PrepTutorEJDIC

(1歳未満の)『乳児』,乳飲み子 / 《英》(普通7歳未満の)学童 / 未成年者 / 幼児の,幼児用の / 始めたばかりの,初期の

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/11/04 22:40:17」(JST)

wiki en

Roseola on a 21-month-old girl

Exanthema subitum (meaning sudden rash), also referred to as roseola infantum (or rose rash of infants), sixth disease (as the sixth rash-causing childhood disease), and (confusingly) baby measles, or three-day fever, is a disease of children, generally under two years old,^[1] although it has been known to occur in eighteen year olds, whose manifestations are usually limited to a transient rash ("exanthem") that occurs following a fever of about three day's duration.

It is frequently called roseola, although this term could be applied to any rose-colored rash.^[2]^{[not in citation given]}

It is caused by two human herpesviruses, HHV-6 (Human herpesvirus 6) and HHV-7, which are sometimes referred to collectively as Roseolovirus. There are two variants of HHV-6 (HHV-6a and HHV-6b) and studies in the US, Europe, Dubai and Japan have shown that exanthema subitum is caused by HHV-6b. This form of HHV-6 infects over 90% of infants by age 2. Research has shown that babies can be congenitally infected with HHV-6 via vertical transmission.^[3] This has been shown to occur in 1% of births in the United States.^[4]^[5]

Clinical features

Typically the disease affects a child between six months and two years of age, and begins with a sudden high fever (39–40 °C; 102.2-104 °F). This can cause, in rare cases, febrile convulsions (also known as febrile seizures or "fever fits") due to the sudden rise in body temperature, but in many cases the child appears normal. After a few days the fever subsides, and just as the child appears to be recovering, a red rash appears. This usually begins on the trunk, spreading to the legs and neck. The rash is not itchy and may last 1 to 2 days.^[6] In contrast, a child suffering from measles would usually appear more infirm, with symptoms of conjunctivitis, coryza, and a cough, and their rash would affect the face and last for several days. Liver dysfunction can occur in rare cases.

The rare adult reactivates with HHV-6 and can show signs of mononucleosis.^[7]

Vaccines and treatment

There is no specific vaccine against or treatment for exanthema subitum, and most children with the disease are not seriously ill. A child with fever should be given plenty of fluids to drink. Paracetamol/acetaminophen or ibuprofen could be given to reduce their temperature (but never aspirin, due to the risk of Reye's Syndrome^[8]).

A small percent of children acquire HHV-6 "subclinically"; in other words, they show no outward sign of the disease. Exanthema subitum occurs in approximately 30% of children during primary HHV-6 infection.^[9] Others may be debilitated enough that a doctor's opinion is required to confirm the diagnosis, and particularly to rule out other more serious infections, such as meningitis or measles. In case of febrile seizures, medical advice is essential.

For HHV-6 infection, no pharmacological treatments have been approved as of June 2012. Although they may be unnecessary for exanthema subitum, the usage of Cytomegalovirus treatments (valganciclovir, ganciclovir,^[10] cidofovir, and foscarnet) have shown some success.^[11] These drugs are given with the intent of inhibiting proper DNA polymerization by competing with deoxy triphosphate nucleotides^[10] or specifically inactivating viral DNA polymerases.^[12]

