Medicinal exanthema. Sudden exanthema (roseola) in children and adults: symptoms, treatment. What causes sudden exanthema

Roseola - symptoms in children and adults (high temperature, spots on the skin), diagnosis and treatment. Differences between roseola and rubella. Photo of a rash on a child's body

Thanks

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

General characteristics of the disease

Roseola for children is an independent infectious disease that mainly affects babies in the first two years of life. In children older than 2 years and adults, it is very rare.

Roseola, as a childhood infectious disease, must be distinguished from the specific dermatological term "roseola". The fact is that in dermatology and venereology, roseola is understood as a certain type rashes on the skin, which can appear with various diseases. So, dermatologists and venereologists define roseola as a small spot, 1-5 mm in diameter, not protruding above the skin surface with smooth or blurry edges, painted in pink or red. The infectious disease of roseola is a separate nosology, and not a type of rash on the body. Although the infection got its name precisely because it has rashes on the body of a child of the roseola type. Despite the completely identical names, the type of rash on the body in the form of roseola should not be confused with the infectious disease roseola. In this article, we will focus on the infectious disease roseola, and not on the type of rash.

So, roseola is one of the most common childhood infections in babies during the first two years of life. Most often, the infection affects children aged 6 months to 2 years. During this period of life, roseola suffers from 60 to 70% of children. And up to the age of 4 years, more than 75 - 80% of babies have been ill with this disease. In adults, in 80 - 90% of cases, antibodies to roseola are found in the blood, which means that at some point during their lives they had this infection.

Many people do not even suspect that they once had roseola, because, firstly, this diagnosis is very rare in early childhood, and secondly, in children over 3 years old, the disease may be completely asymptomatic, since the already formed the immune system is able to suppress a relatively weak virus so that it does not cause clinical manifestations.

The infection is characterized by seasonality, the highest incidence rate is recorded in the spring-autumn period. Boys and girls get infected and get sick equally often. After once transferred roseola, antibodies are formed in the blood that protect a person from re-infection throughout life.

The disease is transmitted by airborne droplets and contact, that is, it spreads quickly and freely. Presumably, the infectious disease is transmitted to children from adults around them who are carriers of the roseola virus. However, the exact transmission mechanism of the virus has not yet been established.

roseola has incubation period lasting 5-15 days, during which the virus multiplies and there are no clinical manifestations. Symptoms appear only after the end of the incubation period and lasts approximately 6 to 10 days.

Pathogen roseola is a herpes virus type 6 or type 7. Moreover, in 90% of cases, the disease is caused by a type 6 virus, and only in 10% - the causative agent is a type 7 virus. After contact with the mucous membranes of the respiratory tract, the virus enters the bloodstream, and during the incubation period it multiplies in the lymph nodes, blood, urine and respiratory fluid. After the end of the incubation period, a large number of viral particles enter the systemic circulation, which causes a sharp increase in body temperature. After 2 to 4 days, viruses from the blood penetrate the skin, causing damage to it, as a result of which, 10 to 20 hours after the temperature normalizes, a small red rash appears all over the body, which disappears on its own within 5 to 7 days.

Clinical manifestations roseola is staged. At the first stage, there is a sharp increase in body temperature to 38 - 40 o C. In addition to high temperature, the child or adult does not have any other clinical manifestations, such as cough, runny nose, diarrhea, vomiting, etc. The fever lasts for 2 to 4 days, after which it passes without a trace, and the body temperature is completely normal. After normalization of body temperature, the second stage of the clinical course of roseola begins, in which, 10 to 20 hours after the fever has passed, a small, profuse red rash appears on the skin. The rash first appears on the face, chest and abdomen, after which the rash covers the entire body within a few hours. Simultaneously with the appearance of rashes in a child or adult, submandibular lymph nodes may increase. The rash stays on the body for 1-4 days, and gradually disappears. There is no flaking or pigmentation at the site of the rash. Lymph nodes may remain enlarged for a week, after which their size also returns to normal. After the convergence of the rash, roseola is completed and a complete recovery occurs, and antibodies to the infection remain in the blood, protecting the person from re-infection throughout life.

Diagnostics roseola is produced based on clinical signs. An infection should be suspected if a child or an adult, against the background of full health, has a fever and does not stubbornly decrease, and there are no other signs of disease.

Treatment roseola is the same as any acute respiratory viral infection (ARVI). That is, in fact, no special treatment is required, it is only necessary to provide a person with comfortable conditions, drink plenty of water and, if necessary, give antipyretic drugs (Paracetamol, Nimesulide, Ibuprofen, etc.). You do not need to take any antiviral drugs to treat roseola.

During the entire period of fever, up to the appearance of a rash, it is necessary to monitor the sick person in order not to miss the appearance of other clinical symptoms that are signs of other serious diseases that also begin with high fever, such as, for example, otitis media, urinary tract infections and others

the only complication of roseola there may be febrile seizures in children in response to high fever. Therefore, with roseola, it is recommended to give antipyretic drugs to children without fail if the body temperature is more than 38.5 o C.

Prevention roseola does not exist, because, in principle, it is not needed. This infectious disease is mild, and therefore it is not advisable to spend significant efforts and funds to prevent it.

Why is roseola rarely diagnosed?

Roseola is a fairly widespread infectious disease in young children, however, despite this epidemiological fact, in practice there is a paradoxical situation when the diagnosis of "sudden exanthema" is practically not made by pediatricians. That is, children get roseola, but they are not diagnosed accordingly.

This paradoxical situation is due to two main reasons - the peculiarities of the course of roseola and the specifics of medical education received in universities of the CIS countries.

