Roseola (roseola infantum or sixth disease)

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Roseola (roseola infantum or sixth disease)

Roseola is a common viral illness affecting babies and young children, usually between six months and three years of age. 

Also known as roseola infantum or sixth disease, roseola is usually a mild illness causing fever and skin rash. Treatment normally involves relieving symptoms while the illness runs its course.      

Causes

Roseola is spread from person to person in respiratory fluids and saliva, or by direct contact with infected persons or items.  It is commonly spread by coughing and sneezing. Once infection with the virus has occurred, the incubation period (the time until symptoms appear) is between nine to 10 days.  It is not known exactly how long a person is contagious for once they have been infected with the virus. 
 
The majority of cases of roseola are caused by human herpes virus 6 (HHV-6), though it can also be caused by human herpes virus 7 (HHV-7).  These viruses are in the same family as the viruses that cause cold sores and chickenpox.  There is no vaccine against HHV-6 and HHV-7.  Thorough and regular hand-washing and drying will help to reduce the spread of the virus, as will not sharing eating and drinking implements.   

Signs and symptoms

The first symptom of roseola is typically a high fever (up to 40ºC). The fever lasts for between three and five days. Often this is the only noticeable symptom, though some children may have a sore throat and/or a runny nose.  They may also be tired and irritable.

After about five days, the fever starts to subside and a rash appears on the body. The rash usually starts on the chest, back and abdomen, then spreads to the arms and neck. It usually has flat pinkish-red spots or patches (though these may occasionally be raised) and is not normally itchy or uncomfortable. The rash lasts about two to three days, and then fades.

Diagnosis

Usually a diagnosis is based on clinical signs and symptoms, and by ruling out other causes for the symptoms.  A blood test can confirm the diagnosis but this is not done routinely when roseola is suspected.  

Treatment

Most cases of roseola require only supportive treatment.  As the condition is caused by a virus, antibiotics will be of no benefit in combating it.  Supportive treatment includes: 
  • Paracetamol to relieve fever
  • Rest
  • Tepid baths for high temperature
  • Adequate fluid intake.

Complications

Roseola does not usually cause complications.  However, some infants may experience seizures (febrile convulsions) if their temperature becomes very high. In rare instances the illness can cause swelling of the lymph nodes, liver and spleen. Very rarely, inflammation of the brain (encephalitis) can occur.   
Roseola is of particular concern in people with weakened immune systems, such as those who have recently received a bone marrow or organ transplant.  They have a higher risk of developing potentially serious complications from the infection, such as pneumonia or encephalitis.

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