Roseola

Related Terms

Baby measles, exanthem subitum, exanthema subitum, human herpesvirus 6, human herpesvirus 7, roseola, roseola infantum, roseola subitum, roseolovirus, sixth disease, three day fever.

Background

Roseola (also known as sixth disease, exanthema subitum, roseola infantum, baby measles, or three day fever) is a type of viral infection that is characterized by a sudden onset of high fever followed by a rash. Roseola is caused by two forms of the herpes virus. The infection can occur at any time of the year and usually is not serious.
Roseola is a common infection that is rare in adults and usually affects young children between the ages of six months and three years. Approximately 77 percent of children develop roseola by two years of age.
Treatment is usually supportive and aimed at relieving symptoms until the infection clears on its own. Some doctor's may prescribe the antiviral medication ganciclovir (Cytovene?) for patients with weak immune systems. The infection usually goes away within one week of developing a fever.

Signs and symptoms

General: Symptoms of roseola usually appear within one to two weeks after becoming infected with HHV6 and HHV7. However, the signs of infection are often too mild to be noticeable.
Fever: Roseola usually begins with a sudden, high fever often greater than 103? F and lasts for about three to seven days. Children may develop slightly sore throats or runny noses along with or before the fever begins. Swollen glands in the neck are often typical symptoms that occur with fever.
Rash: Once the fever has improved, a rash may develop on many areas of the body and can last anywhere from several hours to several days before fading. The rash consists of many small pink spots or patches, which are usually flat but can also be raised. Additional characteristics include a white ring around some of the spots. The rash usually starts on the chest, back, and stomach areas and then spreads to the neck and arms. Additionally, the rash usually isn't itchy or uncomfortable.

Diagnosis

Physical exam: Roseola is usually difficult to diagnose until the fever drops and the rash appears. The doctor will often take a detailed medical history and perform a physical examination. Additionally, signs and symptoms may be similar to other illnesses such as the common cold or an ear infection so these infections should be ruled out.

Complications

General: Individuals do not usually experience complications from roseola. Children usually have a complete and rapid recovery within one week of developing a fever.
Compromised immune system: Individuals with weak immune systems who develop roseola may have a greater risk of experiencing pneumonia or encephalitis (life-threatening inflammation of the brain).
Dehydration: Patients should drink plenty of fluids to prevent dehydration.
Febrile seizure: A febrile seizure occurs when an infant or young child develops a seizure or convulsions when he/she has a fever higher than 102 ?F. Children with roseola occasionally experience febrile seizures when the body temperature rises rapidly. Symptoms may include shaking or jerking of the arms or legs, fixed stare, eyes rolling back, heavy breathing, drooling, bluish skin, and loss of consciousness. However, the seizures usually finish quickly and are rarely harmful. Patients who experience any of these symptoms should be taken to the emergency department of a nearby hospital immediately.

Treatment

General: Roseola goes away on its own. Since roseola is a virus, antibiotic treatment is generally not an option. Patients receive treatment to reduce symptoms of the roseola until the infection clears up on its own. The goal of treatment is to reduce the high fever. Most children fully recover from roseola within one week after the fever begins. Antivirals such as Cytovene? may be used in children with weak immune systems.
Fluids: Children infected with roseola should drink plenty of water and other clear fluids, to prevent dehydration. Patients may also benefit from drinks that contain electrolytes, including Pediatric Electrolyte?, Pedialyte?, or Enfalyte?. Individuals should avoid diuretics, such as caffeine, because they worsen symptoms of dehydration.
Fever-reducing medications: Fever reducing medications such as acetaminophen (Tylenol?) or ibuprofen (Motrin?, Advil?) can be used. Use of aspirin should be avoided since it has been associated with the development of Reye syndrome, a condition linked with the use of aspirin in children that may cause sudden brain damage and liver failure.

