Roseola

The Infection and the Roseola Rash

Fever

Roseola is usually a mild infection. It occurs most often in children younger than four. It begins with a high fever, which comes on suddenly. Some children will also have a sore throat, runny nose, or other non-specific symptoms that resemble a cold. The fever will last for a few days, then get better.

Rash

After the fever, many (but not all) children develop a skin rash. the rash usually goes away within two days. Chracteristics include:

• The rash covers the entire body.
• It may be faint or more prominent.
• It often looks like small, pink spots, which can be flat or raised.
• It can also be a combination of flat and raised spots which lose color when pressed.
• Spots may have a lighter “halo” around them.
• The rash doesn’t hurt or itch.

In addition to the rash, children may have swollen lymph nodes, also called swollen glands, at the back of the head where it meets the neck.

Some children also have a different kind of rash inside their mouths. Around the fourth day after the fever begins, some children will have small, reddish bumps that appear on the soft palate (the inner part of the “roof of the mouth”) and on the uvula. These will go away on their own.

Seizures

Rapid, high fevers can cause seizures in small children, and about 15% of roseola patients will have one of these seizures. If this happens, it’s important to seek medical attention immediately. A doctor can help bring the fever down and make sure that the seizure did not have a more serious cause.

The Cause

Roseola is caused by a type of herpes virus called Human Herpesvirus 6 (HHV-6). This is not the same type that causes genital herpes or cold sores.

The virus is transmitted in fluids from the nose and mouth. A child can spread the virus by coughing, sneezing, or even just playing near another child. Since small children often put their hands —and everything else!— in their mouths, the virus can spread quickly in daycare centers and other places children spend time together.

It’s possible to spread the virus even before the disease has appeared. That’s probably why this infection is so common: by the time a parent realizes that a child has it, he/she has already given the virus to others.

Who Gets It

Medical tests suggest that, in the United States, nearly everyone is been exposed to HHV-6 at some point. More than three quarters of people have antibodies to the virus by age 2.

Roseola usually appears in children under four. The most common age is between nine and twenty-one months, but younger babies and older children can get it too. It’s rare for a person to have roseola more than once.

In adults, new HHV-6 infection is uncommon. The virus can remain in the body after the initial infection, but in healthy people it almost never causes any problems. Very rarely, it can re-activate, causing an illness with swollen lymph nodes, liver inflammation, and symptoms that resemble mononucleosis. In people with damaged immune systems, such as transplant recipients or cancer patients, HHV-6 reactivation happens more often and can cause a more serious illness.

Treatment

Home Treatment

There is no specific treatment for roseola. Almost all children will get better in about a week without any medicine. As with most childhood illnesses, rest, fluids, and healthy foods are all appropriate ways to help the child feel better.

Over the counter medicines formulated especially for children can bring down the fever. (Never give aspirin to a child; your pediatrician can recommend age-appropriate choices.) In most cases, even children who have had fever-related seizures will not need any extra treatment.

When to Call the Doctor

The fever of roseola can be very high. Many doctors will want parents to call them for fevers over 103 that don’t get better with over-the-counter treatment; ask your doctor for his/her recommendation. According the American Academy of Family Physicians, an oral temperature of 105 degrees or above can be dangerous.

Many doctors will recommend giving age-appropriate, fever-reducing medicine and then going straight to the emergency room. (For babies under three months, any fever at all is reason to call the doctor.)

A very few children do develop more serious cases of roseola. Always seek medical treatment for a child who is:

• Not eating or drinking.
• Appears listless.
• Cries uncontrollably.
• Or otherwise seems to be very ill.

In these cases, the child may need hospital care to prevent serious dehydration or to treat complications.