Roseola pathophysiology: Difference between revisions
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{{Roseola}} | {{Roseola}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}}{{DAMI}} | ||
==Overview== | ==Overview== | ||
Roseola has two phases, the [[febrile]] and the [[Rash maculopapular|rash]] <nowiki/>([[maculopapular]]) phase. During the first phase, HHV6 replicates in [[Salivary gland|salivary glands]] and is secreted as primary source of infection. After completes resolution of the febrile phase, due to the latency of the [[virus]] in the [[Lymphocyte|lymphocytes]] and [[Monocyte|monocytes]], the [[rash]] phase begins. | |||
==Pathophysiology== | ==Pathophysiology== | ||
Roseola has two phases: | |||
#The [[febrile]] phase | |||
#The [[Rash maculopapular|rash]] phase | |||
===Transmission of infection=== | ===Transmission of infection=== | ||
* | ====The febrile phase==== | ||
*Intrauterine transmission was suggested by polymerase chain reaction (PCR) positivity of uncultured cord blood mononuclear cells. | *HHV 6 virus is replicated in the [[Salivary gland|salivary glands]] and secreted in saliva in the primary infection.<ref name="pmid13958107">{{cite journal| author=JURETIC M| title=Exanthema subitum a review of 243 cases. | journal=Helv Paediatr Acta | year= 1963 | volume= 18 | issue= | pages= 80-95 | pmid=13958107 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13958107 }} </ref> | ||
*Intrauterine transmission was suggested by [[polymerase chain reaction]] (PCR) positivity of uncultured [[cord blood]] [[mononuclear cells]].<ref name="pmid8265302">{{cite journal| author=Asano Y, Yoshikawa T, Suga S, Kobayashi I, Nakashima T, Yazaki T et al.| title=Clinical features of infants with primary human herpesvirus 6 infection (exanthem subitum, roseola infantum). | journal=Pediatrics | year= 1994 | volume= 93 | issue= 1 | pages= 104-8 | pmid=8265302 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8265302 }} </ref> | |||
*[[CNS]] invasion is believed to occur in rare cases accounting for some of the [[CNS]] manifestations such as [[Febrile seizure|febrile seizures]].<ref name="pmid10774474">{{cite journal| author=Stoeckle MY| title=The spectrum of human herpesvirus 6 infection: from roseola infantum to adult disease. | journal=Annu Rev Med | year= 2000 | volume= 51 | issue= | pages= 423-30 | pmid=10774474 | doi=10.1146/annurev.med.51.1.423 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10774474 }} </ref> | |||
====The rash phase==== | |||
*In the second phase of the disease, the HHV 6 virus is found to remain latent in [[Lymphocyte|lymphocytes]] and [[Monocyte|monocytes]] and found in low levels in some tissues. [[CD4 T cells|CD4 positive T cells]] have been found to support the growth of roseola.<ref name="pmid13958107">{{cite journal| author=JURETIC M| title=Exanthema subitum a review of 243 cases. | journal=Helv Paediatr Acta | year= 1963 | volume= 18 | issue= | pages= 80-95 | pmid=13958107 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13958107 }} </ref><ref name="pmid18138680">{{cite journal| author=BERENBERG W, WRIGHT S, JANEWAY CA| title=Roseola infantum (exanthem subitum). | journal=N Engl J Med | year= 1949 | volume= 241 | issue= 7 | pages= 253-9 | pmid=18138680 | doi=10.1056/NEJM194908182410701 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18138680 }} </ref> | |||
===Pathogenesis=== | ===Pathogenesis=== | ||
*The human herpes virus infects the T cells, monocytes-macrophages, epithelial cells, and central nervous system cells resulting in a | *Infection of the [[CD134]] cells has been shown in some studies to be responsible for the reactivation of HHV 6 from latency [[in vitro]]. | ||
*HHV-6 has tropism towards CD4 T cells and replicates in the T cells inducing a lifelong latent infection in humans | *The [[Human herpes virus 6|human herpes virus]] infects the [[T cell|T cells]], [[Monocyte|monocytes]]-[[Macrophage|macrophages]], [[epithelial cells]], and [[central nervous system]] cells resulting in a lifelong latency or persistence of virus at multiple sites. HHV-6 exists in a true state of viral latency in [[Monocyte|monocytes]] and [[Macrophage|macrophages]].<ref name="pmid18138680">{{cite journal| author=BERENBERG W, WRIGHT S, JANEWAY CA| title=Roseola infantum (exanthem subitum). | journal=N Engl J Med | year= 1949 | volume= 241 | issue= 7 | pages= 253-9 | pmid=18138680 | doi=10.1056/NEJM194908182410701 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18138680 }} </ref> | ||
