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Key Features

Essentials of Diagnosis

  • High fever in a child aged 6–36 months

  • Minimal toxicity

  • Rose-pink maculopapular rash appears when fever subsides

General Considerations

  • Caused by HHV-6 or HHV-7

  • Occurs predominantly in children aged 6 months to 3 years, with 90% of cases occurring before the second year

  • HHV-7 infection tends to occur somewhat later in childhood

Clinical Findings

Symptoms and Signs

  • Fever

    • Abrupt onset, often reaching > 39.5°C

    • Lasts up to 8 days (mean, 4 days) in an otherwise mildly ill child

    • Ceases abruptly, and a characteristic rash may appear

  • Rash

    • Incidence is 20–30%

    • Begins on the trunk and spreads to the face, neck, and extremities

    • May occur without fever

    • Characteristics

      • Rose-pink macules or maculopapules, 2–3 mm in diameter

      • Nonpruritic

      • Tend to coalesce and disappear in 1–2 days without pigmentation or desquamation

  • Pharynx, tonsils, and tympanic membranes may be injected

  • Conjunctivitis and pharyngeal exudate are notably absent

  • Diarrhea and vomiting occur in one-third of patients

  • Adenopathy of the head and neck often occurs

  • The anterior fontanelle is bulging in one-quarter of HHV-6–infected infants

Differential Diagnosis

  • Measles

  • Rubella

  • Adenoviruses

  • Enteroviruses

  • Drug reactions

  • Scarlet fever

  • Bacterial meningitis


  • Leukopenia and lymphocytopenia are present early

  • Hepatitis occurs in some patients


  • Acetaminophen and sponge baths used for fever control, especially in children with history of febrile seizures

  • Antiviral agents are used for systemic infection in immunocompromised children



  • Febrile seizures occur in up to 10% of patients (even higher percentages in those with HHV-7 infections)

  • Meningoencephalitis caused by HHV-6 directly infecting the central nervous system

  • Multiorgan disease may occur in immunocompromised patients

    • Pneumonia

    • Hepatitis

    • Bone marrow suppression

    • Encephalitis


Stone  RC  et al: Roseaola infantum and its causal human herpesviruses. Int J Dermatol 2014 Apr;53(4):397–403
[PubMed: 24673253] .

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