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Other namesExanthema subitum,[1] roseola infantum,[1] sixth disease,[1] baby measles, rose rash of infants, three-day fever
Roseola on a 21-month-old girl.jpg
Roseola on a 21-month-old girl
SpecialtyInfectious disease
SymptomsFever followed by rash[1]
ComplicationsFebrile seizures[1]
Usual onsetBefore the age of three[1]
DurationFew days[2]
CausesHuman herpesvirus 6 (HHV-6) or human herpesvirus 7 (HHV-7)[1]
Diagnostic methodTypically based on symptoms[1]
Differential diagnosisMeasles, rubella, scarlet fever[1]
TreatmentSupportive care[1]
PrognosisGenerally good[1]

Roseola is an infectious disease caused by certain types of virus.[2] Most infections occur before the age of three.[1] Symptoms vary from absent to the classic presentation of a fever of rapid onset followed by a rash.[1][2] The fever generally lasts for three to five days.[1] The rash is generally pink and lasts for less than three days.[1] Complications may include febrile seizures, with serious complications being rare.[1][2]

It is caused by either human herpesvirus 6 (HHV-6) or human herpesvirus 7 (HHV-7).[1] Spread is usually through the saliva of those who are otherwise healthy.[1][2] However, it may also spread from the mother to baby during pregnancy.[1] Diagnosis is typically based on symptoms but can be confirmed with blood tests.[1] Low numbers of white blood cells may also be present.[1]

Treatment includes sufficient fluids and medications to treat the fever.[1] Nearly all people are infected at some point in time.[2] Males and females are affected equally often.[1] The disease was first described in 1910 while the causal virus was determined in 1988.[1] The disease may reactivate in those with a weakened immune system and may result in significant health problems.[2]

Signs and symptoms[edit]

Roseola typically affects children between six months and two years of age, and begins with a sudden high fever (39–40 °C; 102.2-104 °F). In rare cases, this can cause febrile convulsions (also known as febrile seizures or "fever fits") due to the sudden rise in body temperature, but in many cases the child appears normal. After a few days the fever subsides, and just as the child appears to be recovering, a red rash appears. This usually begins on the trunk (torso) and then spreads to the arms, legs, and neck. The rash is not itchy and may last 1 to 2 days.[3] In contrast, a child suffering from measles would usually appear sicker, with symptoms of conjunctivitis, cold-like symptoms, and a cough, and their rash would affect the face and last for several days. Liver dysfunction can occur in rare cases.

A small percentage of children acquire HHV-6 with few signs or symptoms of the disease. Exanthema subitum occurs in approximately 30% of children during primary HHV-6 infection.[4] Others may show symptoms significant enough that other more serious infections, such as meningitis or measles should be ruled out. In case of febrile seizures, medical advice can be sought for reassurance. However, febrile seizures are not harmful, do not require treatment, and have no long term negative effects unless they last longer than five minutes.

In rare cases, HHV-6 can become active in an adult previously infected during childhood and can show signs of mononucleosis.[5]


Electron micrograph of HHV-6

Roseola is caused by two human herpesviruses, human herpesvirus 6 (HHV-6) and human herpesvirus 7 (HHV-7), which are sometimes referred to collectively as Roseolovirus. There are two variants of HHV-6 (HHV-6a and HHV-6b) and studies in the US, Europe, Dubai and Japan have shown that exanthema subitum is caused by HHV-6b. This form of HHV-6 infects over 90% of infants by age 2.


There is no specific vaccine against or treatment for exanthema subitum, and most children with the disease are not seriously ill.


Most cases of HHV-6 infection get better on their own.[6] If encephalitis occurs ganciclovir or foscarnet may be useful.[7]


John Zahorsky MD wrote extensively on this disease in the early 20th century, his first formal presentation was to the St Louis Pediatric society in 1909 where he described 15 young children with the illness. In a JAMA article published on Oct 18, 1913 he noted that "the name 'Roseola infantilis' had an important place in the medical terminology of writers on skin diseases" but that descriptions of the disease by previous writers tended to confuse it with many other diseases that produce febrile rashes. In this JAMA article Zahorsky reports on 29 more children with Roseola and notes that the only condition that should seriously be considered in the differential diagnosis is German Measles (rubella) but notes that the fever of rubella only lasts a few hours whereas the prodromal fever of Roseola lasts three to five days and disappears with the formation of a morbilliform rash.[8]


