-8. Abstract
Braun DK, Dominguez G, Pellett PE. Human herpesvirus 6. Clin Microbiol Rev. 1997;10:521-67.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Measles
- Enterovirus
- Epstein-Barr virus
More DifferentialsGuidelines
- Human herpesvirus 6 (including roseola) and 7
- Viral exanthems
More Guidelines
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