Roseala Infantum Flashcards
What is Roseola Infantum?
Roseola Infantum, also known as exanthem subitum or sixth disease, is caused by the human herpes virus 6 (HHV6) and typically affects children aged 6 months to 2 years.
What is the incubation period for Roseola Infantum?
The incubation period for Roseola Infantum is 5-15 days.
What are the primary features of Roseola Infantum?
Features include a high fever lasting a few days followed by a maculopapular rash, Nagayama spots on the uvula and soft palate, and possible febrile convulsions (10-15%).
What other symptoms are common with Roseola Infantum?
Common symptoms include diarrhea and cough.
What are some possible consequences of HHV6 infection other than Roseola Infantum?
Other consequences of HHV6 infection can include aseptic meningitis and hepatitis.
Is school exclusion necessary for a child with Roseola Infantum?
School exclusion is not necessary for a child with Roseola Infantum.
summarise Roseola infantum
Roseola infantum
Roseola infantum (also known as exanthem subitum, occasionally sixth disease) is a common disease of infancy caused by the human herpes virus 6 (HHV6). It has an incubation period of 5-15 days and typically affects children aged 6 months to 2 years.
Features
high fever: lasting a few days, followed later by a
maculopapular rash
Nagayama spots: papular enanthem on the uvula and soft palate
febrile convulsions occur in around 10-15%
diarrhoea and cough are also commonly seen
Other possible consequences of HHV6 infection
aseptic meningitis
hepatitis
School exclusion is not needed.
A 10-month-old infant is brought to accident and emergency with a 3 day history of fever and a new onset rash affecting the arms, legs and abdomen that began today. Despite this fever the child has been his usual self and does not seem to be irritated by the rash.
On closer inspection, the rash appears erythematous with small bumps that are merging together. None of the lesions have scabbed over. The rash is predominantly on the limbs and there are no signs of excoriation. The child is now afebrile at 36.9ºC.
Bearing in mind the likely diagnosis, what is the most likely causative organism?
Epstein Barr virus
Human herpes virus 2
Human herpes virus 6
Neisseria meningitides
Varicella zoster virus
Roseola infantum is caused by human herpes virus 6
Important for meLess important
Roseola infantum is a common viral illness that causes a characteristic 3 day fever and then emergence of a maculopapular rash on the 4th day, following the resolution of the fever. The fever is typically rapid onset and can often predispose to febrile convulsions. The rash typically starts on the trunk and limbs (this is different to chickenpox which is typically a central rash). HHV6 is neurotropic (attacks the nervous system) and thus a rare complication is encephalitis and febrile fits (after cessation of the fever).
Epstein Barr virus causes glandular fever.
Human herpes virus 2 causes genital herpes.
Neisseria meningitides is a common cause of bacterial meningitis which would present with symptoms of meningism (photophobia, stiff neck, headache) +/- non-blanching rash seen with meningococcal septicaemia.
Varicella zoster virus causes chicken pox or shingles and typically produces lesions that scab over. They tend to occur in crops and the child will likely have patches of rash that have scabbed and others that are still vesicular. Additionally, the rash associated with VZV is characteristically itchy and often causes discomfort to the child.
An 18-month-old boy is brought in by his mother who is about a rash that developed after a febrile illness, just as he seemed to be getting better.
On examination, you note wide-spread pink-red papules and macules (2-5 mm in diameter) mostly on the trunk, that blanch when touched. The child does not seem distressed by them and appears otherwise well with normal observations.
What is the most likely diagnosis?
Chickenpox
Hand, foot and mouth disease
Measles
Roseola
Rubella
Roseola infantum
common 6 months - 2 years
fever followed later by rash
febrile seizures common
Roseola (‘sixth disease’) is common in this age group and typically starts with a fever followed by a fine rash which is maculopapular, painless and non-pruritic, and typically affects the trunk most. Lesions usually last around 2 days and do not blister. The child may also have febrile seizures. Roseola is caused by the human herpes virus type 6B or 7. No treatment is required, and long-term complications are rare.
Chickenpox would be very pruritic (itchy) and so the child would very likely be more bothered by the lesions. The rash is also characteristically blistering, rather than maculopapular, with the lesions eventually scabbing over. This does not fit the examination findings in this scenario.
Hand, foot and mouth disease would typically affect the specific areas included in the illness’ name (limbs/extremities and mouth), rather than mostly affecting the trunk as in this case, making it a less likely diagnosis. The rash would be described as flat discoloured spots or bumps that may blister. Hand, foot and mouth disease is usually due to coxsackie A16 or enterovirus 71.
A rash due to the measles virus would typically start from the face and spread down to the torso and limbs. Similarly to roseola, the measles rash appears roughly 3-5 days after symptoms begin and is not itchy. In the case of measles, however, the fever symptoms do not subside and instead accompany the rash, making this diagnosis less likely in this case. A defining characteristic of measles is that the fever disappears when the rash stops spreading. While a roseola rash is usually more pink-red, a measles rash is more red-brown. Small white spots known as Koplik’s spots may form inside the mouth two or three days after the start of symptoms and are commonly mentioned in exam questions.