Country Local name (language) Translated name
Belgium Driedagenkoorts (Dutch)
Zesde ziekte (Dutch)
Roséole (French)
"three-day fever"
"sixth disease"
China (PRC) 急疹 (Mandarin) jí zhěn (pinyin) "fast rash"
Czech republic Šestá nemoc (Czech) "sixth disease"
Denmark Tredagsfeber (Danish) "three day fever"
Estonia Roseool, kolme päeva palavik Roseola/three day fever
Finland Vauvarokko (Finnish) "baby measles"
France Roséole "Roseola"
Germany Drei-Tage-Fieber (German) "three-day fever"
Greece Αιφνίδιο εξάνθημα (Greek) "sudden rash"
Hungary Háromnapos láz (Hungarian)
Hatodik betegség (Hungarian)
"three-day fever"
"sixth disease"
Iceland Mislingabróðir (Icelandic) "measles' brother"
Israel Tifrachat vrooda תפרחת ורודה (Hebrew) "rose/pink rash"
Italy Sesta malattia (Italian) "sixth disease"
Japan 突発性発疹 (Japanese) toppatsuseihasshin "fast/sudden rash"
Korea (South) 돌발진 (Korean) Dolbaljin "fast/sudden rash"
Malaysia Campak halus (Malay) "small/tiny measles"
Netherlands Zesde ziekte (Dutch) "sixth disease"
Norway Fjerde barnesykdom (Norwegian)[9] "fourth disease"
Philippines Tigdas Hangin (Tagalog) "wind measles"
Poland Gorączka trzydniowa (Polish) "three-day fever"
Romanian Roseola
eruptia subita
Russia Розеола (Russian)
шестая болезнь (Russian)
"sixth disease"
Singapore Jiǎ má 假麻 (Chinese) "false measles"
Slovakia Šiesta (detská) choroba (Slovak) "sixth disease"
Slovenia Šesta bolezen (Slovenian) "sixth disease"
South Africa Roseola (English) "Roseola"
Sweden Tredagarsfeber
Sjätte sjukan (Swedish)
"three-day fever"
Sixth disease
Taiwan Méiguī zhěn 玫瑰疹 (Chinese) "rose rash"
Turkey Altıncı hastalık (Turkish) "sixth disease"
Vietnam Sốt phát ban (Vietnamese) "baby rash"


HHV-6 has been tentatively linked with neurodegenerative disease.[10]

See also[edit]


  1. ^ a b c d e f g h i j k l m n o p q r s t u v w x Stone, RC; Micali, GA; Schwartz, RA (April 2014). "Roseola infantum and its causal human herpesviruses". International Journal of Dermatology. 53 (4): 397–403. doi:10.1111/ijd.12310. PMID 24673253.
  2. ^ a b c d e f g Campadelli-Fiume, Gabriella (1999). "Human Herpesvirus 6: An Emerging Pathogen". Emerging Infectious Diseases. 5 (3): 353–366. doi:10.3201/eid0503.990306. PMC 2640789. PMID 10341172. Archived from the original on 26 September 2017. Retrieved 26 September 2017.
  3. ^ Roseola – Topic Overview Archived 2008-07-27 at the Wayback Machine,
  4. ^ Zerr, D. M.; Meier, A. S.; Selke, S. S.; Frenkel, L. M.; Huang, M. L.; Wald, A.; Rhoads, M. P.; Nguy, L.; Bornemann, R.; Morrow, R. A.; Corey, L. (2005). "A Population-Based Study of Primary Human Herpesvirus 6 Infection". New England Journal of Medicine. 352 (8): 768–776. doi:10.1056/NEJMoa042207. PMID 15728809.
  5. ^ Stoeckle MY (2000). "The spectrum of human herpesvirus 6 infection: from roseola infantum to adult disease". Annu. Rev. Med. 51: 423–30. doi:10.1146/ PMID 10774474.
  6. ^ Tesini, BL; Epstein, LG; Caserta, MT (December 2014). "Clinical impact of primary infection with roseoloviruses". Current Opinion in Virology. 9: 91–6. doi:10.1016/j.coviro.2014.09.013. PMC 4267952. PMID 25462439.
  7. ^ Ongrádi, J; Ablashi, DV; Yoshikawa, T; Stercz, B; Ogata, M (February 2017). "Roseolovirus-associated encephalitis in immunocompetent and immunocompromised individuals". Journal of NeuroVirology. 23 (1): 1–19. doi:10.1007/s13365-016-0473-0. PMC 5329081. PMID 27538995.
  8. ^ John Zahorsky. Roseola Infantum. Journal of the American Medical Association. Oct 18, 1913 pages 1446-1450
  9. ^ Nylander, Gro (2009) "Lille venn, hva nå?"
  10. ^ Hogestyn, JM; Mock, DJ; Mayer-Proschel, M (February 2018). "Contributions of neurotropic human herpesviruses herpes simplex virus 1 and human herpesvirus 6 to neurodegenerative disease pathology". Neural Regeneration Research. 13 (2): 211–221. doi:10.4103/1673-5374.226380. PMC 5879884. PMID 29557362.

External links[edit]

External resources