Disease: Roseola

    Roseola facts

    • Roseola is a mild illness caused by a virus infection most commonly involving, young children.
    • A sudden high fever that lasts for three to five days is an early feature of roseola. Mild nasal congestion and loose stools may accompany the fever.
    • When the fever disappears, a rash appears, which may last one to two days. The rash is not contagious.
    • Roseola usually resolves without any treatment.

    What is roseola?

    Roseola is a temporary illness caused by one of two viruses. Characteristically, roseola has a sudden onset and relatively short duration. Roseola is most common in children 6 to 24 months of age, with the average age around 9 months. Less frequently, older children, teens, and (rarely) adults may be infected.

    Picture of the roseola rash; SOURCE: "Fitzpatrick's Dermatology in General Medicine." Klaus Wolff, Lowell A. Goldsmith, Stephen I. Katz, Barbara A. Gilchrest, Amy S. Paller, David J. Leffell. Seventh Edition. Copyright 2008, 2005, 2001, 1997, 1993 by The McGraw-Hill Companies. All rights reserved.

    What virus causes roseola?

    Roseola is primarily caused by a virus called human herpesvirus 6 (HHV-6) and less commonly by human herpesvirus 7 (HHV-7).

    How is roseola spread?

    Roseola is spread from person to person, typically by transfer of oral secretions. Roseola is not very contagious. The incubation period between exposure to the virus and onset of symptoms is nine to 10 days. Humans are the only natural hosts for HHV-6 and HHV-7. Unlike other viral infections, roseola occurs throughout the year without seasonal variation.

    What are roseola symptoms and signs?

    The signs and symptoms of HHV-6 (or HHV-7) infection vary depending upon the age of the patient. Infants and toddlers routinely will develop sudden symptoms with a sudden onset of a high fever that lasts for three to five days. The child may also develop irritability, bulging "soft spot" on the head (fontanel), swollen glands in the front or back of the neck, runny nose, puffy eyelids (due to swelling with fluid), and mild diarrhea. Within 12-24 hours of the fever breaking, a rash rapidly appears. Older children who develop HHV-6 (or HHV-7) infection are more likely to have an illness characterized by several days of high fever and possibly a runny nose and/or diarrhea. Older children less commonly develop a rash as the fever abates.

    How is the diagnosis of roseola established?

    The characteristic clinical pattern of sudden onset of high fever and development of the typical rash at the time of fever resolution generally leads to a diagnosis without any laboratory studies. For unusual presentations, patients with complications or those with immune deficiency states, several forms of blood tests can assist in establishing the diagnosis.

    How high can the fever go with roseola?

    The fever can be quite high. The fever averages 103.5 F (39.7 C), but it can go up as high as 106 F (41.2 C).

    What is the treatment for the fever of roseola?

    If the fever is not causing the child to be uncomfortable, the fever need not be treated. It is not necessary to awaken the child to treat a fever unless instructed to do so by a health-care professional.

    If you wish to treat the fever, acetaminophen (Tylenol and others) can be used. The dosage interval is every four hours. Ibuprofen (Advil, Motrin and others) may be used in lieu of acetaminophen on an every six-hour basis. Both types of medication are equally effective in lowering a child's fever. There is no medical benefit alternating acetaminophen with ibuprofen. Aspirin should never be used for fever in children or adolescents.

    Learn more about: Tylenol | Aspirin

    A child with a fever should be kept comfortable and not be overdressed. Overdressing can cause the temperature to go higher. Bathing with tepid water (85 F or 29.5 C) may help bring down a fever. If a child develops shivering during the bath, the temperature of the bath water should be raised. Never sponge a child (or an adult) with alcohol; the alcohol fumes may be inhaled, causing many problems.

    Can the fever cause a seizure?

    Yes. The sudden and rapid rise in temperature elevation may trigger a seizure (a convulsion). Febrile seizures (convulsions due to fever) are common (3%) in children between 18 months to 3 years of age. They occur in 5% to 35% of children with roseola.

    Is a seizure due to fever dangerous?

    The seizure may look very frightening, but it is usually quite harmless. Febrile seizures are not associated with long-term nervous-system side effects or brain damage. Anticonvulsant medications are very rarely prescribed for the treatment or prevention of febrile seizures.

    What should I do if my child with roseola has a seizure?

