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Roseola is a topic covered in the 5-Minute Clinical Consult.

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Omnipresent infection occurring in infancy and childhood. Majority of cases are caused by human herpesvirus 6 (HHV-6); may be associated with other diseases including encephalitis


  • Acute infection of infants or very young children (1)
  • Causes a high fever followed by a skin eruption as the fever resolves (1)
  • Transmission via contact with salivary secretions or respiratory droplet (1)
  • Incubation period of 9 to 10 days (1)
  • System(s) affected: skin/exocrine, metabolic, gastrointestinal, respiratory, neurologic
  • Synonym(s): roseola infantum, exanthem subitum; pseudorubella; sixth disease; 3-day fever (1)

Pediatric Considerations
A disease of infants and very young children (2)


  • Predominant age
    • HHV-6
      • Infants and very young children (<2 years old) (3)
      • Peak age infection 6 to 9 months, rarely congenital or perinatal infection (1)
      • 95% of children have been infected with HHV-6 by 2 years of life.
    • HHV-7
      • Later childhood
      • Mean age of infection 26 months
      • >90% population with HHV-7 by 10 years (1)
  • Predominant sex: male = female (1)
  • No seasonal variance

Common—accounts for 20% ED visits for febrile illness among children 6 to 8 months (4)

  • Peak prevalence is between 9 and 21 months (3).
  • Nearly 100% population carrying HHV-6 by 3 years (1)
  • Approximately 20% patients with primary HHV-6 have roseola (4).

Etiology and Pathophysiology

  • HHV-6 and HHV-7 (2)
  • Majority of cases (60–74%) due to HHV-6
    • HHV-6B > HHV-6A (2)
    • HHV-6A seen in children in Africa
    • HHV-6 binds to CD46 receptors on all nucleated cells (2).
  • Primary infection typically through respiratory droplets or saliva
  • Congenital infection/vertical transmission occurs in 1% of cases (1).
    • Transplacental transmission
    • Chromosomal integration (clinical significance unknown)
  • Lifelong latent or persistent asymptomatic infection occurs after primary infection (1).
    • 80–90% of population intermittently sheds HHV-6/HHV-7 in saliva (2).
    • Patients are viremic from 2 days prior to fever until defervescence and onset of rash.
    • HHV-6 latency is also implicated in CSF (4).

HHV-6 is integrated into the chromosomes of 0.2–3.0% of the population. This leads to vertical transmission of the virus. Clinical significance of this is unknown (1).

Risk Factors

  • Female gender (3)
  • Having older siblings (3)
  • At-risk adults: immunocompromised (5)
    • Renal, liver, other solid organ, and bone marrow transplant (BMT) (3)
    • HHV-6 reactivation can occur in 1st week posttransplant (5). HHV-6 viremia occurs in 30–45% of BMT within the first several weeks after transplantation (4).
      • Usually asymptomatic (4)
      • Up to 82% of HHV-6 reactivation/reinfection in solid organ transplant (5)
  • Nonrisk factors (3)
    • Child care attendance
    • Method of delivery
    • Breastfeeding (HHV does not appear to pass through breast milk)
    • Maternal age
    • Season

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Stephens, Mark B., et al., editors. "Roseola." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116535/all/Roseola.
Roseola. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116535/all/Roseola. Accessed April 26, 2019.
Roseola. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116535/all/Roseola
Roseola [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 26]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116535/all/Roseola.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Roseola ID - 116535 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116535/all/Roseola PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -