Human herpesvirus 6 (HHV-6) is the most common cause of a febrile illness called roseola or exanthem subitum. This illness typically occurs in young children ages six months to three years. High fever, skin rash, and mild cold-like symptoms characterize roseola, which is also known as sixth disease. Seizures related to high fever can occur.
Fever
Sudden onset of high fever is the presenting symptom of roseola. The fever is typically 103 degrees F to 106 degrees F. It characteristically lasts three to five days, though it may occasionally persist longer.
Rash
Within 48 hours of the fever breaking, a rash usually erupts. Small red spots roughly as big around as an apple seed--but not raised--first appear on the trunk and spread to the neck, arms and legs. The face is usually spared. The rash does not itch and usually clears within three to four days.
Runny or Stuffy Nose and Sore Throat
Children with roseola often have a runny or stuffy nose and a scratchy throat, much like they have with a common cold. These symptoms typically resolve when the fever breaks.
Earache
Roseola may cause an earache due to inflammation in the middle ear. Comfort measures are appropriate, but antibiotics are not needed since the cause is viral not bacterial.
Eye Redness
Roseola commonly causes redness of the eyes, which may be accompanied by swelling. These symptoms typically clear when the fever breaks.
Decreased Appetite and Mild Diarrhea
Decreased appetite is a common symptom of roseola. Infants may refuse to feed. Mild diarrhea may also accompany HHV-6 infection. Because the high fever of roseola can cause dehydration, it is important to be sure your child is taking in sufficient fluids.
Fatigue and Irritability
Children with roseola are typically irritable and lack their usual level of energy. These symptoms characteristically resolve quickly once the fever breaks.
Seizures
The high fever of HHV-6 infection may cause seizures. With a febrile seizure, the child has repetitive jerking movements usually involving both the arms and legs. It typically lasts less than two minutes. The child usually loses consciousness during the seizure. If your child has a seizure, gently intervene as needed to keep him from injuring himself or falling. It is not necessary to try to hold down the limbs; this will not stop the seizure and may cause accidental injury. Place the child on her stomach or side to prevent choking, but do not place anything in her mouth. Her tongue will not cause her choke, despite what you may have seen on television. A seizure that persists for 10 minutes or more is a medical emergency; call 911.
