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Roseola Infantum in Emergency Medicine


Roseola infantum is the sixth of the traditional exanthems of childhood. The condition is an acute benign disease of childhood classically characterized by a history of a prodromal febrile illness lasting approximately 3 days, followed by defervescence and the appearance of a faint pink maculopapular rash.

Since identification of the etiologic agent human herpesvirus type 6 (HHV-6), infection has been documented without the characteristic fever or rash. The virus may present as an acute 3-7 day febrile illness (characteristically >39.5 º C) associated with respiratory or gastrointestinal symptomatology. In one prospective cohort, 93% of newly acquired infections were symptomatic, with fever, fussiness, diarrhea, and rash as the most distinguishing features.

Newly recognized clinical manifestations of HHV-6 infection include hepatitis, encephalitis, myocarditis, hemophagocytic syndrome, and an adult mononucleosislike illness. The virus persists and may reactivate, primarily in immunocompromised hosts. Reactivation manifestations may present as fever, rash, pneumonia, hepatitis, bone marrow suppression, and encephalitis.
The full spectrum of clinical manifestations of HHV-6 has not been elucidated.

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