Roseola, a mild viral illness, is seen most often in children between 6 and 24 months old, with the average age of 9 months. It can also affect adolescents, teens, and adults, albeit rarely. Usually, it has a sudden onset and relatively short duration and resolves without any treatment.
Roseola has been called roseola infantum or roseola infantilis to indicate its prevalence among very young children. Because roseola rash appears so suddenly after the fever dramatically departs, the condition may be called exanthem subitum. To distinguish roseola from other childhood diseases involving skin rashes, it was once named “sixth disease” to indicate that it was the sixth disease young children typically developed and that it lasted about six days.
What Causes Roseola?
Roseola is contagious, spreading from one person to another. The exact cause of the illness is not very well understood. Researchers think that secretions from the respiratory system are responsible for roseola. The mild illness incubates for a period of about 9 or 10 days between exposure to the virus and the beginning of symptoms.
Two different viruses cause roseola—usually human herpesvirus 6, also known as HHV-6, and to a lesser extent human herpesvirus 7, also known as HHV-7, the same virus family that causes chickenpox and shingles. While they belong to the same family of viruses that cause genital herpes and cold sores, they are different from them. The sole biological hosts for these two viruses are humans.
According to several studies, there are no apparent symptoms in people who become infected with human herpesvirus 6 and human herpesvirus 7, because the virus gets removed by their immunological systems prior to the development of symptoms. When people do manifest the symptoms of a herpes infection, they usually have no side effects.
If a person’s immune system is not functioning well, he or she might be at risk for encountering complications with the disease. Such patients might be cancer patients getting chemotherapy, people with illnesses impacting the immune system (including AIDS and HIV), and children who are 8 weeks old or younger.
While some experts say that roseola occurs throughout the year regardless of season, others say that most cases appear during the spring and fall, but the reasons for this remain unknown.
Signs and symptoms of HHV-6 (or HHV-7) infection depend on how old the person with roseola is. Most often, the illness occurs in children. Babies and small children normally get a rapid-onset, quickly-spiking fever of three- to five-day duration. It can rise to 106°F, but it is usually logged at an average of 103.5°F. Additional symptoms may include crankiness, reduced appetite, minimal diarrhea, pain in the ear, swelled glands, swelled eyelids, and runny nose. The children carry on with the fever, staying alert and not seeming to be sick.
About one or two days after the fever breaks, the patient quickly gets a rash that is not painful or itchy on the trunk, abdomen, neck, and possibly arms and legs. The appearance of this rash, in which the skin is red but turns white when pressure is applied, is either as individual 3- to 5-millimeter papules or lesions, or as 3- to 5-millimeter macular or flat circles. The non-contagious rash is present for a day or two and does not reappear. Sometimes, the roseola rash is barely visible or not visible at all.
A sudden, rapid increase in temperature may cause a seizure, also known as a convulsion. Febrile seizures occur in 3% of children with roseola between 18 months to 3 years of age and in 5 to 35% of children with the illness overall. While frightening, febrile seizures do not usually cause long-term nervous-system side effects or brain damage. While it is important to seek medical attention, doctors rarely prescribe anticonvulsant medications for the treatment or prevention of febrile seizures. This type of seizure may run in families.
When older individuals contract the viral infection, they usually are sick for a few days with a high temperature and sometimes a nasal drip and loose bowels. Occasionally, lowering of the fever is accompanied by the development of the rash.
Roseola can infect adults who were not previously infected as children. As in children, symptoms entail fever, rash, and seizures. Sometimes, there are other symptoms, such as loss of desire to eat, sore throat, runny nose, and swollen lymph nodes. When adults have weak immune systems—including elderly people and those undergoing chemotherapy treatments or recent transplants—they are more likely to contract the virus. Roseola has the potential of causing serious complications in adults. Meningoencephalitis infects the brain tissue and its surrounding layers, and hepatitis is inflammation of the liver.
Because the immune system is restrained, pregnant woman are exposed to viruses frequently. If a pregnant woman is exposed to the HHV-6 virus, there is a chance of getting the roseola infection. If she has had roseola in her childhood, she would likely be immune and not get it again. While being exposed to roseola and getting infected during pregnancy may have no impact on the mother or child, it could have some risk to the developing fetus. Most likely, the virus would not affect the pregnancy adversely, but possible complications include an increased risk of miscarriage during the first trimester and a possible chance of birth defects if the virus occurs in the later stages of pregnancy.
The tell-tale sign of roseola is the characteristic rash, but physicians may also confirm their diagnosis with a blood sample that tests for roseola antibodies. Laboratory testing exists to demonstrate elevation of antibodies to HHV-6 (or HHV-7). Such testing may be required if the patient’s immune system is compromised.
Antipyretic medications are beneficial in lowering fever and reducing discomfort, including headache. Recommended medications are acetaminophen and/or ibuprofen. Dosage interval for acetaminophen is every four hours, and dosage interval for ibuprofen is every six hours. Both are equally effective in lowering the fever.
Experts advise keeping a child with the fever comfortable but not overdressed. Overdressing can cause the temperature to go higher. A cool bath with a water temperature of about 85 degrees could be therapeutic.
Keeping children well rested and hydrated will enable their bodies to clear the infection. If the fever is not causing discomfort, it is not necessary to treat it, especially if it requires awakening a child. When a child starts to shiver when being bathed, simply raise the temperature of the water in the bathtub.
No therapy is needed for the roseola rash because it does not cause symptoms, is short-lived, and resolves spontaneously.
Avoid using aspirin for treating fever in children or adolescents, because it has been implicated in Reye’s syndrome, which is a life-threatening condition that can cause deadly inflammation of the brain and liver. Never sponge anyone with alcohol, because fumes may be harmful when inhaled.
When a child appears to be experiencing a seizure, maintain a calm demeanor. Assist the child in getting onto a floor, loosen garments around the child’s neck, ascertain that there are no pointed objects that could injure the child, and move the child onto one side to allow the flow of saliva to come from his or her mouth. While it is acceptable to create a pillow out of a piece of clothing or a cushion under the child’s head, nothing should be placed in his or her mouth. Since most of these seizures are likely to last for five minutes or less, it is recommended that an adult should just wait for it to end without trying to do anything special.
Children who have seizures should not be left unattended when adults are getting in contact with a physician or an ambulance. When the seizure ends, it is normal for the children to be somnolent and ready to sleep. At that point, it is recommended that the child’s doctor is contacted to ascertain whether it is necessary to have an immediate examination.
People of all ages appear to develop a lifelong immunity to HHV-6 or HHV-7. Complications of roseola are rare except in people who have suppressed immune systems. The prognosis for people who contract roseola is excellent without long-term side effects.
Prevention of roseola is challenging. During the incubation period, an infected child is contagious but has no symptoms. A child is most contagious during the high fever, before the rash. General health awareness and avoidance of ill and febrile children will lessen the exposure risk to roseola and other infectious diseases. Because roseola is a viral infection, antibiotics are of no value. Routine antiviral agents, such as acyclovir, have limited effect and are not recommended.
No vaccine for roseola is available. Since it does not usually cause painful, long-lasting symptoms or complications, numerous scientists believe that the large expenditure necessary to create such a medication would not be worthwhile.
Routine hygienic practices, such as washing hands frequently and avoiding contact with people diagnosed with the fever appear to be the best ways to avoid contracting the illness. Places where children congregate—such as preschools and daycare centers–need to decontaminate toys and other shared articles while encouraging the children and adults to maintain good hygiene.