The rubella virus (German measles or three-day measles) would typically cause a mild febrile illness with a rash that starts from the face and spreads down. The rash appears early in the illness, disappearing after 3 days. Therefore, it is not the most likely diagnosis in this case.
buzz words for roseala infantum
infant
a rash that developed after a febrile illness/fever
OE: wide-spread pink-red papules and macules (2-5 mm in diameter), that blanch when touched.
erythematous with small bumps that are merging together.
trunk, arms, legs (limbs) and abdomen
not irritated by rash (no signs of excoriations), otherwise well with normal observations.
arms, legs and abdomen
None of the lesions have scabbed over.
Fever settling during onset of rash
pink spotted rash on his torso
rash spread to all limbs
high grade fever prior
getting better before the onset of this rash
is now afebrile.
A 4-year-old boy presents to the GP with a pink spotted rash on his torso which has now spread to all limbs. On further questioning his mother states that he has had a high grade fever for 3 days prior, and in fact seemed to be getting better before the onset of this rash. He is now afebrile.
On examination there is a maculopapular red rash over his trunk and limbs. All other examinations are normal. Observations are stable.
What is the likely diagnosis?
Measles
Roseola infantum
Erythema multiforme
Chicken pox
Coxsackievirus A6
Roseola infantum
Roseola infantum typically starts with a high grade fever which resolves before the onset of the rash. The rash typically starts abruptly after the temperature subsides, and usually starts on the trunk before spreading to the limbs. It is a maculopapular rash and it not itchy.
Measles rash occurs alongside other systemic symptoms. It typically starts on the face before spreading to other parts of the body. The characteristic ‘koplik spots’ are classical of this illness.
Chicken pox typically starts as an itchy red papular rash which becomes vesicular in nature. This can occur on any part of the body.
The macules of erythema multiforme are typically larger than other rashes and can progress to plaque-like lesions. It is not caused by a virus but rather is a hypersensitivity reaction in response to herpes 7 virus.
Coxsackie A6 virus is responsible or hand foot and mouth disease which is characterised by sore vesicular lesions on the palms, soles and buccal mucosa.
A 10-month-old boy is brought to surgery. Around 4 days ago he developed a fever after being irritable the previous day. The fever settled after around 3 days but following this he developed a rash, which prompted his mother to bring him to surgery. He is taking around 75% of his normal feeds, is producing wet nappies and has had two episodes of loose stools. On examination he is alert, temperature is 37.0ºC, chest is clear, ears/throat unremarkable. There are a number of blanching, rose pink macules present on his trunk. What is the most likely diagnosis?
Rubella
Chickenpox
Roseola infantum
Pityriasis rosea
Measles
Roseola infantum
Roseola infantum - fever followed later by rash
The correct answer is Roseola infantum. This is because the clinical presentation of the 10-month-old boy aligns with the typical features of Roseola infantum, also known as Exanthem subitum or sixth disease. It is a common childhood illness caused by human herpesvirus 6 (HHV-6) or sometimes human herpesvirus 7 (HHV-7). The disease usually presents with a sudden high fever lasting for around three days, followed by a characteristic rash consisting of rose-pink macules and papules that appear once the fever subsides. The rash typically starts on the trunk and may spread to the limbs and face.
Rubella, also known as German measles, is an incorrect answer. Rubella is caused by the rubella virus and typically presents with a mild fever, lymphadenopathy, and a fine pink maculopapular rash that begins on the face and spreads to the trunk and limbs. However, rubella’s rash usually appears at the same time as fever rather than after it has resolved.
Chickenpox is another incorrect answer. Chickenpox is caused by varicella-zoster virus (VZV) and presents with a pruritic vesicular rash that progresses through different stages (macules, papules, vesicles, pustules, crusts) in crops over several days. Fever may be present but it does not have a distinct pattern like Roseola infantum.
Pityriasis rosea would also be an incorrect diagnosis in this case. Pityriasis rosea is a self-limiting skin condition characterized by herald patch followed by multiple smaller oval scaly plaques distributed along skin cleavage lines in a ‘Christmas tree’ pattern. It usually affects older children and young adults rather than infants and does not typically present with fever.
Finally, Measles is not the correct answer. Measles is caused by the measles virus and presents with a prodromal phase characterized by fever, cough, coryza, conjunctivitis, and Koplik spots (small white spots on the buccal mucosa). This is followed by a maculopapular rash that starts on the face and spreads to the trunk and limbs. The rash in measles usually appears alongside fever, rather than after its resolution.
In summary, based on the clinical presentation of high fever followed by a rose-pink macular rash appearing once the fever has resolved, Roseola infantum is the most likely diagnosis for this 10-month-old boy.