Integrative therapies

Note: Currently, there is little information available on the safety and effectiveness of integrative therapies for the prevention or treatment of roseola. The therapies listed below have been studied for related conditions, should be used only under the supervision of a qualified healthcare provider, and should not be used in replacement of other proven therapies or preventive measures.
Strong scientific evidence:
Vitamin A: Vitamin A should be given to children diagnosed with measles in areas where vitamin A deficiency may be present. Giving vitamin A supplements to children with measles has been shown to be beneficial, by decreasing the length and impact of the disease. Side effects such as diarrhea, pneumonia, and death have been reduced by vitamin A. Measles treatment should be performed under the care of a doctor.
Vitamin A toxicity, or hypervitaminosis A, is rare in the general population. Vitamin A toxicity can occur with excessive amounts of vitamin A taken over short or long periods of time. Consequently, toxicity can be acute or chronic. An infant with acute vitamin A toxicity can develop a bulging fontalle (the soft spot on the head). Adults experience less specific symptoms such as headache, dizziness, fatigue, malaise, blurry vision, bone pain and swelling, nausea, and/or vomiting. Severe toxicity can lead to eye damage, high levels of calcium, and liver damage. Individuals with liver disease and those with a high alcohol intake may be at an increased risk for hepatotoxicity while taking vitamin A supplementation. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or cardiovascular disease.
The U.S. Recommended Daily Allowance (RDA) for adults has been established by the U.S. Institute of Medicine of the National Academy of Sciences. Recommendations are: 900 micrograms per day (3,000 IU) for men; and 700 micrograms per day (2,300 IU) for women. For pregnant women 19 years and older, 770 micrograms per day (2,600 IU) is recommended. For lactating women 19 years and older, 1,300 micrograms per day (4,300 IU) is recommended.
Pediatric recommendations are: for children one to three years-old, 300 micrograms per day (1,000 IU); for children 4-8 years-old, 400 micrograms per day (1,300 IU); for children nine to 13 years-old, 600 micrograms per day (2,000 IU). For pregnant women between 14-18 years-old, 750 micrograms per day (2,500 IU) is recommended; for lactating women between 14-18 years-old, 1,200 micrograms per day (4,000 IU) is recommended.
Unclear or conflicting scientific evidence:
Alizarin: Limited available evidence suggests that alizarin may be of benefit in the treatment of viral infections. Additional research is needed in this area.
Avoid if allergic or hypersensitive to alizarin or any plants in the Rubiaceae family. Alizarin may be toxic and should not be handled for long periods of time, rubbed in the eyes, or eaten. Avoid if pregnant or breastfeeding.
Blessed thistle: Laboratory studies report no activity of blessed thistle against herpes viruses, influenza, or poliovirus. Human research of blessed thistle as a treatment for viral infections is lacking.
Blessed thistle is generally considered to be safe when taken by mouth in recommended doses for short periods of time, with few reported side effects such as birth defects, bleeding, breathing problems, bruising, cancer of the nose or throat, increased production of stomach acid, itching, kidney disease, liver toxicity, skin rash, stomach discomfort, stomach ulcers, and vomiting. Allergic reactions to blessed thistle including rash may occur, as well as cross-sensitivity to mugwort and Echinacea. Cross-reactivity may also occur with bitter weed, blanket flower, Chrysanthemum, coltsfoot, daisy, dandelion, dwarf sunflower, goldenrod, marigold, prairie sage, ragweed or other plants in the Asteraceae/Compositae family. Avoid if pregnant or breastfeeding.
Cranberry: Limited laboratory research has examined the antiviral activity of cranberry. Further research is warranted in this area.
Avoid if allergic to cranberries, blueberries, or other plants of the Vaccinium species. Sweetened cranberry juice may affect blood sugar levels. Use cautiously with a history of kidney stones. Pregnant and breastfeeding women should avoid cranberry in higher amounts than what is typically found in foods.
Sorrel: There is currently not enough evidence on the proposed antiviral effects of sorrel. More research is needed.
Avoid large doses of sorrel because there have been reports of toxicity and death. This may be because of the oxalate found in sorrel. Many sorrel tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. These sorrel formulations may cause nausea or vomiting when taken with the prescription drugs metronidazole (Flagyl?) or disulfiram (Antabuse?). Avoid if pregnant or breastfeeding.
Turmeric: Turmeric is a perennial plant native to India and Indonesia, and it is often used as a spice in cooking. Based on early research, turmeric may help treat various viral infections. However, reliable human studies are lacking in this area. Well-designed trials are needed.
Avoid if allergic or hypersensitive to turmeric (curcumin), yellow food colorings, or plants belonging to the Curcuma or Zingiberaceae (ginger) families. Use cautiously with a history of bleeding disorders, immune system deficiencies, liver disease, or gallstones. Use cautiously with blood thinners (e.g. warfarin). Use cautiously if pregnant or breastfeeding.

Prevention

There is no vaccine to prevent roseola. Infected children should avoid contact with others.
When children are exposed to roseola, they may develop some lasting immunity to it. This means that the body is able to recognize the roseola virus quickly if it enters the body in the future. As a result, the immune system quickly attacks the virus and prevents individuals from becoming infected. In other words, patients who are infected with roseola are not likely to become infected again in the future.

Author information

This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Caserta MT, Mock DJ, Dewhurst S. Human herpesvirus 6. Clin Infect Dis. 2001 Sep 15;33(6):829-33. Epub 2001 Aug 10.
Cleveland Clinic. .
Leach CT. Human herpesvirus-6 and -7 infections in children: agents of roseola and other syndromes. Curr Opin Pediatr. 2000 Jun;12(3):269-74.
Lyall EG. Human herpesvirus 6: primary infection and the central nervous system. Pediatr Infect Dis J. 1996 Aug;15(8):693-6.
Meade RH 3rd. Exanthem subitum (roseola infantum). Clin Dermatol. 1989 Jan-Mar;7(1):92-6.
Millichap JG, Millichap JJ. Role of viral infections in the etiology of febrile seizures. Pediatr Neurol. 2006 Sep;35(3):165-72.
Natural Standard: The Authority on Integrative Medicine. .

Causes

Human herpes virus 6 (HHV6) and human herpes virus 7 (HHV7): Roseola is usually caused by HHV6, but it can also be caused by HHV7. These two forms do not cause cold sores and genital herpes infections; they cause several days of fever followed by a rash.
Roseola is contagious and can be spread by contact with an infected person's respiratory secretions or saliva. Activities such as laughing, sneezing, talking, or coughing may spread roseola. Also, individuals can spread roseola when they have a fever, even before showing signs of a rash. Adults who were not infected as children may become infected with roseola. However, roseola does not spread as quickly as other conditions, such as the chickenpox.

Risk factors

Older infants between the ages of six and 12 months have an increased risk of developing roseola because antibodies they received while in their mothers' womb may have faded. Antibodies are an important part of the immune system because they identify harmful substances that enter the body and trigger other immune cells to destroy the invading substance.
Research suggests that babies who are breastfed are less likely to develop infections (especially lung infections, ear infections, and diarrhea) during their first year of life than babies who are fed formulas. This is because the mother's breast milk contains important antibodies, enzymes, fats, and proteins that help boost the baby's immune system.