So, the onset of roseola is characterized by a sharp increase in body temperature and accompanying fever symptoms of malaise, such as lethargy, drowsiness, lack of appetite, etc. In addition to high body temperature, nothing bothers the child - there is no rhinitis (snot), no cough, no sneezing, no redness of the throat, no diarrhea, no vomiting, no other additional symptoms characteristic of viral infections or food poisoning. After 2 - 5 days, the inexplicable temperature subsides, and another 10 - 20 hours after the child seems to have recovered, a small red rash appears on his body. Such a rash lasts 5-7 days, after which it disappears without a trace, and the child recovers completely.

Naturally, the presence of a high body temperature, which usually lasts 2 to 4 days, makes parents and pediatricians suspect an acute viral infection in a child or even a reaction to something. That is, elevated body temperature without any other signs of an acute viral respiratory infection or any other disease is often perceived by parents and pediatricians as an inexplicable and incomprehensible phenomenon that, of course, needs to be treated. As a result, despite the absence of other signs of SARS, an incomprehensible increase in temperature is interpreted as a viral infection that occurs atypically, and the child is prescribed appropriate treatment. Naturally, the child is “treated” with medicines, and when, 10 to 20 hours after normalization of body temperature, he develops a rash, it is simply considered as a reaction to drugs.

The diagnosis of roseola in such situations, as a rule, is not even suspected by pediatricians, but not because their qualifications are low or the doctors are bad, but due to the current system of medical education. The fact is that in almost all medical universities, future doctors at all stages of training are never "acquainted" with this infection. That is, in the training system, future doctors were shown children with various diseases, they learned to recognize and treat them, but they never saw roseola! Accordingly, there is no clear picture of this infection in the head of the future doctor, and he simply does not see it when looking at a sick child, since he was never shown roseola in class.

Naturally, students read about roseola in textbooks on pediatrics and even answered questions about it during exams, but this infection, which has never been seen with their own eyes during the years of study at the medical institute and internship, remains a kind of "curiosity" for the doctor. Accordingly, since in reality no one has ever shown roseola to students, the theoretical material about this disease is simply forgotten after a while due to lack of demand, as a result of which the infection is not diagnosed and continues to disguise itself as an atypical SARS.

Another reason for not recognizing roseola is, relatively speaking, its safety. The fact is that this infection does not cause complications, proceeds easily and quickly ends with a complete recovery (usually within 6-7 days) of a child or adult. Roseola does not require any special treatment - this disease, like a common respiratory viral infection, goes away on its own and does not cause complications. The only therapeutic measures that can be taken in this situation are symptomatic treatment aimed at eliminating the painful manifestations of the infection and alleviating the child's condition. Accordingly, even if roseola is not detected, nothing terrible will happen, since the child will simply recover on his own, and the episode of an inexplicable temperature increase, followed by the appearance of a red, small-spotted rash, will simply be forgotten. This means that an undiagnosed roseola will not turn into any formidable or severe complications for the child. And such a mild course of the disease with no risk of complications does not force doctors to be vigilant and vigilant about roseola, because skipping this infection will not result in serious consequences for the child.

Causes of roseola

Roseola is caused by the human herpes virus type 6 or 7. In 90% of cases, an infectious disease is caused by the herpes virus type 6 and in 10% by the type 7 virus. The initial entry of the virus into the human body causes roseola, after which antibodies remain in the blood that protect against re-infection throughout life.

What virus causes roseola?

Roseola is caused by the human herpesvirus 6 or 7. A specific virus that provokes an infectious disease was established in 1986. And until that moment, the exact causative agent of roseola was unknown. Human herpesvirus types 6 and 7 are part of the genus Roseolovirus, and belong to the subfamily beta-Herpesvirus.

When the virus was isolated in 1986, it was named human B-lymphotropic virus (HBLV) because it was found in the B-lymphocytes of people with HIV infection. But later, after finding out its exact structure, the virus was renamed and assigned to the herpes family.

Currently, two variants of human herpesvirus type 6 are known - these are HHV-6A and HHV-6B. These varieties of the virus differ from each other quite significantly in various parameters, such as prevalence, transmission, clinical symptoms caused, etc. So, roseola is caused only by a variety HHV-6B.

Ways of transmission of infection

The human herpes virus type 6 or 7 is transmitted by airborne droplets and contact routes. Moreover, it is assumed that the virus is transmitted not necessarily from a sick person, but also from a carrier. And this means that literally every adult can be the source of infection, since 80 - 90% of people by the age of 20 have antibodies in their blood, indicating that roseola was transferred in the past.

After a person has had roseola, antibodies remain in his blood that protect him from re-infection, and the virus itself remains in the tissues in an inactive state. That is, after an episode of roseola, a person becomes a lifelong carrier of the herpes virus type 6 or 7. As a result, the virus can periodically become activated and be released with biological fluids (saliva, urine, etc.) into the external environment. Activation of the virus does not cause a re-infection with roseola - there are antibodies in the blood that suppress its action, as a result of which the pathogenic microorganism can only be released into the external environment in a small amount. It is at such moments that a person can become a source of infection for the small children around him.

And since periods of virus activation do not manifest any clinical symptoms, it is not possible to recognize potentially dangerous adults. As a result, the child is literally surrounded by adults, who at different times are the sources of the roseola virus. That is why babies become infected with the herpes virus type 6 or 7, and get sick with roseola in the first two years of life.

Is roseola contagious?

Currently, there is no exact data on whether roseola is contagious. However, scientists suggest that a sick child is still contagious to other small children around him who have not yet recovered from roseola, since the virus is present in his biological fluids. Therefore, it is recommended to isolate a child with roseola from other children, although this measure will not protect them from infection, since any adult carrier of the virus can become a source of the virus for them.

