Roseola

Diaper rash

Roseola: When a High Fever Comes with a Red Rash in Toddlers

Roseola is a common viral infection in toddlers, especially children aged 6 months to 2 years. Many parents may have experienced a child having a high fever for several days, then suddenly the fever subsides, along with a red rash spreading all over the body. This is a classic picture of roseola. Although it may seem alarming, this disease is usually not serious and will go away on its own.

What viruses are caused by this disease?
The causes of roseola are viruses in the Herpesvirus group, including:
•HHV-6 (Human Herpesvirus 6) — the main cause
•HHV-7 — less common
These viruses are transmitted through saliva or contaminated objects, such as baby bottles, spoons, toys, and can also spread even when the infected child has no symptoms (because the virus can remain in the body latently).

What happens in the body when a child is infected?
When the virus enters the body, it enters the T-cells, a type of white blood cell, which is part of the immune system, and spreads through the bloodstream, causing a high fever very quickly within 1–2 days after infection. The immune system will start to respond to the infection and control the virus. When the virus starts to subside, the body releases immune substances (cytokines), which have a side effect of causing a red rash to appear on the skin, especially when the fever starts to subside.

Symptoms to know
Roseola disease has quite specific characteristics, allowing doctors to diagnose it from the symptoms without further testing.
1. Fever stage
• A sudden high fever of 38.5–40.5°C for 3–5 days.
• Most children still appear energetic, not as lethargic or weak as with high fevers from other causes.
• Some may have slightly red eyes, runny nose, or loose stools.
2. Rash stage
• When the fever subsides immediately, a red rash will appear on the trunk, arms, legs, and sometimes on the neck.
• The rash appears as a flat rash or small raised patches of pink to red.
• It is not itchy and will disappear within 1–3 days.
3. Febrile Seizure
• A high fever may trigger seizures in some children (10–15%).
• It is generally a short seizure, lasting no more than 1–2 minutes and does not cause brain damage.

So how do we diagnose it?
Doctors usually diagnose roseola based on its unique symptom pattern: High fever for several days, followed by a rash when the fever subsides immediately. No blood tests or special tests are required, except in cases where the symptoms are not clear or other diseases with similar symptoms are suspected, such as dengue fever or measles.

Treatment methods
There is no specific treatment for roseola, but children can recover on their own within 7 days. Treatment focuses on supportive care:
• Give fever-reducing drugs, such as paracetamol, and avoid aspirin in children.
• Wipe the body to reduce fever when the fever is high.
• Give plenty of fluids or give ORS if there is also loose stools.
• Get enough rest.
• If there are seizures, turn the child on his/her side and take him/her to see a doctor immediately.

In children with immunodeficiency, such as organ transplant patients, the disease may become more severe and may require antiviral drugs, such as ganciclovir, under the care of a specialist.

Is this disease curable?
In general, children will have immunity to HHV-6 after the first infection, making them susceptible to reinfection. However, the virus may remain dormant in the body for life. Asymptomatic. For HHV-7, it is similar, but may cause disease later in life if the immune system is low, such as in the case of bone marrow suppression or after a bone marrow transplant.

Summary
Roseola is a common viral disease in young children. Although it starts with a high fever that looks scary, most people recover on their own without serious complications. Understanding the characteristics of the disease will help parents take care of their children with more confidence and reduce unnecessary anxiety.