Local terms

Country	Local name (language)	Translated name
Belgium	Driedagenkoorts (Dutch) Zesde ziekte (Dutch) Roséole (French)	"three-day fever" "sixth disease" -
China (PRC)	急疹 (Mandarin) jí zhěn (pinyin)	"fast rash"
Czech republic	Šestá nemoc (Czech)	"sixth disease"
Finland	Vauvarokko (Finnish)	"baby measles"
Germany	Dreitagefieber (German)	"three-day fever"
Greece	Αιφνίδιο εξάνθημα (Greek)	"sudden rash"
Hungary	Háromnapos láz (Hungarian) Hatodik betegség (Hungarian)	"three-day fever" "sixth disease"
Iceland	Mislingabróðir (Icelandic)	"measles' brother"
Italy	Sesta malattia (Italian)	"sixth disease"
Netherlands	Zesde ziekte (Dutch)	"sixth disease"
Norway	Fjerde barnesykdom (Norwegian)^[13]	"fourth disease"
Philippines	Tigdas Hangin (Tagalog)	"wind measles"
Poland	Trzydniowa goraczka (Polish)	"three-day fever"
Singapore/Malaysia	Jia3 Ma2 假麻 (Chinese)	"false measles"
Turkey	Altıncı hastalık (Turkish)	"sixth disease"
Israel	Adamdemet / אדמדמת (Hebrew)	"reddish disease"
Vietnam	Sốt phát ban (Vietnamese)	"baby rash"

References

^ Zerr DM, Meier AS, Selke SS, et al. (February 2005). "A population-based study of primary human herpesvirus 6 infection". N. Engl. J. Med. 352 (8): 768–76. doi:10.1056/NEJMoa042207. PMID 15728809. http://content.nejm.org/cgi/content/abstract/352/8/768.
^ "exanthema subitum" at Dorland's Medical Dictionary
^ Universal childhood virus is inherited in DNA, newscientist.com
^ Flamand, Louis. "Review, part1:Human herpesvirus-6-basic biology, diagnostic testing, and antiviral efficacy". Journal of medical virology 82 (9): 1560.
^ Lymphohistiocytic activation syndrome and Burkholderia cepacia complex infection in a child revealing chronic granulomatous disease and chromosomal integration of the HHV-6 genome.
^ Roseola – Topic Overview, webmd.com
^ 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. http://arjournals.annualreviews.org/doi/abs/10.1146/annurev.med.51.1.423?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dncbi.nlm.nih.gov.
^ What is the role of aspirin?, reyessyndrome.org
^ Zerr, Danielle M. et al. A population-based study of primary human herpesvirus 6 infection., N Engl J Med 2005; 352:768-776
^ ^a ^b Nakano (2009). Detection and identification of U69 gene mutations encoded by ganciclovir-resistant human herpesvirus 6 using denaturing high-performance liquid chromatography.
^ Flamand, Louis (2010). "Review, part 1: Human herpesvirus-6-basic biology, diagnostic testing, and antiviral efficacy". journal of medical virology 82 (9): 1560.
^ Jaworska J, Gravel A, Flamand L. Divergent susceptibilities of human herpesvirus 6 variants to type I interferon PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA 107 (2010): 8369-8374.
^ Nylander, Gro (2009) "Lille venn, hva nå?"

External links

MedlinePlus encyclopedia entry on "roseola"
Links to roseola pictures, Hardin MD/Univ of Iowa
Newly Found Herpes Virus Is Called Major Cause of Illness in Young, New York Times
HHV-6 Foundation
DermNet viral/roseola

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 小児ばら疹（突発性発疹） roseola infantum exanthem subitum
2. 小児におけるヒトヘルペスウイルス6感染：臨床症状、診断および治療 human herpesvirus 6 infection in children clinical manifestations diagnosis and treatment
3. 複視の概要 overview of diplopia
4. Surgical resection of sporadic pancreatic neuroendocrine tumors
5. 視覚変化が認められた小児患者に対するアプローチ approach to the pediatric patient with vision change

English Journal

Catastrophic Kawasaki disease unresponsive to IVIG in a 3-month-old infant: a diagnostic and therapeutic challenge.