Incubation period

The incubation period for roseola is 5 to 15 days. At this time, the virus multiplies in the tissues of the human body, after which it enters the systemic circulation and causes the first stage of clinical manifestations - high fever.

Symptoms

General characteristics of the symptoms of roseola

Roseola has a two-stage course. Accordingly, certain clinical symptoms are characteristic for each stage.

First stage(beginning) of the disease is characterized by a sharp increase in body temperature to at least 38.0 o C. The temperature can rise to large values, up to 40.0 o C. On average, with roseola, a temperature of 39.7 o C is recorded. At the same time, fever provokes signs intoxications, such as irritability, drowsiness, lethargy, tearfulness, lack of appetite and apathy, which are not independent symptoms, but only a consequence of high body temperature in a child or adult.

At the first stage of roseola, in most cases, a person does not have any other clinical symptoms, except for a high, stubborn temperature. However, in more rare cases, in addition to fever, a child or adult may experience the following symptoms:

• Enlarged cervical and occipital lymph nodes;
• Swelling and redness of the eyelids;
• Swelling of the mucous membrane of the nose and throat;
• Redness of the pharynx and sore throat;
• A small amount of mucous snot;
• A rash in the form of small blisters and red spots on the mucous membrane of the soft palate and uvula (Nagayama spots).

At the second stage, 5 - 24 hours after the temperature normalizes or simultaneously with its decrease, a rash appears on the body. In very rare cases, the rash appears before the temperature drops, but in such situations, the fever always stops shortly after the formation of the rash. Rashes are small spots and bubbles with a diameter of 1 - 5 mm with uneven edges, rounded or irregular in shape, painted in various shades of pink and red. When pressing on the elements of the rash, they become pale, but after the cessation of exposure, they again acquire their original color. The elements of the rash almost never merge, do not itch or peel off. The skin under the rash is unchanged, there is no puffiness, peeling, etc. The rash with roseola is not contagious, therefore, it is possible to contact the person carrying the disease.

The rash usually first appears on the trunk and very quickly, within 1 to 2 hours, spreads to the entire body - to the face, neck, arms and legs. Further, the rashes persist for 2-5 days, after which they gradually turn pale and completely disappear in 2-7 days after the appearance. As a rule, rashes disappear without a trace, there are no pigmented spots or peeling on the former places of their localization. But in rare cases, a slight reddening of the skin may remain at the site of the rash after their convergence, which soon disappears on its own. This completes the second stage of roseola and complete recovery occurs.

In addition, during the period of the appearance of rashes on the body, the lymph nodes decrease in size, which were enlarged at the first stage of the course of roseola. As a rule, the lymph nodes take on normal size by 7-9 days after the onset of the disease.

The classic course of roseola in two stages is usually observed in young children under the age of 2 to 3 years. At the age of over 3 years, roseola, as a rule, proceeds atypically. The most common atypical course of roseola is a sharp increase in body temperature without any other symptoms, which after 2 to 4 days returns to normal, and rashes do not appear on the body. Also atypical is the variant of the course of roseola, in which there are no clinical symptoms at all, with the exception of lethargy and drowsiness for 2 to 4 days.

Roseola usually does not cause complications in either children or adults, if their immune system is not affected by any diseases. The only complication of roseola in such cases is convulsions in response to high body temperature in children or adults. But if a child or adult suffers from immunodeficiency (for example, HIV-infected people who take immunosuppressants after an organ transplant), then roseola can be complicated by meningitis or encephalitis.

After the transferred roseola, antibodies to the virus remain in the blood, which protect the person for the rest of his life from re-infection. In addition, after roseola, the herpesvirus type 6 is not removed from the body, like other viruses of the herpes family, but remains in the tissues in an inactive state for the rest of life. That is, a person who once had roseola becomes a lifelong virus carrier. Such virus carrying should not be feared, since it is not dangerous and represents exactly the same situation as the carriage of the herpes simplex virus.

temperature with roseola

An increase in body temperature with roseola always occurs, except in cases of asymptomatic infection. Moreover, roseola begins precisely with an inexplicable sharp increase in body temperature against the background of the absence of any other symptoms.

As a rule, the temperature rises to high and very high values ​​- from 38.0 to 41.2 o C. The most common fever is in the range of 39.5 - 39.7 o C. Moreover, the younger the sick person, the lower his roseola temperature. That is, babies carry the infection with a lower temperaturecompared to adults. In the morning, body temperature is usually slightly lower than during the day and evening.

Self-diagnosis of the disease is possible only after the appearance of a rash. During this period, to distinguish roseola from other diseases, you need to press on the spots with your finger for 15 seconds. If after pressing the spot turned pale, then the person has roseola. If the spot does not become paler after pressing on it, then the person has some other disease.

The rash in roseola is very similar to that in rubella, which causes misdiagnosis. In fact, it is very simple to distinguish rubella from roseola: with rubella, the rash appears at the very beginning of the disease, and with roseola, only for 2-4 days.

Treatment

General principles for the treatment of roseola

Roseola, like other acute respiratory viral infections, does not require any specific treatment, since it resolves itself within 5 to 7 days. In fact, the main treatment for roseola is to provide the patient with comfortable conditions, plenty of fluids, as well as light meals. This means that a person suffering from roseola should be given plenty to drink. At the same time, you can drink any drinks (with the exception of carbonated water and coffee) that a person likes more, for example, juices, fruit drinks, compotes, weak tea, milk, etc. The room in which the patient is located should be regularly ventilated (for 15 minutes every hour) and the air temperature should not be higher than 22 o C. The clothes on the patient should not be too warm so that the body can give off excess heat from the temperature to the external environment and don't get too hot. For a period of high temperature, it is recommended to stay at home, and after its normalization from the moment the rash appears, you can go for walks.

