Friday, April 11, 2014


Roseola is a very common childhood illness.
Other rarely used names for it are exanthema subitum (which means sudden rash), roseola infantum, or sixth disease.

There are a few different strains of the Herpes virus that  can cause it, so some kids may seem to get it more than once.
It is most common among children between the ages of 6 months and 3 years.

Patients present with a very high fever, but here is the big clue...they are acting fairly normal.
I have had many phone calls when the parents call to report that their child has a temperature that is over 104, and yet I can hear the child chattering or even singing happily away in the back ground.

Keep in mind that anytime I have a child with a very high fever who is also very fussy, I am likely going to suggest that they get seen. Fussy kids might be telling us something. I would want to rule out an ear infection or a urinary tract infection. I would want to check their throats and listen to their lungs.
Roseola kids, on the other hand are typically not terribly fussy at all. The fever can hang on for about three days and then the fever is gone and here comes there rash.
This is a very rosy red rash that started all over the trunk and spreads.
It will lighten when you press on it.
Once the rash comes along many of my patients also may become somewhat fussy for the next several days. In general they seem to be a bit more miserable in the rash phase of the illness than they were with the fever.
Roseola is one of the reasons that I have my "3 day fever rule".
If I have a reasonably happy patient who is eating and drinking I am fine waiting to see if we are dealing with this very common illness.
At day 3, the fever is usually gone and the rash has declared itself.

Any fever that is lingering longer than 3 days needs to be checked.
With Measles back on the horizon, we need to be a little more wary of the fever/ rash combination illnesses.
With Measles, the fever and rash may at the same time. 
The child will look sick.
To Review: 
Classic Roseola clues include
*child does not look or seem very sick even though they have a high fever
*the rash comes out AFTER the fever is gone

As with many viral syndromes the only treatment is symptomatic.
Keep your child hydrated and keep the fever down with baths, Tylenol or Advil.

Because about 10% of children can have a seizure (usually harmless but super scary) with very high fevers, I suggest treating a fever if it is higher than 101.5

Roseola is contagious.
The exposure period is about 9-15 days.
This means that  they usually won't get sick until a week or two after they were around patient X. 
Kids can spread the virus starting about a day or two before you know they are ill.
They are usually no longer contagious once the fever is gone.
Many schools want kids home for at least 24 hours after a fever is gone. This is not unreasonable.
Consider this one just another "right of passage" 

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