Exanthema subitum B08.20

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 03.09.2023

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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.

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. Onset with lassitude, fatigue, possibly mild or moderate sore throat; sudden (subitum) rise in fever to 39-40 °C, critical fall after 3 days.

Volatile pinkish exanthema, progressing centrifugally from the trunk to the extremities, usually excluding the face, rubeoliform or morbilloid. Lymphadenopathy

Occasional papular enanthem around the uvula and soft palate (so-called "Nagayama spots").

In adults, analogous exanthema with lymphadenopathy.

In adults, the primary infection is accompanied by a highly febrile clinical picture with maculo-papular exanthema, gastroenteritis, lymphadenopathy, and possible complicating 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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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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  1. Fried I et al (2009) HHV-6 infection - not always a three-day fever. SDDG 7: 234-236
  2. Meigs JF, Pepper W (1870) A practical treatise of the diseases of children. Lindsay and Blakiston, Philadelphia, pp. 701-703 and 803-806
  3. Zahorsky J (1910) Roseola infantilitis. Pediatrics 22: 60-64
  4. Zahorsky J (1913) Roseola infantum. JAMA 61: 1446-1450

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 03.09.2023