If the high temperature is not well tolerated, then you can take antipyretic drugs. It is optimal for children to give drugs based on paracetamol (Panadol, Paracetamol, Tylenol, etc.), and if they are not effective, then use drugs with ibuprofen (Ibufen, etc.). In extreme cases, if the child does not tolerate the temperature well, and drugs with ibuprofen do not help to reduce it, you can give funds with nimesulide (Nimesil, Nimesulide, Nise, etc.). For adults, the optimal antipyretic agent is acetylsalicylic acid (Aspirin), and if it is ineffective, preparations with nimesulide.

Taking antipyretics for roseola is recommended only if the high temperature is extremely poorly tolerated or there is a high risk of febrile seizures. In other cases, it is better to refrain from taking antipyretic drugs, because, firstly, they are not very effective for roseola, and secondly, they create an additional burden on the body.

The roseola rash does not itch or itch, it goes away on its own, so it does not need to be lubricated with any drugs, creams, ointments, lotions or solutions, either in children or adults.

Treatment of roseola in children

The principles of roseola treatment in children are the same as in adults. That is, you do not need to use any special medicines, it is enough to give the child plenty to drink, maintain the temperature in the room where he is located from 18 to 22 o C, air it regularly (for 15 minutes every hour) and do not dress the baby warmly. Remember that too warm clothes will lead to overheating and an even higher increase in body temperature. For a period of high temperature, the child should be left at home, and after it normalizes and the rash appears, you can go for walks.

If the child normally tolerates temperature, is active, plays, is not naughty or sleeps, then it is not necessary to knock it down with antipyretics. The only situation when you need to bring down the temperature with roseola with the help of antipyretics is the development of febrile convulsions in a child. In other cases, to reduce the temperature, you can bathe the child in warm water (29.5 o C).

Convulsions against the background of high temperature scare parents, but in fact, as a rule, they are not dangerous, since they are not associated with long-term side effects and damage to the structures of the central nervous system. If a child has febrile convulsions against the background of roseola, then, first of all, you should not panic, but calm down and help the baby survive this moment. To do this, free the child's neck from clothes, remove all sharp, piercing and dangerous objects from the area where the baby lies, and turn it over on either side. Also remove all objects from the child's mouth. Try to calm the baby so that he is not afraid. Place a pillow or cushion made of any fabrics (clothes, bedding, etc.) under the child's head and gently hold the baby so that he does not fall until the convulsions end. After seizures, the child may be drowsy, which is normal, so put him to bed, give him a drink and an antipyretic drug. Then put the baby to sleep. After an episode of seizures, be sure to call the pediatrician at home to examine the child for any previously undiagnosed diseases.

For children, the best antipyretic drugs are those with paracetamol (Tylenol, Panadol, etc.), so these drugs should be given to babies to reduce the temperature in the first place. If the medicine with paracetamol did not help, then you should give the child a remedy with ibuprofen (Ibufen, Ibuklin, etc.). And only if the temperature is very high, and neither paracetamol nor ibuprofen helped to reduce it, you can give the child a remedy with nimesulide (Nise, Nimesil, etc.). To reduce the temperature of children under 15 years of age, Aspirin and other medicines containing acetylsalicylic acid should not be given in any case, since this can cause the development of Reye's syndrome.

Rashes with roseola do not need to be lubricated with anything, because they do not bother the child, do not itch, do not itch and do not cause discomfort. You can bathe the baby against the background of rashes, but only in warm water and without using a washcloth.

Can you walk with roseola?

With roseola, you can walk after the body temperature returns to normal. You can’t walk during a period of high temperature, but at the stage of the appearance of rashes, you can, because, firstly, they are not contagious to other children, and secondly, the child already feels fine, and the disease has practically disappeared.

After roseola

After roseola once transferred, a person develops immunity that protects him from re-infection throughout his life. Rashes and fever pass without a trace and do not leave any complications, therefore, after roseola, you can and should lead a normal life, equating an episode of this disease with any other acute respiratory viral infection that a person suffers many times during his life.

Rash in a newborn: skin care for the face and head of a child (opinion of a pediatrician) - video

SUDDEN EXTREME

PhD A.I. Ivanov

Synonyms: sixth disease; exanthema subitum, exanthema criticum, roseola infantum (Latin), Das kritische Dreitagefieber-exanthem der kleinen Kinder, 3-Tage-Fieber (German), Bose Bash of Infants, Zahorskys Disease (English), Fievre de trois jours avec exantheme critique (French).

Story

The disease was first described in America by Zahorsky in 1910-1913. called roseola infantilis. In 1921, Veeder and Hempelmann proposed a better name - exanthema subitum (sudden), which reflects the rapid appearance and disappearance of the rash in this disease.

In our country, sudden exanthema was first described by prof. V. I. Molchanov in 1927 (3 own observations and 4 observations of employees). In the future, M. A. Rozentul and B. JI reported sudden exanthema. Khlebnikova (2 cases, 1927), P. A. Byreev (5 cases, 1928), S. S. Kanevskaya and P. M. Sosnova (4 cases, 1929), A. A. Tagunov (2 cases, 1929), L. D. Steinberg (12 cases, 1931), A. A. Tarasenkov (5 cases, 1948).

Etiology and epidemiology

For a long time, sudden exanthema was considered as a syndrome that occurs in young children due to various reasons - infection, intoxication, nutritional errors and other factors. After the works of Ketre (1950), there is no doubt that sudden exanthema is an infection in which the pathogen circulates in the patient's blood. The authors induced a typical disease in a healthy child by intravenous administration of bacteria-free blood serum taken from the patient. The incubation period lasted 9 days. Similar experiments were later repeated by other researchers abroad with similar results.

