Roseola (Exanthem subitum): Nursing

Definitions & Key takeaways

Roseola, also called exanthem subitum, or sixth disease, is a viral exanthem typically caused by human herpesvirus 6 or HHV-6, but can also be caused by other viral pathogens like human herpesvirus 7 (HHV-7). Children between 6 months and 2 years are most commonly affected by this condition.

Signs and symptoms start with the febrile phase which lasts about 3 to 5 days. This phase is characterized by a fever that can exceed 104 degrees F or 40 C, and general symptoms like cough, runny nose, swollen lymph nodes, malaise, diarrhea, and vomiting. Next comes the maculopapular phase, which involves small rose-colored macules and papules. These tend to appear on the neck and trunk and then spread to the face and extremities. The rash usually lasts 1 to 2 days.

Diagnosis of roseola is most commonly made through history and physical assessment along with measuring HHV-6-specific IgM antibodies. Treatment focuses on supportive therapies, while immunocompromised clients might require the administration of antivirals.

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Introduction0:00–0:30

Roseola, also known as roseola infantum, exanthem subitum, or sixth disease, is a self-limiting, viral exanthem, most commonly caused by human herpesvirus 6, or HHV-6.
Roseola is typically seen in children between the ages of six months and two years, and it’s characterized by a fever that may exceed 104 F or 40 C.Let’s start by discussing the physiology of the immune response with a focus on T lymphocytes.

Physiology0:30–1:33

It all begins in the bone marrow where undifferentiated hematopoietic stem cells begin to differentiate into different types of white blood cells.
Some of these cells migrate to the thymus where they become mature T cells, also known as T lymphocytes. These cells defend us against intracellular viruses, fungi, and tumor cells and are responsible for long-term immunity.
Now, after a foreign antigen enters the body, it runs into antigen-presenting cells, like macrophages and dendritic cells, which engulf the foreign antigen and digest it into fragments.
These antigen fragments are then presented on their surface and recognized by T helper cells, which help activate B cells to produce antibodies against that antigen.
Next, these antibodies bind to any affected cell that expresses the antigen on its surface, eventually enabling natural killer, or NK cells, and cytotoxic T cells to easily recognize and destroy them.Now, the most common cause of roseola is human herpesvirus 6, or HHV-6 for short, which is a small DNA virus that belongs to the Herpesviridae family.

Causes & risk factors1:33–2:01

Less commonly, roseola can also be caused by enteroviruses and adenoviruses, as well as human herpesvirus 3 and 7. Important risk factors for developing roseola include age between 6 and 24 months and immunosuppression.Now moving on to pathology.

Pathology2:01–3:30

HHV-6 is an airborne virus, meaning it spreads via small virus-containing droplets that get flung in the air when an infected client coughs or sneezes.
If an individual inhales these droplets or they come in contact with infected surfaces and then touch their eyes, nose, or mouth, they can become infected.
Once the virus enters the body, it attaches to dendritic cells, which then migrate to the lymph nodes where they interact with T helper lymphocytes.
T lymphocytes then ingest the virus and get infected. Once inside the cell, the virus replicates, forming new viral particles, which eventually destroy the T lymphocyte.
As a result, the surrounding tissue cells get infected and the replication of the virus continues. HHV-6 can also enter a latent state, where the virus stays inside the cell instead of killing it.
This may seem harmless, but in immunosuppressed clients, the virus can reactivate and cause serious life-threatening complications.
Some serious neurologic complications of roseola include febrile seizures, encephalitis, and aseptic meningitis. Some clients can also develop thrombocytopenia, rhabdomyolysis, and Guillain-Barre syndrome, which is an autoimmune demyelinating condition that affects the peripheral nervous system.Now, clinical manifestations of roseola typically appear after an incubation period of 5 to 15 days and they can be subdivided into two main phases: febrile and maculopapular phases.