*HHV-6 has [[tropism]] towards [[CD4 T cells]] and replicates in the [[T cell|T cells]] inducing a lifelong latent infection in humans. | |||
===Genetics=== | ===Genetics=== | ||
[[Chromosome|Chromosomal]] integration of HHV-6A and HHV-6B is responsible for transmission of infection from the parents to the newborn and is observed in 1% of the population. | |||
===Associated conditions=== | ===Associated conditions=== | ||
A more serious form of HHV 6 is seen in older children, [[immunocompromised]] adults and [[Organ transplant|organ transplant patients]]. | |||
===Gross pathology=== | ===Gross pathology=== | ||
There are no gross pathologic findings associated with roseola. | |||
===Microscopic pathology=== | ===Microscopic pathology=== | ||
There are no microscopic findings associated with roseola. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Emergency mdicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
[[Category:Neurology]] | |||
[[Category:Pediatrics]] | |||
[[Category:Dermatology]] | |||
Latest revision as of 00:03, 30 July 2020
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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 has two phases, the febrile and the rash (maculopapular) phase. During the first phase, HHV6 replicates in salivary glands and is secreted as primary source of infection. After completes resolution of the febrile phase, due to the latency of the virus in the lymphocytes and monocytes, the rash phase begins.
Pathophysiology
Roseola has two phases:
Transmission of infection
The febrile phase
- HHV 6 virus is replicated in the salivary glands and secreted in saliva in the primary infection.[1]
- Intrauterine transmission was suggested by polymerase chain reaction (PCR) positivity of uncultured cord blood mononuclear cells.[2]
- CNS invasion is believed to occur in rare cases accounting for some of the CNS manifestations such as febrile seizures.[3]
The rash phase
- In the second phase of the disease, the HHV 6 virus is found to remain latent in lymphocytes and monocytes and found in low levels in some tissues. CD4 positive T cells have been found to support the growth of roseola.[1][4]
Pathogenesis
- Infection of the CD134 cells has been shown in some studies to be responsible for the reactivation of HHV 6 from latency in vitro.
- The human herpes virus infects the T cells, monocytes-macrophages, epithelial cells, and central nervous system cells resulting in a lifelong latency or persistence of virus at multiple sites. HHV-6 exists in a true state of viral latency in monocytes and macrophages.[4]
- HHV-6 has tropism towards CD4 T cells and replicates in the T cells inducing a lifelong latent infection in humans.
Genetics
Chromosomal integration of HHV-6A and HHV-6B is responsible for transmission of infection from the parents to the newborn and is observed in 1% of the population.
Associated conditions
A more serious form of HHV 6 is seen in older children, immunocompromised adults and organ transplant patients.
Gross pathology
There are no gross pathologic findings associated with roseola.
Microscopic pathology
There are no microscopic findings associated with roseola.
References
- ↑ 1.0 1.1 JURETIC M (1963). "Exanthema subitum a review of 243 cases". Helv Paediatr Acta. 18: 80–95. PMID 13958107.
- ↑ Asano Y, Yoshikawa T, Suga S, Kobayashi I, Nakashima T, Yazaki T; et al. (1994). "Clinical features of infants with primary human herpesvirus 6 infection (exanthem subitum, roseola infantum)". Pediatrics. 93 (1): 104–8. PMID 8265302.
- ↑ Stoeckle MY (2000). "The spectrum of human herpesvirus 6 infection: from roseola infantum to adult disease". Annu Rev Med. 51: 423–30. doi:10.1146/annurev.med.51.1.423. PMID 10774474.
- ↑ 4.0 4.1 BERENBERG W, WRIGHT S, JANEWAY CA (1949). "Roseola infantum (exanthem subitum)". N Engl J Med. 241 (7): 253–9. doi:10.1056/NEJM194908182410701. PMID 18138680.