The causative agent of the disease remains unknown, it is assumed a virus. In 1954, Neva and Enders, in 1961 Jansson, as well as other authors isolated adenoviruses from patients with sudden exanthema. According to these researchers, the causative agent of sudden exanthema is a viral agent that is widespread in the external environment, because young children become ill as soon as their immunity received from the mother decreases. Adenoviruses are such widespread viruses. The clinic of sudden exanthema is in many ways similar to the so-called Boston disease, which was described for the first time in 1951 and is caused by ECHO 16 viruses. The question of the identity of these diseases remains open.

According to many authors, about 90% of patients are children aged 6 months to 3 years. Adolescents and adults get sick very rarely. Both sexes are equally affected. The contagiousness is insignificant. Small epidemic outbreaks in maternity hospitals, nurseries, families are described. The incidence is observed mainly in spring and autumn. The mode of transmission of the infection is unknown.

Pathogenesis and pathological anatomy . The pathogenesis and pathological anatomy of sudden exanthema have not been studied.

Clinic

Incubation lasts 3-7 days. The beginning is sharp. The temperature rises to 39-40 °, in some cases higher. Despite the high fever, the general condition of sick children remains satisfactory. They continue to play, but in some cases they can be whiny, irritable, restless. Older children complain of headaches and pain in the limbs.

On objective examination, light catarrhal phenomena from the respiratory tract, moderate conjunctivitis, a slight increase in cervical, behind-the-ear and occipital lymph nodes are noted intermittently. Sometimes the spleen is enlarged.

The temperature on the 3rd-4th day of illness, in a few hours without sweat, decreases to normal. The duration of fever for more than 5-6 days puts the diagnosis of sudden exanthema under great doubt. It is extremely characteristic that at the same time as the temperature falls, a rash appears on the skin. Rarely, its development begins before the decrease in fever or it is delayed by 1-2 days. The rash first appears on the back, after a few hours it spreads to the chest, abdomen, neck, back of the head, scalp, face and limbs. Most of all, the rash is on the back, on the face there are very few - separate elements at the wings of the nose, on the cheeks, around the ears. There is no predominance of a rash on the extensor surfaces of the limbs. The elements of the rash are pale pink spots with a diameter of 2-5 mm with uneven, jagged edges. Often they are surrounded by a pale halo. The rash may merge and resemble measles, but unlike the latter, it is never so bright, and if it stands above the surface of the skin, then less. Often it is very similar to the rubella rash. The rash process ends after a few hours. The rash persists for 2-3 days, without causing any disturbance to the child, after which it quickly disappears without peeling and pigmentation.

During fever, in severe cases, the phenomena of meningo-encephalitis can be observed: loss of consciousness, convulsions, increased intracranial pressure, which in young children can be seen from the swelling of the fontanel. In the cerebrospinal fluid, there are changes characteristic of serous meningitis. When a child is restless, often cries, turns his head on the pillow, and pressure on the tragus from one or both sides causes a painful reaction and increased crying, then otoscopy may reveal signs of catarrhal otitis media. Purulent otitis media with perforation of the tympanic membrane develops very rarely. Cases are described in which in infants in the clinical picture of the disease, intestinal phenomena came to the fore - vomiting and frequent liquid green mucous stools (Glanzmann). In general, the disease always proceeds benignly, even in those cases when the phenomena of meningo-encephalitis develop.

With a sudden exanthema, changes in the blood are very characteristic. In the first 1-2 days, moderate neutrophilic leukocytosis is noted intermittently. With a drop in temperature, leukopenia always develops (up to 3000 and less) due to neutropenia, there is a pronounced stab shift of neutrophils, relative lymphocytosis (up to 90% or more). During fever, thrombocytopenia occurs. The blood picture returns to normal a few days after the disappearance of the rash. In the urine, protein, leukocytes are often determined, which quickly disappear after a decrease in temperature.

Diagnosis

Recognition of a sudden exanthema in a febrile period is extremely difficult due to the absence of any typical symptoms. Only observation of the dynamics of the disease allows you to correctly diagnose. For a sudden exanthema, a satisfactory condition of the child with high fever, a rapid decrease in temperature on the 3rd-4th day of illness and, at the same time, the appearance of an abundant pale pink rash, mainly on the back, the development of leukopenia with pronounced relative lymphocytosis, are very characteristic. When conducting a differential diagnosis in the initial period of the disease, central pneumonia, pyelocystitis should be excluded, after the appearance of a rash - drug exanthema, mild measles, rubella, scarlet fever, infectious erythema.

Treatment and prevention

Patients with mild forms of the disease do not require special treatment. With a strong anxiety of the child and insomnia, warm baths are prescribed. In case of increased intracranial pressure, a lumbar puncture is performed. For convulsions, chloral hydrate enemas are indicated. The development of purulent complications from the ears or upper respiratory tract requires the appointment of antibiotics (penicillin, streptomycin, biomycin) in dosages corresponding to the age and weight of the child.

Methods of prevention have not been studied. The disease apparently leaves lifelong immunity.

Literature for Chapter XIII. Acute infectious erythema [show]

There are many diseases that affect the skin and manifest as a rash. Roseola rosea refers to similar pathologies and can develop in children from the first months of life and adults.

The disease has many synonyms - the sixth disease, pseudorubella, children's three-day fever, roseola infantum. The ICD-10 code is B-08.2 "Sudden exanthema."

What is this disease?

At risk for the development of pseudorubella are children under 2 years old, often the disease is diagnosed in infants. The peak incidence occurs between the ages of 6 months and 2 years - about 70% of children suffer from pseudorubella.

In young children, roseola pink is an independent viral pathology, and in adults it is just a symptom of another systemic disease - syphilis.