    Though it may seem difficult, keep calm while helping the child to the floor and loosening any clothing around the neck. Remove any sharp objects that could cause injury, and turn the child on one side so saliva can flow from the mouth. Putting a cushion or a folded coat under the head for a pillow is fine, but do not put anything in the child's mouth. The best thing is just to wait it out. Most febrile seizures (whether associated with roseola or other viruses) last less than five minutes. Do not leave the child unattended while calling the paramedics of the doctor's office. Children are often drowsy and sleep after a seizure. That is normal. After the seizure, contact your child's health-care professional to determine if your child should be immediately examined.

    Is there a rash with roseola?

    Yes, but not in the beginning. When the fever disappears, a rash appears. The rash is mainly located on the neck and torso (the abdomen, trunk, and back), but it can also be on the arms and legs (extremities).

    The rash may appear as separate little raised (“goose bump” size) dots (papules) or as a flat (macular) rash. The skin is often mildly red in color and temporarily blanches with pressure. The rash is not itchy or painful. It is not contagious. The rash lasts one to two days and does not return.

    What is most remarkable characteristic of roseola?

    What is most striking is that the child seems so well despite having a high fever.

    What is the course of roseola?

    The fever of roseola lasts three to five days followed by a rash lasting about one to two days that resolves without treatment. Immunity to HHV-6 seems to be lifelong.

    Are there any complications of roseola?

    Complications are rare with roseola except in children with suppressed immune systems. Individuals with healthy immune systems generally develop lifelong immunity to HHV-6 (or HHV-7).

    Should I take my child to the doctor with roseola?

    Yes, an evaluation by a health-care professional is a good idea. A child with a fever and a rash should not go back to child care until they are medically evaluated.

    When can the child return to child care?

    A child with just the rash of roseola and no fever can usually return to child care.

    Is it possible to prevent roseola?

    The primary mechanism for HHV-6 or HHV-7 transmission is via human-to-human respiratory droplet secretions. Therefore, basic hand-washing and avoidance of acutely ill individuals (such as those with fever) is the best way to avoid contracting the illness. Day-care centers and preschools should follow routine principles of hygiene and decontamination of toys and articles shared by their children.

    What is the prognosis for a child with roseola?

    With the exception of immune-compromised patients, the prognosis for a child with roseola is excellent and no long-term side effects should be anticipated.

    How is roseola spread?

    Roseola is spread from person to person, typically by transfer of oral secretions. Roseola is not very contagious. The incubation period between exposure to the virus and onset of symptoms is nine to 10 days. Humans are the only natural hosts for HHV-6 and HHV-7. Unlike other viral infections, roseola occurs throughout the year without seasonal variation.

    What are roseola symptoms and signs?

    The signs and symptoms of HHV-6 (or HHV-7) infection vary depending upon the age of the patient. Infants and toddlers routinely will develop sudden symptoms with a sudden onset of a high fever that lasts for three to five days. The child may also develop irritability, bulging "soft spot" on the head (fontanel), swollen glands in the front or back of the neck, runny nose, puffy eyelids (due to swelling with fluid), and mild diarrhea. Within 12-24 hours of the fever breaking, a rash rapidly appears. Older children who develop HHV-6 (or HHV-7) infection are more likely to have an illness characterized by several days of high fever and possibly a runny nose and/or diarrhea. Older children less commonly develop a rash as the fever abates.

    How is the diagnosis of roseola established?

    The characteristic clinical pattern of sudden onset of high fever and development of the typical rash at the time of fever resolution generally leads to a diagnosis without any laboratory studies. For unusual presentations, patients with complications or those with immune deficiency states, several forms of blood tests can assist in establishing the diagnosis.

    How high can the fever go with roseola?

    The fever can be quite high. The fever averages 103.5 F (39.7 C), but it can go up as high as 106 F (41.2 C).

    What is the treatment for the fever of roseola?

    If the fever is not causing the child to be uncomfortable, the fever need not be treated. It is not necessary to awaken the child to treat a fever unless instructed to do so by a health-care professional.

    If you wish to treat the fever, acetaminophen (Tylenol and others) can be used. The dosage interval is every four hours. Ibuprofen (Advil, Motrin and others) may be used in lieu of acetaminophen on an every six-hour basis. Both types of medication are equally effective in lowering a child's fever. There is no medical benefit alternating acetaminophen with ibuprofen. Aspirin should never be used for fever in children or adolescents.

