History

Fact Explanation
Fever Exanthema subitum/ Roseola Infantum is a viral infection caused by human herpes virus type 6 (HHV-6) and type 7 (HHV-7). It is spread from person to person via respiratory fluids or saliva of infected individuals. Typically the patient presents with an acutely onset high degree of fever of 3 – 5 days. [1,2,3,4,5]
Nasal congestion Upper respiratory symptoms such as sore throat, cough, runny nose or congestion are not uncommon. [2,3,4]
Irritability Patient looks very tired, irritable and ill due to the high fever. [1,3,5]
Fits Very rarely the rapid rise of fever predisposes the patient to febrile fits. The patient may lose the consciousness. The care giver may give a history of jerking or twitching movements in the arms, legs or face which lasted for 2 to 3 minutes. [2,3,5]
Rash As the fever subsides, a rash appears. This usually begins on the trunk, spreading to the legs and neck. They are small pink or red raised spots that turn white when touched. Without any treatment, they may fade within a few hours or persist for as long as 2-3 days. [1,2,3]
At risk population Exanthema subitum typically occurs in children between six months and two years of age who present with high fever. [1,3,5]
References
  1. MAGALHãES IDE M, MARTINS RV, VIANNA RO, MOYSéS N, AFONSO LA, OLIVEIRA SA, CAVALCANTI SM. Detection of human herpesvirus 7 infection in young children presenting with exanthema subitum. Mem Inst Oswaldo Cruz [online] 2011 May, 106(3):371-3 [viewed 23 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/21655829
  2. TAIT DR, WARD KN, BROWN DW, MILLER E. Exanthem subitum (roseola infantum) misdiagnosed as measles or rubella [corrected]. BMJ [online] 1996 Jan 13, 312(7023):101-2 [viewed 23 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/8555893
  3. SCOTT LA, STONE MS. Viral exanthems. Dermatol Online J [online] 2003 Aug, 9(3):4 [viewed 23 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/12952751
  4. CAMPADELLI-FIUME G, MIRANDOLA P, MENOTTI L. Human herpesvirus 6: An emerging pathogen. Emerg Infect Dis [online] 1999 May-Jun, 5(3):353-66 [viewed 23 August 2014] Available from: doi:10.3201/eid0503.990306
  5. MCQUITTY EL. Roseola infantum; 13 cases seen in general practice. Br Med J [online] 1955 Apr 23, 1(4920):1005-6 [viewed 23 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/14363773

Examination

Fact Explanation
Fever Patients usually have a high degree of fever. (up to 40 degrees of Celsius) [1,2,3]
Rash A rash appears when the fever resolves. They are small pink or red raised spots. The rash is not itchy. The size of a single spot ranges from 2 to 5 mm in diameter. Initially the rash is visible in the trunk. Late presenters may have the rash in the limbs, neck and face as well. [1,2,3]
References
  1. TAIT DR, WARD KN, BROWN DW, MILLER E. Exanthem subitum (roseola infantum) misdiagnosed as measles or rubella [corrected]. BMJ [online] 1996 Jan 13, 312(7023):101-2 [viewed 23 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/8555893
  2. MAGALHãES IDE M, MARTINS RV, VIANNA RO, MOYSéS N, AFONSO LA, OLIVEIRA SA, CAVALCANTI SM. Detection of human herpesvirus 7 infection in young children presenting with exanthema subitum. Mem Inst Oswaldo Cruz [online] 2011 May, 106(3):371-3 [viewed 23 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/21655829
  3. MCQUITTY EL. Roseola infantum; 13 cases seen in general practice. Br Med J [online] 1955 Apr 23, 1(4920):1005-6 [viewed 23 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/14363773

Differential Diagnoses

Fact Explanation
Meningococcemia Meningococcemia is caused by a bacteria called Neisseria meningitidis. Patients present with fever, headache, irritability, muscle pain, nausea and rash with red or purple spots. [1]
Rubella Rubella, also known as the German measles, is an infection in which there is a rash on the skin. Rubella is caused by a virus that is spread through the air or by close contact. Children generally have few symptoms. Adults may experience a fever, headache, general discomfort (malaise), and a runny nose before the rash appears. [2]
References
  1. LEEUWENBURGH-PRONK WG, SMITH PJ, VAN VUGHT AJ, LANTOS JD, TIBBOEL D, DE HOOG M, BUYSSE C. A baby with meningococcemia and septic shock. Pediatrics [online] 2012 Jul, 130(1):134-8 [viewed 25 August 2014] Available from: doi:10.1542/peds.2011-2635
  2. CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC). Rubella and congenital rubella syndrome control and elimination - global progress, 2000-2012. MMWR Morb Mortal Wkly Rep [online] 2013 Dec 6, 62(48):983-6 [viewed 25 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/24304830

Management - General Measures

Fact Explanation
Antipyretics Paracetamol/acetaminophen or ibuprofen could be given to reduce the temperature. [1,2,3]
Supportive care Rest and maintaining fluid intake are needed for support during the illness. [2,3,4]
Anticonvulsants Anticonvulsants are not recommended in the rare cases of Exanthema subitum which are complicated with fits. [1,4]
References
  1. TAIT DR, WARD KN, BROWN DW, MILLER E. Exanthem subitum (roseola infantum) misdiagnosed as measles or rubella [corrected]. BMJ [online] 1996 Jan 13, 312(7023):101-2 [viewed 23 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/8555893
  2. MCQUITTY EL. Roseola infantum; 13 cases seen in general practice. Br Med J [online] 1955 Apr 23, 1(4920):1005-6 [viewed 23 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/14363773
  3. CAMPADELLI-FIUME G, MIRANDOLA P, MENOTTI L. Human herpesvirus 6: An emerging pathogen. Emerg Infect Dis [online] 1999 May-Jun, 5(3):353-66 [viewed 23 August 2014] Available from: doi:10.3201/eid0503.990306
  4. MAGALHãES IDE M, MARTINS RV, VIANNA RO, MOYSéS N, AFONSO LA, OLIVEIRA SA, CAVALCANTI SM. Detection of human herpesvirus 7 infection in young children presenting with exanthema subitum. Mem Inst Oswaldo Cruz [online] 2011 May, 106(3):371-3 [viewed 23 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/21655829

Management - Specific Treatments

Fact Explanation
Antiviral therapy This is not currently recommended. [1,2,3]
References
  1. TAIT DR, WARD KN, BROWN DW, MILLER E. Exanthem subitum (roseola infantum) misdiagnosed as measles or rubella [corrected]. BMJ [online] 1996 Jan 13, 312(7023):101-2 [viewed 23 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/8555893
  2. CAMPADELLI-FIUME G, MIRANDOLA P, MENOTTI L. Human herpesvirus 6: An emerging pathogen. Emerg Infect Dis [online] 1999 May-Jun, 5(3):353-66 [viewed 23 August 2014] Available from: doi:10.3201/eid0503.990306
  3. MCQUITTY EL. Roseola infantum; 13 cases seen in general practice. Br Med J [online] 1955 Apr 23, 1(4920):1005-6 [viewed 23 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/14363773