Syphilitic roseola in adults is not caused by the lymphotropic herpes virus, but by pale treponema and is transmitted through sexual and household contacts.

The cause of the development of the disease lies in the ingress of the pathogen into the body, classical route of infection - airborne.

The herpes virus type 6 is transmitted from a sick person and easily penetrates the nasopharynx, actively multiplies on the mucous membranes, quickly penetrating into the general bloodstream.

The incubation period lasts from 1 to 2 weeks. After the rapid multiplication of the pathogen, the body produces immune agents in response to the penetration of the virus. This is how childhood illness develops.

Often, pseudorubella develops in infants during teething or after vaccination, when natural immunity is weak.

The causes of the development of the disease in adults are associated with the ingestion of pale treponema on the mucous membranes during sexual intercourse or through small wounds on the skin.

The incubation period is longer than with the childhood form of roseola - from 2 to 4 weeks.

The classic signs of pseudorubella in a child include a febrile syndrome and skin rashes directly.

Main symptoms:

If the disease occurs in a weakened child, additional symptoms may appear:

• red throat and feeling of itching;
• weak cough;
• tongue coated with white coating;
• short-term diarrhea;
• general malaise - a capricious child during a fever may refuse to eat, sleep poorly, look pale and tired, lethargic;
• swelling of the eyelids.

Doctor Komarovsky will tell about the symptoms of roseola in children:

Pseudo-rubella: contagious or not for others?

The contagious period for pseudorubella lasts from the beginning of the incubation period until the temperature drops.

After the temperature has stabilized and the first rashes appear on the face, a roseola patient does not pose a danger to others.

The period of contagiousness in adults is much longer due to the long incubation period and slow activation of the virus.

In most cases, after the transfer of pseudorubella, especially in childhood, 100% immunity is produced in the body and there is no likelihood of a relapse.

In exceptional cases, re-infection is possible:

• weak immune defense or immunodeficiency;
• use in the treatment of hormones that prevent the synthesis of antibodies to the causative agent of roseola.

Roseola is most often confused with rubella. The main difference is that with rubella, the rash covers the entire body from the first days of illness, the rash and temperature are combined, in contrast to sudden erythema.

Other pathologies that are important to distinguish from pseudorubella:

stages

Pink roseola in children proceeds in several stages:

• latent - lasts from 48 to 72 hours, is associated with the entry of the pathogen into the systemic circulation;
• exanthema - directly the appearance of elements of the rash, duration - from 72 to 96 hours;
• recovery - relief of all negative symptoms, duration - up to 96 hours.

Diagnosis of three-day fever

If you suspect pseudorubella in a child, it is important to contact a pediatrician in a timely manner and consult an infectious disease specialist.

The list of studies to confirm the diagnosis of "sixth disease":

• general analysis of blood and urine;
• PCR to detect herpes virus.

If there is a suspicion of syphilitic roseola, adults need to be examined by a dermatologist and venereologist.

As accurately as possible, pathology can be diagnosed using tests for the detection of antibodies to pale treponema - PCR, ELISA, blood serology.

You can treat pseudorubella in children at home. Infantile roseola proceeds in uncomplicated forms and is amenable to symptomatic therapy:

Infectious pseudorubella in adults requires serious treatment. The main direction is the suppression and elimination of pale treponema. For this, antibiotics are used.

The head physician of the Pediatric Plus outpatient clinic, Andrey Penkov, will talk about the treatment of roseola:

How to treat babies and pregnant women

Infants tolerate roseola rosea in mild or moderate severity. It happens that in infants the temperature does not rise to high readings, but keeps around 37.5-37.9 °.

The treatment of infants is aimed at correcting the temperature, other medicines (including immunomodulators) are not needed by the child's body. After recovery, pseudorubella will no longer recur.

Occasionally there are cases of infection with roseola in pregnant women, which is due to a decrease in immunity in a woman during the period of bearing a child.

The herpes virus type 6 itself is not dangerous for the expectant mother and fetus. But for pregnant women, fever is dangerous in the first 3 days of illness.

Therefore, the goal of treatment is to bring down the temperature and increase immunity.

For this, paracetamol-based antipyretics (at the minimum dosage) and vitamin-mineral complexes for pregnant women are shown. Plus bed rest.

Expert opinion of Dr. Komarovsky

Dr. Komarovsky considers roseola rosea a unique disease that is not uncommon, but the true diagnosis of "sudden exanthema" is almost never made by pediatricians.

Komarovsky explains this by the peculiar course of the disease and the similarity of the clinical picture with other viral infections.

Evgeny Olegovich claims that no medical treatment is required for roseola in children. Medicines for fever are the only thing that can be given to the baby.

For the rest - drinking plenty of water, light food (soups, vegetable purees, fish) and a calm regimen will help you recover faster.

Is it possible to bathe a child and walk with him

Roseola rosea is distinguished by an unusual clinical course, a period of significant temperature increase is replaced by relative well-being in the child's condition, although it is accompanied by rashes.

During the period of temperature fever, the child's well-being worsens, at high readings (over 38.5 °) walks are prohibited required bed rest.

After the temperature drops and the rash appears, the state of health improves, it is possible and even useful to walk.

Question about bathing children with pseudo-rubella is relevant for parents. Bathing should not be carried out at the initial stage of the disease and elevated temperature.

It is better to simply, if necessary, wipe the child with a napkin moistened with warm water, wash hands and face, and genitals. After the temperature stabilizes, you can bathe children with roseola.

For a sudden exanthema, the development of serious complications is not typical. In children under one year old, the main danger of roseola is associated with high fever and the risk of developing convulsive syndrome.

