Exanthema subitum B08.20

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 29.10.2020

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Synonym(s)

Pseudorubella; Roseola infantum; Rose rash of infants; sixth disease; Three-day fever

History
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Meigs and Pepper, 1870; Zahorsky, 1910

Definition
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Sporadically occurring, aerosol-spreading, characteristically lasting for 3 days ("three-day fever"), highly febrile, virus-induced "childhood disease" (HHV-6 (occasionally also HHV-7), a DNA virus from the herpes family) with permanent immunity.

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Pathogen
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Human DNA virus from the herpes family (HHV-6 and 25% by HHV-7). S.u. Herpes viruses, human.

Manifestation
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Occurs in 95% of cases in the 6th month to 3 years before age; rarely in adulthood.

Clinical features
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Incubation period: 3-7 days. Start with fatigue, tiredness, possibly light or moderate sore throat; sudden (subitum) fever rise to 39-40 °C, critical drop after 3 days.

Fleeting pinkish exanthema, progressing centrifugally from the trunk to the extremities, usually avoiding the face, rubeoliform or morbilloidal. Lymphadenopathy, convulsions...

No enanthema. In adults analogous exanthema with lymphadenopathy.

In adults, primary infection is accompanied by a highly febrile clinical picture with maculo-papular exanthema, gastroenteritis, lymphadenopathy and possible complicative hepatitis and meningoencephalitis.

Laboratory
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Leukocytopenia, lymphocytosis, monocytosis. Detection of HHV-6 IgM and IgG antibodies.

Histology
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Relatively unspecific picture with a discrete, lymphocytic superficial dermatitis, discrete or also distinct erythrocyte extravasations, focal exocytosis.

Differential diagnosis
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Measles; infectious mononucleosis; influenza; scarlet fever; erythema infectiosum; coxsackievirus infection.

Complication(s)
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Fulminant concomitant hepatitis and meningoencephalitis may occur (apparently more frequently in the rare primary infection in adulthood than in childhood).

External therapy
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Symptomatic with shaking mixtures.

Internal therapy
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Antipyretic measures such as paracetamol in age-appropriate dosages.

Literature
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Fried I et al (2009) HHV-6 infection - not always a three-day fever. SDDG 7: 234-236
Meigs JF, Pepper W (1870) A practical treatise of the diseases of children. Lindsay and Blakiston, Philadelphia, pp. 701-703 and 803-806
Zahorsky J (1910) Roseola infantilitis. Pediatrics 22: 60-64
Zahorsky J (1913) Roseola infantum. JAMA 61: 1446-1450