What is Roseola Infantum (Sixth Disease)? Symptoms, Contagion, and Treatment

Roseola Infantum

Roseola Infantum is a contagious infectious disease that primarily affects infants and young children, characterized by a sudden onset of high fever followed by skin rashes. Symptoms of Roseola Infantum often resolve on their own within 1 week to 10 days. During this period, supportive treatment methods aimed at alleviating the child's symptoms can be utilized. However, it is recommended that children who have a high fever that does not subside despite supportive treatments be taken to a healthcare facility without delay.

What is Roseola Infantum?

Roseola Infantum is a viral infectious disease characterized by high fever and skin rash, caused by HHV-6, which belongs to the herpes virus family, and rarely by HHV-7. Also known in medical literature by different names such as roseola infantum or exanthema subitum, roseola infantum is generally seen in infants and young children between the ages of 6 months and 2 years. According to research, approximately 90% of roseola cases occur in infants under 2 years of age. However, in some cases, adults who did not contract the disease during childhood may also become infected with roseola.

Roseola infantum is the most common exanthematous viral infectious disease after measles, scarlet fever, rubella, Dukes' disease, and fifth disease (slapped cheek syndrome). Although the incubation period of roseola infantum varies from person to person, it manifests itself with a sudden onset of high fever on average 9-10 days after infection. Roseola infantum can be transmitted through droplets spread into the air when an infected person coughs, sneezes, or speaks.

What Are the Symptoms of Roseola Infantum?

The symptoms of roseola infantum may not be the same in everyone. While some children experience a sudden onset of high fever, others may develop skin rashes without a high fever. After infection, a fever reaching 39.5-40 °C can be seen in children within 9-10 days. The high fever usually subsides after 3-5 days. Roseola infantum is generally contagious during the period when the fever is present. Therefore, although it varies from person to person, the contagion period of roseola infantum can range between 3-5 days.

Red, raised skin lesions may appear within approximately 24 hours after the fever subsides. Some children may experience other symptoms before the roseola infantum rash even appears. Accordingly, the main symptoms of roseola infantum are as follows:

Digestive system problems such as vomiting and diarrhea

Loss of appetite

Cough

Sore throat

Runny nose

Swollen lymph nodes

Redness in the eyes

In addition to those listed, roseola infantum can also cause swelling in and around the eyelids. A characteristic feature of roseola infantum is the skin rash that appears after the fever subsides. However, unlike some exanthematous viral diseases, roseola infantum is not an infectious disease characterized by itching.

What Causes Roseola Infantum?

The primary cause of roseola infantum is the entry of human herpesvirus 6 (HHV-6), which is in the beta herpesvirus group of the herpesviridae family, and rarely human herpesvirus 7, into the human body via droplets. HHV-6, which is divided into two classes as HHV-6A and 6B, is a double-stranded DNA virus. HHV-6 uses a protein called CD46 found on the cell surface to enter the cell. With the help of the CD46 protein, after the virus attaches to the cell membrane, the part carrying the virus's genetic material is transported into the cell. As a result, the virus begins to multiply inside the cell.

Because their immune systems are not yet fully developed, roseola infantum is more common in infants and children. Thanks to antibodies passed from the mother, infants, especially newborns, may be more protected against roseola infantum. However, as the immunity passed from the mother decreases over time, infants may become susceptible to infection in the later period.

The risk of roseola infantum may be higher in children and infants who attend daycare, live in crowded homes, or have a weakened immune system for any reason. Additionally, roseola infantum can cause serious complications in adults who have undergone organ transplants or have chronic health problems.

How Is Roseola Infantum Diagnosed?

The diagnosis of roseola infantum can often be made based solely on the child's symptoms and physical examination. The sudden subsidence of a high fever that has lasted for several days, followed by pink-red, non-itchy skin rashes that start on the trunk and then spread to the rest of the body, usually lasting 1–2 days, can lead experts to suspect roseola infantum. Roseola infantum can usually be diagnosed without the need for laboratory tests.