Other complications include:

• inflammation in the middle ear, or otitis;
• encephalitis - brain damage;
• gastrointestinal upset - diarrhea, nausea, vomiting;
• swelling on the eyelids.

Prevention

Since the infection often affects children and adults against the background of reduced immune protection, prevention is aimed at strengthening immunity:

• regular walks;
• high physical activity (by age);
• hardening procedures;
• rational fortified nutrition;
• optimal alternation of work and rest.

The ways of infection with roseola rosea are associated with close contacts, therefore, an important role in prevention belongs to the timely isolation of the sick person from the team.

- a skin disease that is a local response of human skin to the appearance of a pathogen.

The appearance of this disease is mainly affected by children, since the provocateur of exanthema is most often "childhood diseases" - measles, scarlet fever, rubella, chickenpox. In adults, viral exanthema can be caused by the same infections, and in addition - herpes, cytomegalovirus.

Symptoms of exanthema

The main symptom of exanthema is the presence of a skin rash. Its appearance depends on the viral pathogen and is divided into types.

morbilliform exanthema

It is named so because of its similarity with rashes during measles. These are single red spots with papules and vesicles. It is possible to combine them into groups. Such a rash is characteristic of infection with viruses:

• rubella;
• roseola;
• enterovirus;
• infectious mononucleosis.

It begins with a manifestation on the face of the neck, gradually descending to the body.

Lace exanthema

Lacy rashes are characteristic of diseases caused by parvovirus B19. The rash appears on the face in small foci, which subsequently merge into one. After 3-4 days, the rash appears on the body, mainly in the elbow and knee folds, also forming spots, the appearance of which, as it recovers, begins to take the form of lace.

Scarlatiniform exanthema

The rash is caused by:

• hepatitis B and C viruses;
• adenoviruses;
• enteroviruses.

It is localized mainly on the limbs - palms, feet.

Pemphigus

Bubble rashes are characteristic of herpes and chicken pox viruses.

Sudden exanthema

This type of exanthema provokes the herpes virus 6. It is characterized by a sharp onset with high fever, swollen cervical lymph nodes, swelling of the face and eyes, and diarrhea. On the second day, a bubble rash forms, after which the temperature begins to subside and recovery occurs on the 7-8th day. This disease affects children under one year old.

Other manifestations of the rash

In areas of the body with low temperature (ears, nose, fingers and toes, buttocks), rashes caused by cytomegalovirus, coxavirus A16, Epstein-Barr virus, hepatitis B may appear.

Against the background of the main symptoms of viral exanthema, manifestations of febrile conditions are possible, which begin 1-2 days before the appearance of the rash and disappear after its formation. With viral exanthema, there are often no cold symptoms (nasal congestion, cough, lowering of the general tone).

Treatment of viral exanthema

The term of the disease, as a rule, lasts from 2 to 3 weeks. Treatment for viral exanthema depends on the virus that caused the skin reaction. In almost all cases, an external diagnosis of a rash against the background of concomitant symptoms is sufficient. In some cases, to confirm the diagnosis, the doctor may write a referral for a blood test or material sampling by scraping.

The main treatment for viral exanthema is to relieve symptoms:

1. With rubella, scarlet fever, measles, bed rest, antipyretics and antihistamines are prescribed.
2. Chicken pox in children can only be expressed by the appearance of an itchy rash, for drying which a solution of manganese, brilliant green is used. It is possible to take baths with the addition of a series. In adults, chickenpox is quite difficult, and analgesics and antipyretics are prescribed.
3. With herpetic eruptions, Acyclovir is prescribed in the form of an ointment.

Exanthema is a skin rash that looks like spots, papules, vesicles. Such pigmentations are characteristic of most infectious, viral diseases, often found in drug allergies. Sudden exanthema is observed with measles, rubella, scarlet fever. Sudden exanthema looks like a rash of various shapes and sizes, often occurs in children. Exanthema in adults in most cases is allergic in nature.

Symptoms and treatment will depend on the specifics of the underlying disease and its pathogen. The underlying disease is diagnosed after a visual examination, and additional studies may be prescribed to determine the cause of the rash, which will help clarify the full picture of the disease.

The children's form of skin rashes very rarely has complications with timely treatment, but childhood diseases in adulthood are much more difficult, and all kinds of complications are almost always observed in the form of a very high temperature, scars on the skin, which can adversely affect the cardiovascular system.

The treatment will be medication and is aimed at getting rid of the infection or viruses, normalizing the temperature, alleviating the rash.

Etiology

Exanthema is skin rashes of various shapes, sizes and localizations. It occurs in young children, less often in adolescents. The causes of the syndrome will depend on the pathogen.

The main causes of rashes in children are:

• 6 and 7 types;
• enteroviruses Coxsackie A, Coxsackie B;
• seasonal viral diseases - respiratory diseases;
• (A group);
• viruses;
• allergic reactions to medications.

Exanthema and enanthema are not the same thing, so it is necessary to distinguish between these two concepts. The first affects the outer skin, and the second pathology refers to the mucous membrane. Infectious and viral illnesses can combine these two forms and appear either separately or together.

Unlike children, sudden exanthema in adults is more often associated with an allergic reaction to drugs. When prescribing treatment, children are constantly prescribed antihistamines, so an allergic reaction is very rare in them.

The main cause of diseases of this type is a weak immune system, the herpes virus. In most cases, the pathology manifests itself after severe respiratory infections, when the body is severely weakened.

Classification

The types of exanthema directly depend on the causative agent of the underlying disease, and it can be an infection, a virus, an allergy. Consider the main types of rashes.

