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]
| Disease | Cause | Typical Season | Typical Age | Prodrome | Fever | Duration of the rash (days) | Rash | Other Signs & Symptoms |
|---|---|---|---|---|---|---|---|---|
| Roseola Infantum (exanthem subitum) | Human herpes virus type 6 | Any season | 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 |
Winter - Spring | 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 | Spring | 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 | Spring | 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 | None | 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 | Winter - Spring | < 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 | Winter | > 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 |
Summer - Fall | 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 | 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 | Winter - Spring | < 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
- ↑ JURETIC M (1963). "Exanthema subitum a review of 243 cases". Helv Paediatr Acta. 18: 80–95. PMID 13958107.
- ↑ 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.
- ↑ Thompson, Amy E. (2015). "Recognizing Measles". JAMA. 313 (15): 1584. doi:10.1001/jama.2015.1889. ISSN 0098-7484.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Jayaprakash B, Sudha V, Shashikiran U (2006). "Atypical presentation of adult rubella". Med J Malaysia. 61 (2): 242–4. PMID 16898322.
- ↑ 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.
- ↑ "Epidemiology and Prevention of Vaccine-Preventable Diseases".