Curriculum · Pediatric / Nutrition & Growth / EPI / Routine Child Examination
Roseola infantum (exanthem subitum)
What it is
Roseola infantum, also called sixth disease, is caused by human herpes virus type 6 or 7. HHV-6 comes from the oral secretions of a family member by the age of 2 years.
How it presents
There are no prodromes. The fever is of sudden onset and high, over 40 C, with no other symptoms for 3-4 days; a febrile convulsion may come with it. Then the fever abates and a widespread rash appears. The rash is maculopapular and generalized on the trunk and proximal extremities, sparing the face, and it is described as rose-pink and abrupt in its appearance during defervescence. Cervical or occipital lymphadenopathy is sometimes present, and there may be red papules and erosions of the soft palate and uvula, the Nagayama spots. The order of the two is what is asked. The fever comes first, of acute onset and high, with no other symptoms for 3-4 days; the rash appears after the fever subsides. So a child seen while still febrile has no rash to show, and the maculopapular rash that follows the fever is what names it.