Sudden exanthema in children is of viral origin, occurs in children under 5 years of age. The disease begins with a high temperature, after which a rash similar to is found on the child's body, and the spots look like maculopapular. This type of disease is absent in adults. The main causative agent is the herpes virus type 6, which can be transmitted from a sick child to a healthy one, more common in spring and autumn. Transmission of the herpes virus can also be carried out from adults to children.

The incubation period covers 10 days, and the disease can manifest itself:

• runny nose;
• enlarged lymph nodes in the neck;
• diarrhea
• swelling of the upper eyelids;
• enanthem in the mouth.

Rashes are roseolous, macular, or a maculopapular rash appears with a pink color and a small diameter of up to 3 millimeters.

Viral exanthema in children is observed after most viral diseases, the cause may be seasonal diseases in winter. In summer, it is more often associated with pathogens of enterovirus infection. It is characterized by polymorphism, the rash has a morbilliform appearance and is combined with swelling of the eyelids, enlarged lymph nodes.

Exanthem with measles is one of the varieties of rashes on the background of a viral infection. It is transmitted from a sick person to a healthy person by airborne droplets, and after the illness, a strong immunity is developed. A respiratory virus can cause pinkish spots that may coalesce. When a child has combined skin rashes with itching and, then adenoviral sudden exanthema is diagnosed.

Unilateral laterothoracic exanthema - it is characterized by a viral nature, and the disease begins with a high fever, cough. A red rash is determined on one side in the chest area or near the armpit, itching may appear. The rash goes away after only two months.

Enteroviral exanthema - it is characterized by a generalized skin lesion with small papules. The causative agent is ECHO viruses that cause fever and symptoms with. After fever, a diffuse rash appears all over the body.

Vesicular exanthema - is one of the varieties of enterovirus infection, manifests itself on the phalanges of the hands and feet. The rash is no more than 3 millimeters with a hyperemic corolla, on the mucous membrane it manifests itself in single aphthous rashes.

Infectious exanthema - affects the hands and feet, less common on the mucosa. The temperature does not rise much, the symptoms of intoxication are not clearly expressed.

Drug exanthema - can manifest itself in patchy, papular, vesicular rashes that may look like nodules. Occurs on the basis of an allergic reaction to any drug or is associated with individual intolerance to one of the components.

Scarlatiniform exanthema - manifests itself in a small dotted rash, more often after the use of penicillin, barbiturates, drugs for treatment. Measles exanthema with irregular red and pink spots, may appear after the use of antibiotics, in which case the temperature rises rarely. Sudden exanthema quickly resolves within 2 or 3 days after taking antiallergic drugs.

Symptoms

Signs of skin rashes will depend on the underlying disease.

At the beginning of the disease appears:

• increased body temperature;
• chills, fever;
• cough;
• runny nose;
• nausea;
• severe weakness;
• drowsiness or insomnia;
• nasal congestion;
• stool disorder;
• enlargement of the cervical lymph nodes;
• convulsions;
• poor appetite.

After this, secondary symptoms occur, that is, a skin rash can take the following forms:

• dotted, spotted;
• distributed throughout the body or with precise localization in certain areas;
• the nature of the rash is roseolous, macular or maculopapular;
• the rash can be on the skin or mucous membranes;
• color of rashes from pink to bright red.

During the period of rashes, the child's well-being improves markedly, but specific treatment is required, and then a specialist consultation is necessary.

Infectious exanthema in children goes away on its own after 4 days, but the high temperature can last for about a week, which exhausts the child and requires a long recovery. The nature of the rash combines measles, scarlet fever, rubella.

Therefore, the main difficulty lies in making an accurate diagnosis and differentiation from the entire array of skin rashes.

Diagnostics

Exanthema syndrome is set after the first examination by a specialist, but determining the cause of the rash is to study the medical history and conduct additional research.

Rash studies:

• papules or small pink spots no more than 5 millimeters with a slight rise from the skin surface are characteristic of sudden exanthema;
• merging skin rashes similar to scarlet fever, measles with enlarged lymph nodes indicate a virus-like exanthema.

Infectious exanthema disappears on its own and cannot be determined by the nature of the rash.

It is necessary to carry out additional procedures for differentiation:

• blood analysis;
• throat swabs;
• analysis of urine and feces;
• rash biopsy.

After all the events, the doctor makes a final diagnosis and prescribes treatment.

Treatment

Most skin rashes resolve on their own within a week and require only supportive care. To prevent further spread, it is necessary to isolate the child until recovery.

Supportive care includes the following activities:

• treatment of rashes from itching;
• a plentiful drink is prescribed;
• constant wet cleaning is carried out;
• antipyretics and antihistamines are prescribed.

Sudden exanthema produces lifelong immunity in the patient, and therapy is supportive in the same way as with an infectious rash.

With measles, general hygiene of the eyes and mucous membranes must be observed. Therapy is supportive, with Interferon often prescribed. When a secondary infection is attached, antibiotics are prescribed.

With scarlet fever, a diet, bed rest is prescribed, and Penicillin helps well from drugs, gargling with furatsilin, chamomile is prescribed.

Possible Complications

Exanthema rarely leads to serious consequences, in most cases it goes away on its own and does not require specific treatment.

Complications are with measles:

• secondary;

The disease is difficult to tolerate by adults and can lead to the development, or provoke autoimmune diseases. can call or .

Prevention

Exanthema in children is common, but with the observance of preventive measures, it is possible to prevent the spread of infection:

• isolate the child from healthy children;
• constantly ventilate the room;
• carry out wet cleaning;
• observe the rules of hygiene.

It is necessary to strengthen the child's immunity, eat healthy food, take vitamin complexes during beriberi, vegetables, fruits, proteins, vegetable and animal fats should be present in food.

Is everything correct in the article from a medical point of view?

Answer only if you have proven medical knowledge