Clinical manifestations3:30–4:51

The febrile phase starts with a sudden, high fever that may exceed 104 F or 40 C. This phase typically lasts for three to five days and during this time, some children may be active and well-appearing.
On the other hand, some clients may present with malaise, cough, runny nose, conjunctivitis, periorbital edema, diarrhea, and vomiting.
Additionally, a client might develop regional lymphadenopathy or swelling of cervical, postauricular, and occipital lymph nodes; and Nagayama spots, which are erythematous papules on the uvula and soft palate.
Once the febrile phase is over, there’s an abrupt fall of the client's temperature, which marks the beginning of the maculopapular phase.
This is characterized by a rash that consists of small rose colored macules and papules. These papules first appear on the neck and trunk, and then spread to the face and extremities.
Usually, this rash lasts for one to two days, but in some clients, it may go away even within two to four hours.Diagnosis of roseola is typically based on the client’s history and physical assessment, followed by detection of HHV-6-specific IgM antibodies.

Diagnosis4:51–5:10

Additionally, a PCR test can be used to detect viral DNA in the client’s respiratory secretions or blood.There’s no cure for roseola.

Treatment5:10–5:39

Usually, treatment for roseola involves supportive care to reduce the symptoms; this includes rest and hydration, as well as medications like analgesics and antipyretics, such as acetaminophen; while in case of vomiting or diarrhea, intake of oral fluids should be increased to avoid dehydration.
Finally, immunocompromised clients might require the administration of antivirals, like ganciclovir.Alright, let’s talk about the management of care for a client experiencing roseola.

Management and care5:39–6:31

The primary goals of care include managing fever and maintaining skin integrity. Now, since high fevers are one of the main symptoms of roseola, be sure to assess your client’s temperature regularly, and administer antipyretics, such as acetaminophen, as ordered, along with non-pharmacologic fever-reducing techniques, like applying cool compresses or sponging with tepid water.
Assess your client’s skin integrity by examining their skin thoroughly, noting the distribution and characteristics of their skin lesions.
Administer the prescribed antipruritics and remind your client and their caregivers to avoid scratching. Also ensure your client’s nails are short, and apply socks or mittens over their hands if scratching occurs.
Okay, moving on to client and family teaching. Begin by reassuring them that roseola is typically a self-limiting illness which will resolve after 1-2 weeks.

General client and family teaching6:31–7:44

Then, teach them what to expect during the illness by explaining that initially there is a febrile phase, which often includes high fevers, followed by a rash phase.
Let them know that their healthcare provider recommends over-the-counter medications such as ibuprofen and acetaminophen to help manage symptoms of roseola such as pain and fever; and instruct them to drink plenty of fluids to help prevent dehydration that can occur during fever.
Remind them to avoid scratching the rash, to take the prescribed antipruritic medication, and to wear mittens or socks on their hands if scratching occurs.
Lastly, teach them about basic infection control techniques such as washing their hands frequently and avoiding sharing food or drinks.
Finally, emphasize the importance of seeking emergency medical attention for signs of dehydration, like decreased urination and lethargy; or signs of febrile seizures, including twitching or jerking movements, bladder incontinence, or loss of consciousness.
All right, as a quick recap…. Roseola, also called exanthem subitum, or sixth disease, is a viral exanthem typically caused by human herpesvirus 6 or HHV-6, but can also be caused by other viral pathogens.

Review7:44–9:09

Children between 6 months and 2 years are most commonly affected by this condition. Signs and symptoms start with the febrile phase which lasts about 3 to 5 days.This phase is characterized by a fever that can exceed 104 degrees F or 40 C, and general symptoms like cough, runny nose, malaise, diarrhea, vomiting.
They may also present with swollen lymph nodes. Next comes the maculopapular phase, which involves small rose colored macules and papules.
These tend to appear on the neck and trunk, and then spread to the face and extremities. The rash usually lasts 1 to 2 days.
Diagnosis of roseola is most commonly made through a history and physical assessment along with measuring HHV-6-specific IgM antibodies.
Treatment focuses on supportive therapies, while immunocompromised clients might require the administration of antivirals.
Goals of nursing care include managing fever and maintaining skin integrity. Client and family teaching centers on what to expect from the infection, home care management, and when to seek medical attention.