However, especially in cases where the rash has not yet appeared or the high fever cannot be brought under control, experts may utilize additional tests to rule out other infectious diseases. Although there is no specific blood value for roseola infantum, some tests can help detect antibodies. Furthermore, according to various studies, roseola infantum multiplies in leukocytes and salivary glands. Therefore, a low or high count of leukocytes, i.e., white blood cells, in blood tests can be an indicator of roseola infantum.

How Is Roseola Infantum Treated?

Currently, there is no known effective method for the treatment of roseola infantum. Since the causative agent of the disease is viruses known as HHV-6 and rarely HHV-7, antibiotics developed against bacterial infections are not effective in the treatment of roseola infantum. Since the most common symptom of roseola infantum is a sudden onset of high fever, experts may prescribe some medications with antipyretic properties to bring the fever under control. Also, parents may avoid giving the child a shower, thinking that the symptoms might worsen. Roseola infantum is not a contraindication for bathing. On the contrary, giving the child a lukewarm shower can help the child feel more comfortable.

The disease usually heals on its own within 1 week to 10 days. During this process, it is important for children to consume plenty of fluids to ensure their comfort and prevent fluid loss. Additionally, ensuring that children get enough rest makes it easier for their immune systems to fight the virus. High fever can cause seizures in some children. While these seizures are mostly harmless, it is important to consult a specialist doctor if they occur.

Frequently Asked Questions

Because their immune systems are not yet fully developed, roseola infantum is usually seen in infants between 6 months and 2 years of age. According to research, approximately 90% of cases occur in infants under 2 years of age. Roseola infantum can easily be transmitted from an infected person to healthy individuals through droplets, especially during the phase when high fever is present. However, the disease is not contagious during the period when the fever has passed and the skin rash has begun. Roseola infantum is generally a short-term viral infectious disease. In the first phase of the disease, the sudden onset of high fever usually subsides after 3 to 5 days. Approximately 12-24 hours after the fever subsides, the skin rash phase, which lasts about 2 to 4 days, begins. In other words, the infection usually heals on its own within an average of 1 week to 10 days. The first symptom of the disease, a high fever that starts suddenly 9-10 days after infection and can reach 39.5-40 °C, usually continues for 3-5 days. Roseola infantum appears as pink and red-colored spots, as in diseases like eczema. However, unlike many skin infections, the rash is not itchy and fades when pressed. Also, one of the characteristic features of the roseola infantum rash is that it spreads to the rest of the body after starting on the trunk. It is quite rare for it to recur after having the disease once. However, HHV-6, the causative agent of the disease, can remain dormant by attaching to some immune cells. When the immune system is weakened for any reason, the virus can reactivate and cause infection. Roseola infantum is an infectious disease known for generally having a mild course. Although seizures due to high fever are rarely seen, these seizures usually do not leave any trace in healthy children. However, in cases such as the child fainting, losing control, or vomiting, it is important to apply to the nearest healthcare facility without delay. For roseola infantum, pediatricians (child health and diseases specialists) are usually consulted. Pediatricians may refer to different departments such as infectious diseases when necessary. In the case of roseola infantum, it is primarily important to bring the high fever under control. If the fever rises above 38°C, experts may prescribe antipyretic medications. Also, during this process, the baby should be given water or milk if breastfeeding at frequent intervals to prevent the risk of dehydration. Since there is a risk of seizures during the febrile period, the child should be monitored carefully. If the child has symptoms such as lethargy, vomiting, severe diarrhea, or respiratory distress, a doctor must be consulted. Additionally, it is important that the child is not sent to crowded environments such as daycare during the period when the child has a fever and until 24 hours have passed after the fever has subsided. Roseola infantum can often heal on its own in a short time with simple methods applied at home. During this process, it is important to ensure that the child eats a balanced and healthy diet, takes plenty of fluids, and rests.

Roseola infantum is the most common, yet generally mild, disease after exanthematous viral infections such as measles, scarlet fever, rubella, Dukes' disease, and fifth disease. High fever can lead to seizures in some children; therefore, it is important to monitor the child carefully and, if necessary, consult the expert Child Health and Diseases specialists at Hisar Hospital.