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Overview |
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Definition |
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Roseola infantum (exanthem subitum or sixth disease) is a nonspecific febrile
disease with an incubation period of one to two weeks, usually followed by skin
rash. Ninety percent of cases (B variant) occur in the first two years of life,
with a prevalence of 30% for children in the United States. Five percent (A
variant) occur in adult patients with the acquired immunodeficiency syndrome
(AIDS) or lymphoproliferative disease.
- As much as 90% of all people older than age two are seropositive for
one or both variants.
- Immune response includes presence of antibodies, T-cell reactivity,
and cytokines.
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Etiology |
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Roseola is most often caused by the human herpesvirus 6 (HHV-6). The virus
was isolated in 1986 from the peripheral blood mononuclear cells of AIDS and
lymphoproliferative patients. As much as 80 to 90% of adults are seropositive
for HHV-6. As maternal antibodies to roseola decrease, infants first become
susceptible. It is still unknown how the disease is acquired but may be from
viral shedding in saliva. The incubation period is 5 to 15 days. As many as 7%
of cases may be caused by other rare pathogens or
enteroviruses. |
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Risk Factors |
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- Age—under age three
- AIDS or other immunocompromised patients (e.g., transplant
recipients)—the virus becomes pathogenic when
reactivated in these patients.
- Males and females are equally likely to acquire
roseola.
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Signs and Symptoms |
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- Fever—sudden onset of high fever (103° to
106°F), usually lasting three to four days; child usually remains alert and
active. Fever subsides promptly with appearance of rash.
- Rash—usually appears as fever resolves and
lasts for three to four days; may be measles-like (macular, coalescent) or
rubella-like (papular); discrete, nonpruritic, rose-colored lesions are 2 to 3
mm in diameter; usually appears first on trunk and spreads to neck and
extremities but spares face
- Seizures—relatively rare, appearing at
height of fever; resolves when fever subsides; may occur without rash
- Bulging anterior fontanelle
- Respiratory symptoms, inflamed tympanic membranes, and diarrhea occur
in about half of the cases.
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Differential
Diagnosis |
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- Bacterial pneumonia
- Measles
- Rubella
- Drug reactions
- Entero- or adenoviral diseases
- Sepsis
- Urinary tract infection
- Meningitis
- Fifth disease
- Otitis media
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Diagnosis |
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Physical Examination |
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Patient may be either listless or normally active with high fever.
Nonpruritic, rose-colored lesions usually appear as fever
resolves. |
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Laboratory Tests |
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- Complete blood count during primary
infection—white cell count averages
8,000/mm3, leukopenia with relative lymphocytosis
- Serologic tests show serum IgM and IgG antibodies to HHV-6; must
exclude human cytomegalovirus
- Increase in neutrophils and an infrequent elevated number of
monocytes
- With rare cases of encephalopathy, DNA may be found in the
cerebrospinal fluid.
- Viral cell culture (or culture on tissue from affected organs) is
done primarily for research purposes or for clinical management in post-primary
infections
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Pathology/Pathophysiology |
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- Viral latency is supported by viral nucleic acid in both peripheral
blood mononuclear cells and saliva in seropositive adults and
children.
- Enlarged spleen—occurs but is
uncommon
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Other Diagnostic
Procedures |
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Diagnosis is by exclusion of other diseases and by observation of the pattern
of fever and rash. Roseola can be suspected when it is known to be in the
community. |
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Treatment Options |
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Treatment Strategy |
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There is no cure for roseola. Most cases are self-limiting and benign. Cool
baths reduce temperature and lightweight bed clothes can lessen the effects of
the condition. |
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Drug Therapies |
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- Antipyretics (e.g., acetaminophen 10 to 15 mg/kg every four hours,
maximum 2.6 g/day)—lower fever, analgesic properties
ease discomfort; caution with aspirin for children as Reye's syndrome may
develop.
- High fluid intake prevents dehydration.
- Sedatives (e.g., diazepam [Valium]) may reduce chance of seizures in
children prone to convulsions.
- Phenobarbital is sometimes given for
seizures.
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Complementary and Alternative
Therapies |
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The main focus is on managing the symptoms and on preventing febrile seizures
(brought on by a rapid rise in the temperature or too high a temperature). The
correct homeopathic remedy can be very effective. Herbal teas are diaphoretic,
antipyretic and calming. Adult doses are listed, unless otherwise specified. The
formula to determine the child's dose is (age of child/20) x adult dose = child
dose. Adult doses may be given to the mother for breast-feeding
babies. |
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Nutrition |
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Immune stimulating: vitamin C (1,000 mg tid), zinc (30 to 60 mg/day) and
beta-carotene (250,000 IU/day). |
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Herbs |
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Herbs are generally a safe way to strengthen and tone the body's systems. As
with any therapy, it is important to ascertain a diagnosis before pursuing
treatment. Herbs may be used as dried extracts (capsules, powders, teas),
glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless
otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water.
Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for
roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as
noted.
- Catnip (Nepeta cataria) is an antipyretic, sedative,
spasmolytic.
- Peppermint (Mentha piperita) is a carminative, spasmolytic,
historic use for colds and fevers
- Elder (Sambucus nigra) to disperse fever; calming
- Fennel (Foeniculum vulgare) for dyspepsia; decreases upper
respiratory catarrh, calming
- Yarrow (Achillea millefolium) for loss of appetite, to
disperse a fever
- Chamomile (Matricaria recutita) stimulates immune system,
relaxing (to allow for sleep)
Mix four to six of the above and drink as a tea, 1 cup tid to qid or
tincture, 60 drops tid to qid. In addition, a strong tea (2 tbsp. herb) can be
made and added to a bath to prevent fever from going too high or rising too
rapidly in children susceptible to febrile seizures.
Garlic/ginger tea (one to three cloves garlic [Allium sativum] and one
to three slices of fresh ginger [Zingiber officinale]) may be drunk to
stimulate the immune system and prevent upper respiratory infections. Lemon and
a sweetener may be added for flavor. Avoid honey in children less than 2 years
old. |
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Homeopathy |
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An experienced homeopath should assess individual constitutional types and
severity of disease to select the correct remedy and potency. For acute
prescribing use 3 to 5 pellets of a 12X to 30C remedy every one to four hours
until acute symptoms resolve.
- Aconitum napellus for rapid onset of a high fever, especially
with restless anxiety
- Belladonna for high fever where the face and/or body are
burning hot to the touch, especially with irritability and sensitivity to noise
or light, or with a history of febrile seizures
- Chamomilla for fever with one cheek red and the other pale,
with hypersensitivity and irritability
- Pulsatilla for fever, child is thirstless, clingy and wants to
be held all the time
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Physical Medicine |
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Warming socks. Put cotton socks wet with cold water and wrung out on the
feet. Put wool socks on top of the cotton socks and go to bed. This treatment,
while uncomfortable at first, will help disperse a fever and allow for a good
night's sleep.
Wet sheet wrap. To bring down a fever, wrap the child in a cotton sheet that
is wet with cold water and wrung out. Next wrap the child in another blanket.
Especially in infants, this will disperse a fever and allow a restful
sleep. |
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Acupuncture |
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Acupressure for children may be quite calming and help release the
fever. |
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Massage |
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Gentle massage may relieve discomfort. A foot massage may help to disperse
the fever and relax the child. Some children will not want to be
touched. |
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Patient Monitoring |
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There is no need for patient monitoring once the disease has been correctly
diagnosed and the roseola rash appears. However, children with previous febrile
seizures should be closely monitored. |
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Other
Considerations |
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Prevention |
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Avoiding crowded environments, such as day care centers, and infected
children is the only prevention. There is no vaccine. |
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Complications/Sequelae |
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- Febrile seizures
- Mononucleosis
- Encephalitis (rare)
- Meningitis
- Hepatitis
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Prognosis |
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In the absence of complications, the prognosis is good for children with
roseola. |
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References |
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Behrman RE, Kliegman RM, Nelson WE, Arvin AM, eds. Nelson Textbook of
Pediatrics. 15th ed. Philadelphia, Pa: WB Saunders Co; 1996.
Bove M. An Encyclopedia of Natural Healing for Children and Infants.
Stamford, Conn: Keats Publishing; 1996:174-176.
Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles
of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.
Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms.
Albany, Calif: Hahnemann Clinic Publishing; 1993:3-6, 58-62, 115-117,
310-315. |
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Copyright © 2000 Integrative Medicine
Communications This publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
responsibility for the accuracy of the information or the consequences arising
from the application, use, or misuse of any of the information contained herein,
including any injury and/or damage to any person or property as a matter of
product liability, negligence, or otherwise. No warranty, expressed or implied,
is made in regard to the contents of this material. No claims or endorsements
are made for any drugs or compounds currently marketed or in investigative use.
The reader is advised to check product information (including package inserts)
for changes and new information regarding dosage, precautions, warnings,
interactions, and contraindications before administering any drug, herb, or
supplement discussed herein. |