Sixth Disease (Roseola Infantum) Symptoms, Cure, Complications

  • Roseola is a viral disease that most often affects children up to 3-4 years of age.
  • Common symptoms of infection are fever, lack of appetite, malaise, and characteristic rashes that appear at later stages.
  • Primary treatments of the sixth disease are meant to relieve symptoms, reduce the fever and rehydrate the patient.

What is Roseola or Sixth Disease?

Roseola infection is quick and sudden. The patient usually gets a high temperature without any cough or runny nose. Body temperature can quickly jump to 40 degrees Celsius.

In the first few days (generally up to 3), parents may not be able to determine the actual cause of the fever. Therefore, it is quite possible that most parents may confuse it with a common cold. However, rashes appear after 2-4 days_ a characteristic symptom of the sixth disease.

Roseola generally affects children from the ages of 2-4 and has nothing to do with environmental changes and seasons.

The disease disappears as unexpectedly as it appears. During the course of the infection, the child develops permanent immunity against the HHV-6 virus. However, another similar episode can be expected from the HHV-7 virus.

Roseola (Sixth Disease) – Causes

The causative agent of the disease is the herpes virus HHV-6 and HHV-7. The vast majority of virus infections occur from 3 months to 3 years of age. Older children can also get sick, but this is too rare.

The infection is contagious and the basic source is usually another infected child. Because the infection is often asymptomatic, sometimes there are small local epidemics in nurseries and kindergartens. All because before the first symptoms appear, the patient continues to infect other people around.

The Sixth Disease – Symptoms

The disease, although harmless, usually begins quite suddenly and dramatically. Parents may get nervous as the temperature can rapidly reach 40 degrees celsius. Some babies may even develop febrile seizures. The increased temperature usually lasts for about three days.

In addition to fever, the symptoms of the infection include:

  • Redness of the throat.
  • Slight enlargement of the lymph nodes.
  • Lack of appetite.
  • Diarrhea.
  • Febrile seizures.
  • Lumps on the soft palate called Nagayama lumps.

These symptoms, however, don’t appear in each and every case. In the febrile stage, for instance, the disease may resemble a bacterial infection, such as inflammation of the ear, meninges, or lungs, but children are usually in good general health condition.

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Roseola (Sixth Disease)- The rash

After about three days of high fever, a rash begins to develop on the child’s body. Red spots generally appear on or around ​​the belly, buttocks, and thighs. These rashes can then appear on the neck and hands (less often on the face).

The rash appears as small red spots and erythema. This condition lasts for about two days and then disappears spontaneously, leaving no trace or scar. There is no need for any treatments including moisturizers or lubricants for the rashes.

Can the patient leave home during the Illness?

During the course of the illness, it is always better to keep the baby at home. This important because of two major reasons_becuase the child’s immunity is weakened fighting the virus, he/she may easily contract other diseases from the surrounding. Secondly, if there are other toddlers in the vicinity, they may contract the virus as well.

The appearance of the rash, however, heralds the end of the disease. The child is no longer contagious and the fever no longer comes back. At this point, it safe to take the toddler for a walk.

Roseola Seizures/Convulsions, What to Do?

During the three-day period, it is possible that febrile seizures may occur in the patient. For children who are predisposed to these symptoms, seizures may occur when the temperature starts to rise sharply. Therefore, it is important not to let the temperature cross 38 degrees Celsius.

If, however, seizures do occur, you as a parent should place the child in a position that prevents the child from choking. Remove the baby’s overcoat and wait for the convulsions to pass. Usually, in these situations, we do not have rectal anticonvulsant medications prepared for the child that could be used if the seizures are prolonged.

Remember that the most important thing is to remain calm. However, if the seizures do not go away within 5 minutes, call an ambulance.

Sixth Disease – When to See a Doctor?

There are factors that can unequivocally point to Roseola:

  • Sudden high fever.
  • When the temperature is lowered, the child is joyful and shows no health-related issues.
  • The child has no characteristic symptoms of a cold. This includes a cough and a runny nose.
  • The patient is not yet four years old.
  • The toddler has never had a similar condition before.

Make sure you see a doctor if:

  • The child has had a fever for more than three days.
  • Temperature does not drop despite the administration of antipyretic drugs in appropriate doses.
  • Febrile seizures last for more than 5 minutes.
  • The rash lasts more than five days
  • The toddler’s health continues to deteriorate.

Sixth Disease – Diagnosis

A health professional will make the diagnosis after looking into the symptoms and basic laboratory test results i.e. ESR, and CRP. The timing of the tests is crucial for the correct diagnosis – They should be carried out on the third day of the fever.

Possible but Rare Complications

Any complications resulting from Roseola are extremely rare. However, however rare they may be, the following complications can be expected:

  • The high temperature is often accompanied by febrile convulsions, which consequently can cause tremors in the limbs. This can sometimes also result in loss of consciousness.
  • Less frequently though, meningitis and encephalitis may also occur.

Prevention is Better Than Cure!

Though there is not too much to prevent the infection, avoiding children with fever is the best you can do. Unfortunately, this does not guarantee your toddler will not get one., because as we mentioned earlier, a baby infected with the virus initially does not show the symptoms but can still transfer the virus.

Another thing to take care of is, to wash your hands thoroughly before you interact with your baby. This is because you may not contract the disease itself as you have developed permanent immunity to it when you yourself were a baby, but you can still carry and transfer the virus to other toddlers.

What is the Disease Frequency?

Contracting the sixth disease is very common.  Although Roseola may occur without fever or typical clinical symptoms, it usually does not occur in the first two months of birth (maternal immunity), as well as after the age of 3.

Possible Treatments

Treatment of a three-day fever is only symptomatic. There is no vaccine to cure the disease instantly. However, antipyretics are administered to keep the temperature low, and if necessary, anticonvulsants are also used.

With a professional’s advice, you can also use anti-inflammatory drugs or local painkillers for the throat. As in any disease with high fever, it is necessary to hydrate intensively hydrate the patient.

How to Controle The Rising Temperature?

You can implement the following common methods to keep the temperature under range:

  • Apply cold compresses to the neck and forehead.
  • With a doctor’s advice, you may give paracetamol to your child orally or rectally(according to the WHO, an effective single dose of oral paracetamol for a child is 10-15 mg/kg per dose, up to four times a day) or ibuprofen only (at a dose of 10 mg/kg body weight).
  • It is worth remembering that paracetamol is also available in the form of oral suspensions, with increased concentration (Forte), which means that the volume of the dose given to the child can be reduced. This is particularly important as children usually have trouble swallowing and therefore taking the correct dose.
  • Make sure your child takes plenty of fluids to avoid dehydration. Raspberry tea, elderberry, or linden tea have proven to be great hydrating drinks.
  • If you have to give your child a bath, keep the temperature of the water at least 2 degrees lower than his/her body temperature.

Roseola and People with Weak Immunity

The sixth disease is more of a concern for people with a weakened immune system.  Children who have recently received a bone marrow transplant are especially susceptible to the infection.

As we mentioned earlier, Roseola patients develop permanent immunity towards the virus, a weakened immune system may still pose the risk of a second infection.

Immunocompromised people have more severe cases of infection and have a harder time fighting the disease.

Be aware that people with a weak immune system who get the sixth disease experience potentially serious complications, such as pneumonia or encephalitis.


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