Now let's talk about roseola. Roseola is a contagious viral illness.
The hallmarks are a high fever followed by a rash. It's also called roseola infantum or sixth disease.
Most children are infected by the time they enter kindergarten
and it's self-resolving and we manage this with supportive care.
So roseola is caused by two herpes viruses, 6th and 7th.
It's transmitted via droplets and these are going to enter the mouth and nose
after an infected person coughs, sneezes, talks, or laughs.
The incubation period is 5-15 days.
Now the patient is only going to be contagious while their fever is present.
It rarely results in community outbreaks and this can occur any time of the year.
Roseola is most commonly seen between 6-15 months of age
when the maternal antibody protection from viruses wanes and the child
has yet to develop their own antibodies to many viruses.
The signs and symptoms start with an acute onset of a very high-grade fever.
This is at least 40 degrees or 104 degrees for 3-5 days. Next, the fever resolves.
Then the child will develop a non-pruritic -- so non-itchy, pink, macular to maculopopular rash
that begins on their trunk and can spread to the neck and arms.
Be sure to examine the skin thoroughly.
Now, roseola is a little bit tricky for clinicians because parents
will usually bring their kid to the clinic when they have the high fever
but they won't have any other symptoms.
So the clinicians really gonna try to find a cause, right?
We don't like calling something a fever of unknown origin.
So remember, when you have a fever, sometimes the eardrums, the tympanic membranes look red
so the clinician may think the child has an ear infection that's causing their fever.
So they'll start them on antibiotics and send them home.
When the child really has roseola, so then the fever breaks
and the parents think that antibiotics is working and then their child develops a rash.
They'll bring them back to the clinic and the ears look better
because they never had an ear infection to begin with but the fever's gone.
So the clinician also thinks the antibiotic worked but now the child is covered in a rash
and the rash that develops with roseola looks like the rash that develops
with an amoxicillin allergy called a morbilliform rash.
So then they'll add amoxicillin to the child's allergy list when really this was just roseola to begin with.
Now, you can see the problems that this has caused
and so it's really important for the clinician to do watchful waiting and close follow up.
What are some other signs and symptoms?
Well, about 15% of children will develop an acute febrile seizure
and this depends on the threshold of the brain to withstand excess electrical activity.
In infants and children, high fevers can lower this threshold resulting in febrile seizures.
Rarely, children will have other symptoms including a cough, swollen lymph nodes,
a sore throat, runny nose, irritability, mild diarrhea, and decreased appetite.
And these are pretty common signs and symptoms that we see with viral illness.
So what do we do on exam?
You're gonna collect a full medical history
and you're going to check the child's immunization status
because you want to exclude other causes of their fever and rash.
Next, you do a physical exam and this involves looking at the vital signs.
Now, when the child comes to the clinic, they may or may not have their fever
so you're always asking the parent, before this rash developed,
if they're coming in with the rash, did they have a high fever in the days preceding?
Next, you'll do a head, eyes, ears, nose, throat exam
and progress down the body to the cardiac, respiratory, and then a full skin exam.
So how do we diagnose roseola? Well, this is a clinical diagnosis.
It's based on the history and physical exam.
And remember, the classic presentation is a really high fever, then the fever breaks,
and then the rash on the trunk will develop.
There's no lab work or testing needed except if you're trying to rule out
other differentials such as strep throat.
So how do we manage roseola? Well, the good thing is this is a self-limiting viral infection.
It will go away on its own and it usually does not require medical evaluation.
Remember, this is viral so antibiotics are not effective.
The child can have acetaminophen to lower their fever as needed
and if they're older than 6 months, they can also use ibuprofen.
You want to push fluids in these children to avoid dehydration
because remember, they have a high fever.
The rash doesn't typically cause itching or pain and remember, no aspirin
should be given to the pediatric population because this can cause Reye syndrome.
It's a rare but serious condition that's gonna cause swelling in the liver and brain.
And remember, roseola is considered contagious until they're fever-free for 24 hours
so by the time they get their rash, they're not usually contagious
and they can go back to daycare and community activities.
Fortunately, complications of roseola are rare and most cases are mild,
and patients recover quickly and completely.
A child can have a febrile seizure and this is due to the rapid rise in body temperature.
During these seizures, the child may lose bowel or bladder control
and have their jerking of their arms, legs, and head for several seconds to minutes.
And this is truly is frightening for parents.
The good news about febrile seizures is they are rarely harmful
and they are not linked with epilepsy.
So in an immunocompromised patient, they can have complications from roseola
and these include the development of pneumonia or encephalitis.