Roseola differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]

Overview

Roseola must be differentiated from other diseases that cause fever and rash, such as Rubella (german measles), Rubeola (measles), hand foot and mouth disease caused by coxakie virus, erythema infectiosum caused by parvovirus B19, scarlet fever and even drug allergy.

Differential diagnosis

Roseola, also known as Exanthem subitum must be differentiated from all other childhood diseases that cause rash, and fever. The following table summarizes the differential diagnosis for roseola.[1][2][3][4][5][6][7][8]

Differential Diagnosis of fever and rash.
Disease Cause Typical Age Prodrome Fever Duration of the rash (days) Workup Treatment
Roseola Infantum (exanthem subitum) Human herpes virus type 6 6 months to 2 years None High 1-2; it follows defervescence Discrete erythematous macules, rarely involves face, begins as fever ends Lymphadenopathy, irritability
Measles Paramyxovirus
Measles virus 		1 to 20 years 2-4 days of cough, conjunctivitis, and coryza High 5 - 6 Erythematous, irregular size, maculopapular; starts on temples and behind ears; progresses down from face; fades to brownish Koplik's spots: C blue-white papules (salt grains) on bright red mucosa opposite premolar teeth
Rubella Togavirus 7 months to 29 years 0 - 4 days; mild malaise, fever; absent in children Low grade 1 - 3 Discrete, rose-pink, diffuse, maculopapular; progresses downward from face, may change quickly Arthralgia (usually in adults), tender posterior cervical and suboccipital lymphadenopathy, malaise, petechiae on soft palate
Erythema Infectiosum (Fifth Disease) Human parvovirus type B19 5 - 10 years None, usually in children, may occur in adults None to low-grade 2 - 4 Starts as “slapped cheek”, maculopapular; progresses to reticular (lacy) pattern; can recur with environmental changes such as sunlight exposure Arthralgia/arthritis in adults, adenopathy
Infectious Mononucleosis Epstein-Barr Virus 10 - 30 years 2 - 5 days of malaise and fatigue Low to high 2 - 7 Trunk and proximal extremities. Rash common if Ampicillin given Pharyngitis, lymphadenopathy, splenomegaly, malaise
Kawasaki disease Unknown < 5 years 3 days of abrupt fever High; fever of 5 days is a diagnostic criteria 5 - 7 Erythematous, morbilliform, maculopapular or scarlatiniform, central distribution; erythematous, indurated palms and soles Acute: dry, fissured and injected lips, strawberry tongue; irritability; cervical lymphadenopathy; conjunctival injection; peripheral edema; Subacute: finger-tip desquamation; Complications: arthritis, carditis
Scarlet Fever ß-hemolytic streptococci > 2 years 0 - 6 day, marked Low to high 2 - 7 Scarlet "sunburn" with punctate papules "sandpaper", circumoral pallor, increased intensity in skin folds, blanches stars face/head, upper trunk and progresses downward Sore throat, exudative tonsillitis, vomiting, abdominal pain, lmphadenopathy, white then red strawberry tongue
Enterovirus Echovirus
Coxsackie virus 		Mainly childhood 0 - 1 day fever and myalias Low to high 1 - 5 Fine, pink, always affects face; variant is Boston exanthem (large ~ 1 cm, discrete maculopapules) Sore throat, headache, malaise, no lymphadenopathy, gastroenteritis
Dengue Fever Flavivirus
Dengue virus types 1 - 4 		None High 1 - 5 Generalized maculopapular rash after defervescence; spares palms and soles Headache, myalgia, abdominal pain, pharyngitis, vomiting
Drug induced rash Many Any Possible due to underlying illness Possible Varies Typically diffuse but may be concentrated in diaper area, typically no progression, erythema multiform rash can progress over a few days Possibly due to underlying illness or complications
Pharyngoconjunctival Fever Adenovirus types 2, 3, 4, 7, 7a < 5 years Low to high 3 - 5 Starts on face and spreads down to trunk and extremities Sore throat, conjunctivitis, headache, anorexia

Table adapted from CDC Pinkbook.[9]

References

  1. ↑ JURETIC M (1963). "Exanthema subitum a review of 243 cases". Helv Paediatr Acta. 18: 80–95. PMID 13958107.
  2. ↑ Robbins, Frederick C. (1962). "Measles: Clinical Features". American Journal of Diseases of Children. 103 (3): 266. doi:10.1001/archpedi.1962.02080020278018. ISSN 0002-922X.
  3. ↑ Thompson, Amy E. (2015). "Recognizing Measles". JAMA. 313 (15): 1584. doi:10.1001/jama.2015.1889. ISSN 0098-7484.
  4. ↑ Kaplan, Leonard J. (1992). "Severe Measles in Immunocompromised Patients". JAMA: The Journal of the American Medical Association. 267 (9): 1237. doi:10.1001/jama.1992.03480090085032. ISSN 0098-7484.
  5. ↑ Ratnam S, Gadag V, West R, Burris J, Oates E, Stead F; et al. (1995). "Comparison of commercial enzyme immunoassay kits with plaque reduction neutralization test for detection of measles virus antibody". J Clin Microbiol. 33 (4): 811–5. PMC 228046. PMID 7790442.
  6. ↑ Papania, Mark J.; Wallace, Gregory S.; Rota, Paul A.; Icenogle, Joseph P.; Fiebelkorn, Amy Parker; Armstrong, Gregory L.; Reef, Susan E.; Redd, Susan B.; Abernathy, Emily S.; Barskey, Albert E.; Hao, Lijuan; McLean, Huong Q.; Rota, Jennifer S.; Bellini, William J.; Seward, Jane F. (2014). "Elimination of Endemic Measles, Rubella, and Congenital Rubella Syndrome From the Western Hemisphere". JAMA Pediatrics. 168 (2): 148. doi:10.1001/jamapediatrics.2013.4342. ISSN 2168-6203.
  7. ↑ Jayaprakash B, Sudha V, Shashikiran U (2006). "Atypical presentation of adult rubella". Med J Malaysia. 61 (2): 242–4. PMID 16898322.
  8. ↑ Dimech, W.; Panagiotopoulos, L.; Marler, J.; Laven, N.; Leeson, S.; Dax, E. M. (2005). "Evaluation of Three Immunoassays Used for Detection of Anti-Rubella Virus Immunoglobulin M Antibodies". Clinical and Vaccine Immunology. 12 (9): 1104–1108. doi:10.1128/CDLI.12.9.1104-1108.2005. ISSN 1556-6811.
  9. ↑ "Epidemiology and Prevention of Vaccine-Preventable Diseases".
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