Three-day fever

The title of this article is ambiguous. Further meanings are listed under Three-Day Fever (disambiguation) .

Classification according to ICD-10
B08.2	Exanthema subitum (Sixth Disease)
ICD-10 online (WHO version 2019)

The roseola (other spellings: 3-day fever or three-day fever also known as Dreitagefieberexanthem , Exanthema Subitum , roseola infantum or sixth disease ) is a contagious infectious disease , the human by two different types of herpes viruses caused. The three-day fever is one of the teething problems . A fever that usually lasts three days is followed by a sudden rash. Complications are rare, which is why treatment is limited to symptomatic measures. A vaccine does not exist.

Pathogen

Human herpes virus 6 (HHV-6)

The three-day fever observed only in the middle of the 20th century is caused by the human herpes virus 6 (HHV-6), discovered in 1986 by Syed Zaki Salahuddin and his research group, or human herpes virus 7 (HHV-7). HHV-6 and HHV-7 are enveloped , double-stranded DNA viruses and are closely related to the cytomegalovirus (CMV, HHV-5). There are two serotypes of HHV-6 (6A mainly in Africa and 6B mainly in Western countries). In Europe, children practically only get type 6B. After the acute infection survived ( persists ) the virus in the host organism and can in severe immunosuppression (such as bone marrow transplantation reactivate).

Symptoms

Typical rash in three-day fever

Three-day fever is a disease affecting infants or early toddlers. Up to the age of three, almost all children had contact with pathogens (almost 100% seropositivity). Older children and adults therefore practically never get three-day fever. The incubation period of the fresh infection is 5 to 15 days. With a typical course, there is a persistent high fever for three (very rarely a maximum of eight) days . There is evidence that a three-day fever is more likely to be associated with a febrile seizure than other infectious diseases. If the patient is defensive, a rash quickly appears with fine, sometimes slightly raised spots that are typically localized on the torso and neck. The spots can flow together and spread to the face. The rash is very fleeting and fades quickly (usually within three days). There are also rarely symptoms-poor courses with no or only slight fever or even completely clinically inapparent courses without fever or rash, which nevertheless lead to immunization and immunity ( silent celebration ).

Epidemiology

Human herpes viruses 6 and 7 are found all over the world. Only humans are the pathogen reservoir . The transmission occurs mainly through saliva, possibly also through droplet infection . Healthy HHV-6/7-seropositive children and adults can excrete the virus intermittently in the saliva without this having a disease value. As a result, these people are dropouts .

Complications

The most common complications from HHV-6 and 7 include diarrhea and vomiting, swelling of the eyelids, papules on the soft palate and uvula, cough, swelling of the cervical lymph nodes, bulging and tense fontanels, and febrile seizures . The latter seem to be slightly more common in HHV-7 than in HHV-6.

diagnosis

In the case of a typical clinical picture with the appearance of the rash after defever, the diagnosis is made clinically, so no laboratory examination is necessary. If necessary, leukopenia and relative lymphocytosis can be found in the blood count . In principle, a suspected primary infection can be proven virologically by the detection of HHV-6 DNA in serum or plasma. Human herpes viruses themselves can be detected in blood, saliva and liquor , and HHV-7 can also be detected in breast milk. However, these investigations have no practical, but exclusively scientific significance. The differential diagnosis of other childhood diseases with skin rashes such as measles , rubella , rubella (erythema infectiosum) or scarlet fever is usually not difficult due to the typical course.

therapy

Most infections do not require therapy. If the fever is high, the fever is symptomatic lowering. Febrile seizures may need to be treated with specific anticonvulsant medication. There is no virus-specific therapy.

prophylaxis

Isolation of children with acute HHV infection is not required. There is no vaccination. So far, there is no knowledge about the prophylactic effect of immunoglobulins .

literature

• Siegfried Wiersbitzky, Roswitha Bruns, Heidrun Wiersbitzky: Infections with the herpes virus 6 - really just "Exanthema subitum"? Part I: More common clinical pictures. In: Advances in Medicine. Volume 110, No. 32 (pp. 41-59), 1992, pp. 599-603.

Individual evidence

1. ↑ Karl Wurm, AM Walter: Infectious Diseases. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition, ibid. 1961, pp. 9–223, here: p. 68.
2. ↑ Werner Köhler : Infectious diseases. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , pp. 667-671; here: p. 671.
3. ↑ Sadao Suga et al .: Clinical characteristics of febrile convulsions during primary HHV-6 infection . In: Arch. Dis. Child . tape 82 , no. 1 , 2000, ISSN  0003-9888 , p. 62–66 , doi : 10.1136 / adc.82.1.62 , PMID 10630916 , PMC 1718177 (free full text) - (English).
4. ^ Pschyrembel Clinical Dictionary . Founded by Willibald Pschyrembel. Edited by the publisher's dictionary editor. 255th edition. De Gruyter, Berlin 1986, ISBN 978-3-11-018534-8 , p. 508.

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