    Learn more about: Tylenol | Aspirin

    A child with a fever should be kept comfortable and not be overdressed. Overdressing can cause the temperature to go higher. Bathing with tepid water (85 F or 29.5 C) may help bring down a fever. If a child develops shivering during the bath, the temperature of the bath water should be raised. Never sponge a child (or an adult) with alcohol; the alcohol fumes may be inhaled, causing many problems.

    Can the fever cause a seizure?

    Yes. The sudden and rapid rise in temperature elevation may trigger a seizure (a convulsion). Febrile seizures (convulsions due to fever) are common (3%) in children between 18 months to 3 years of age. They occur in 5% to 35% of children with roseola.

    Is a seizure due to fever dangerous?

    The seizure may look very frightening, but it is usually quite harmless. Febrile seizures are not associated with long-term nervous-system side effects or brain damage. Anticonvulsant medications are very rarely prescribed for the treatment or prevention of febrile seizures.

    What should I do if my child with roseola has a seizure?

    Though it may seem difficult, keep calm while helping the child to the floor and loosening any clothing around the neck. Remove any sharp objects that could cause injury, and turn the child on one side so saliva can flow from the mouth. Putting a cushion or a folded coat under the head for a pillow is fine, but do not put anything in the child's mouth. The best thing is just to wait it out. Most febrile seizures (whether associated with roseola or other viruses) last less than five minutes. Do not leave the child unattended while calling the paramedics of the doctor's office. Children are often drowsy and sleep after a seizure. That is normal. After the seizure, contact your child's health-care professional to determine if your child should be immediately examined.

    Is there a rash with roseola?

    Yes, but not in the beginning. When the fever disappears, a rash appears. The rash is mainly located on the neck and torso (the abdomen, trunk, and back), but it can also be on the arms and legs (extremities).

    The rash may appear as separate little raised (“goose bump” size) dots (papules) or as a flat (macular) rash. The skin is often mildly red in color and temporarily blanches with pressure. The rash is not itchy or painful. It is not contagious. The rash lasts one to two days and does not return.

    What is most remarkable characteristic of roseola?

    What is most striking is that the child seems so well despite having a high fever.

    What is the course of roseola?

    The fever of roseola lasts three to five days followed by a rash lasting about one to two days that resolves without treatment. Immunity to HHV-6 seems to be lifelong.

    Are there any complications of roseola?

    Complications are rare with roseola except in children with suppressed immune systems. Individuals with healthy immune systems generally develop lifelong immunity to HHV-6 (or HHV-7).

    Should I take my child to the doctor with roseola?

    Yes, an evaluation by a health-care professional is a good idea. A child with a fever and a rash should not go back to child care until they are medically evaluated.

    When can the child return to child care?

    A child with just the rash of roseola and no fever can usually return to child care.

    Is it possible to prevent roseola?

    The primary mechanism for HHV-6 or HHV-7 transmission is via human-to-human respiratory droplet secretions. Therefore, basic hand-washing and avoidance of acutely ill individuals (such as those with fever) is the best way to avoid contracting the illness. Day-care centers and preschools should follow routine principles of hygiene and decontamination of toys and articles shared by their children.

    What is the prognosis for a child with roseola?

    With the exception of immune-compromised patients, the prognosis for a child with roseola is excellent and no long-term side effects should be anticipated.

    Source: http://www.rxlist.com

    If the fever is not causing the child to be uncomfortable, the fever need not be treated. It is not necessary to awaken the child to treat a fever unless instructed to do so by a health-care professional.

    If you wish to treat the fever, acetaminophen (Tylenol and others) can be used. The dosage interval is every four hours. Ibuprofen (Advil, Motrin and others) may be used in lieu of acetaminophen on an every six-hour basis. Both types of medication are equally effective in lowering a child's fever. There is no medical benefit alternating acetaminophen with ibuprofen. Aspirin should never be used for fever in children or adolescents.

    Learn more about: Tylenol | Aspirin

    A child with a fever should be kept comfortable and not be overdressed. Overdressing can cause the temperature to go higher. Bathing with tepid water (85 F or 29.5 C) may help bring down a fever. If a child develops shivering during the bath, the temperature of the bath water should be raised. Never sponge a child (or an adult) with alcohol; the alcohol fumes may be inhaled, causing many problems.

    Source: http://www.rxlist.com

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