Sudden exanthema, yes roseola infantum named, is an infection caused by a virus. At the beginning of the last century, it was part of a group of frequent ailments in children, which had in common the appearance of rashes on the skin.
These conditions, including measles, rubella, and chickenpox, were listed as they were described. In this way, sudden exanthema became known as the “sixth disease.”
The term exanthema refers to the presence of a rash affecting the body surface. When the rash involves the mucous membranes, the term enanthema used.
Why does exanthema suddenly occur?
Sudden rash is known as a viral condition, caused by the human herpesvirus (HHV) types 6 and 7. There are two variants of HHV. There are two variants of HHV-6 (A and B), but 6B is the one that most often causes sudden exanthema.
These viruses occur in more than 95% of adults, making it a common infection worldwide.
Up to now the mechanism of transmission is believed to be via saliva droplets spread by breathing, coughing or speaking. However, congenital infection is also possible, as HHV has the ability to bind to the genome, transferring it with the chromosomes during conception, although this transmission is rare.
The presence of the virus in different cells of the organism is maintained for life.
Who is affected?
More than 95% of those presenting with sudden exanthema are between 6 months and 3 years old. It is therefore considered a typical childhood disease.
However, because the virus remains latent in the body, reactivations are possible, although they usually go unnoticed. In young children, this condition is rare due to protection by maternal antibodies that have crossed the placenta.
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Symptoms of sudden exanthema
Sudden exanthema is usually distributed over the chest and abdomen, with small rashes on the surface of the limbs, face and behind the ears. Very rarely, lesions on the palate and uvula can be observed.
The first symptom is a fever, which is usually high and lasts for a few days. After the temperature has normalized, the typical appearance appears: a small, irregular, pinkish rash, mainly on the trunk.
It is important to note that because the fever has subsided when the rash appears, the child is usually in good general condition is. Therefore, the infection is sometimes underestimated by parents.
In addition to the rash, some patients also have tonsillitis, pharyngitis or otitis media, the symptoms of which indicate a viral origin. Enlargement of the cervical lymph nodes is also common, but examination is not painful for the child.
In some patients the infection is symptomless. Other less common symptoms include the following:
- Stomach ache
- Reddish spots on the palate and uvula.
After 24 to 48 hours, the rash disappears completely.
It should be noted that sometimes antibiotics are prescribed hastily for fear of the high fever. Because the rash appears a few days later, it’s easy to misinterpret it as a drug hypersensitivity reaction.
Complications of sudden exanthema
It is not yet known which patients are most likely to develop complications , but up to a third of children are at risk. The most serious are those affecting the central nervous system (CNS), including febrile seizures and encephalitis.
As for the mechanisms that can cause neurological symptoms, much remains to be discovered. Some authors even say that the virus remains in the CNS after the initial infection, which involves an increased risk of febrile convulsions and neurological symptoms in the patient.
However, there are discrepancies between the different studies, so more research is needed.
On the other hand, although the rash is usually considered minor, people with immune system deficiencies and those who have received transplants show a greater predisposition to more serious infections, and also a greater risk of complications and the reactivation of the viral process. Therefore, close follow-up of transplant recipients is vital.
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How Do Doctors Diagnose Sudden Exanthema?
The infection can be diagnosed medically, and this is based both on the presence of the rash and on the remission of the fever before the rash appears. Additional tests are not indispensable, but they be able to determine the existence of antibodies.
For example, the polymerase chain reaction (PCR) is also used to detect viral DNA. But its cost, compared to the relative insignificance of the condition, does not justify its regular use.
The main difference with the other exanthematous childhood diseases is that in this condition the fever subsides before the lesions appear. On the other hand, the characteristics of the rash help distinguish it from other viral processes.
However, it is important to know some related diagnoses:
- scarlet fever
- The measles
- Infectious mononucleosis
Treatment of sudden rash
Since it is a viral process that inhibits completely spontaneously, it has no specific treatment required. Therefore, the recommendation is simply to manage the child’s symptoms.
This means that the doctor must prescribe antipyretics to treat the fever. Likewise is It is important to recommend rest and fluid intake.
Some authors (Spanish link) believe that administering antiviral drugs (e.g. ganciclovir) might have some benefit in reducing viral load. However, this theory has not been proven and more research is needed.
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