CBL 9-Fever with rash

What are the key components to the history that are concerning?

− Age, 12 months

− Fever, 40.3oC

− He attended daycare regularly, susceptible to infectious disease

− History of vaccination, reaction to vaccination. However, He had no history of vaccine reactions

− Rash appear after stopped of the fever , suggest of Roseola infuntum

− No convulsions, exclude febrile convulsions which is common with RI

2. Are there any key components to the examination that are concerning?

− Moderate general condition male

− Afebrile with normal vital signs

− There was no conjunctival or pharyngeal injection, occurring with measles

− He had shoddy anterior cervical lymph nodes and groin nodes with all < 1.0 cm, significant
enlargement occurring with germen measles

− Skin showed an erythematous macular-papular rough rash on the body, groin, and axilla. It was
blanching and non-pruritic, suggestive of Roseola infuntum

− He had no mucositis or joint swelling or pain, no enanthema

− The rest of his examination was normal.

3. What is the diagnosis? Explain

− The diagnosis of a viral exanthem most likely roseola infantum (exanthem subitum) sixth disease.

− It is an acute infectious exanthematous disease of infancy; his age 12 months and he attended daycare
regularly .

− It is a mild viral disease characterized by high grade fever (40.3oC) followed by maculopapular rash
appearing after drop of the fever.

− The rash on the body, groin, and axilla.

− It was blanching and non-pruritic.

− The patient’s clinical course showed that he had resolution of the rash and other symptoms over the
next 1.5 days. Long-term he had no similar reactions with subsequent vaccines.

4. Why it is named exanthem subitum and sixth disease.

− Exanthem subitum means a sudden rash

− Roseola is also called sixth disease because the HHV type 6 most often causes the illness.

− Less frequently, it can also be due to HHV type 7

5. What is the incubation period ? what is the age of susceptibility to RI?

− Incubation period, 1-2 weeks (10 days)

− Transplacentally acquired antibody protects most infants until 6 months of age.

− The incidence of infection increases as maternally derived antibody levels decline.

− By 12 months of age, approximately 60-90% of children have antibodies to HHV-6

− Essentially all children are seropositive by 2-3 years of age.

6. Do this infant need laboratory workup?

− Routine laboratory findings are nonspecific and do not aid in diagnosis.

− Encephalitis with roseola is characterized by pleocytosis (30-200 cells/mm3) with mononuclear cell
predominance, elevated protein concentration, and normal glucose concentration.

− PCR has also been used to detect HHV-6 in blood but may not be sensitive in primary infection.

7. What are the complications?

− The prognosis for roseola is excellent.

− A few deaths have been attributed to HHV-6, usually in cases complicated by encephalitis or virus-
associated hemophagocytosis syndrome.

8. Outline the treatment plan for this patient? How to prevent RI?

− There is no specific therapy for roseola.

− Routine supportive care includes maintaining adequate hydration and antipyretics.

− In immunocompromised hosts, use of ganciclovir can be considered.

− No preventative measures are available.