Conditions with Similar Symptoms
View Conditions
  Drug Monographs
Acetaminophen
Diazepam
Phenobarbital
  Herb Monographs
Chamomile, German
Garlic
Ginger
Peppermint
Yarrow
  Supplement Monographs
Vitamin C (Ascorbic Acid)
Zinc
  Learn More About
Acupuncture
Homeopathy
Massage Therapy
Nutrition
Western Herbalism
Look Up > Conditions > Roseola
Roseola
Overview
Definition
Etiology
Risk Factors
Signs and Symptoms
Differential Diagnosis
Diagnosis
Physical Examination
Laboratory Tests
Pathology/Pathophysiology
Other Diagnostic Procedures
Treatment Options
Treatment Strategy
Drug Therapies
Complementary and Alternative Therapies
Patient Monitoring
Other Considerations
Prevention
Complications/Sequelae
Prognosis
References

Overview
Definition

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.

Etiology

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.


Risk Factors
  • 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.

Signs and Symptoms
  • 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.

Differential Diagnosis
  • Bacterial pneumonia
  • Measles
  • Rubella
  • Drug reactions
  • Entero- or adenoviral diseases
  • Sepsis
  • Urinary tract infection
  • Meningitis
  • Fifth disease
  • Otitis media

Diagnosis
Physical Examination

Patient may be either listless or normally active with high fever. Nonpruritic, rose-colored lesions usually appear as fever resolves.


Laboratory Tests
  • 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

Pathology/Pathophysiology
  • 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

Other Diagnostic Procedures

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.


Treatment Options
Treatment Strategy

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.


Drug Therapies
  • 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.

Complementary and Alternative Therapies

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.


Nutrition

Immune stimulating: vitamin C (1,000 mg tid), zinc (30 to 60 mg/day) and beta-carotene (250,000 IU/day).


Herbs

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.


Homeopathy

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

Physical Medicine

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.


Acupuncture

Acupressure for children may be quite calming and help release the fever.


Massage

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.


Patient Monitoring

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.


Other Considerations
Prevention

Avoiding crowded environments, such as day care centers, and infected children is the only prevention. There is no vaccine.


Complications/Sequelae
  • Febrile seizures
  • Mononucleosis
  • Encephalitis (rare)
  • Meningitis
  • Hepatitis

Prognosis

In the absence of complications, the prognosis is good for children with roseola.


References

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.


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.