Magalhães CM, Alves NR, Melo AV, Silveira Junior CA, Nobrega YK, Gandolfi L, Pratesi R.AbstractABSTRACT: The present report describes the severe evolution of Kawasaki disease in a three-month-old infant. The ailment was initially atypical in its presentation, with the patient exhibiting only persistent fever in association with a progressive lethargy and maculopapular rash on the face, trunk and limbs erroneously diagnosed as roseola infantum. On the 10th day of the condition, mainly due to the unexplained persistence of fever, the infant was admitted to a local hospital. The typical features of KD appeared only on the 14th day of illness with the relapse of the maculopapular rash in association with non-purulent conjunctivitis; dry, reddish and fissured lips; tongue with reddish and hypertrophic papillae; erythema and edema of the palms and soles. During the following days, the ailment rapidly evolved to a catastrophic clinical picture characterized by generalized vasculitis, splenic infarction, pulmonary thrombosis, giant right and left coronary aneurysms, dilatation of common and internal iliac arteries and progressive ischemia of the distal third of the feet resulting in necrotic lesions of both halluces. Appropriate therapy was initiated, but repeated administration of intravenous immunoglobulin G (IVIG) followed by three days of administration of methylprednisolone did not abate the intense inflammatory activity. The remission of inflammation and regression of vascular lesions were only achieved during the following five weeks after the introduction of methotrexate associated with etanercept. The report of this case aims to draw attention to severe forms of KD that exhibit an unfavorable evolution and can be extremely refractory to the conventional therapy.
Pediatric rheumatology online journal.Pediatr Rheumatol Online J.2012 Aug 28;10(1):28. [Epub ahead of print]
ABSTRACT: The present report describes the severe evolution of Kawasaki disease in a three-month-old infant. The ailment was initially atypical in its presentation, with the patient exhibiting only persistent fever in association with a progressive lethargy and maculopapular rash on the face, trunk
PMID 22929725

Simultaneous presence of human herpesvirus 6 and adenovirus infections in intestinal intussusception of young children.

Lappalainen S, Ylitalo S, Arola A, Halkosalo A, Räsänen S, Vesikari T.SourceVaccine Research Center, University of Tampere Medical School, Tampere, Finland.
Acta paediatrica (Oslo, Norway : 1992).Acta Paediatr.2012 Jun;101(6):663-70. doi: 10.1111/j.1651-2227.2012.02616.x. Epub 2012 Feb 21.
AIM: This prospective study investigated the role of viral infections in the pathogenesis of intussusception, including human herpesvirus 6 (HHV-6), a known lymphotropic virus.METHODS: Fifty-three children with intussusception treated in hospital were enroled, and children of comparable age and gend
PMID 22296119

Japanese Journal

五類感染症(定点把握) 突発性発疹 (新感染症学(下)新時代の基礎・臨床研究) -- (感染症法分類--発症・病態・診断・治療)

多屋馨子
日本臨床 65(-) (911), 349-354, 2007-03
NAID 40015386811

Clinical features of infants with primary human herpesvirus 6 infection (exanthem subitum, roseola infantum)

ASANO Y
Pediatrics 93, 104-108, 1994
NAID 10004998528

Clinical and virological analyses of 21 infants with exanthema subitum (roseola infantum) and central nervous system complications

SUGA S.
Ann Neurol 33, 597-603, 1993
NAID 30008832059

Related Pictures

★リンクテーブル★

リンク元	「突発性発疹」「exanthema subitum」「小児ばら疹」
関連記事	「infantum」「roseola」

「突発性発疹」

Roseola
	Classification and external resources
	; Electron micrograph of HHV-6
ICD-10	B08.2
ICD-9	057.8
DiseasesDB	5857
MedlinePlus	000968
eMedicine	emerg/400 derm/378 ped/998
MeSH	D005077

　　[★]

ラ: exanthema subitum, ES
同: 突発性発疹症、小児バラ疹 roseola infantum [[]]、第六病 sixth disease
関: ヒトヘルペスウイルス6, ヒトヘルペスウイルス7

病原体

潜伏期間

約2週間(NDE.440)。約10日

疫学

1-2歳まででほとんどが感染
症例の90%が1歳以下で発症

感染経路

唾液
成人咽頭由来のウイルス

症状

発熱(38-39℃)
発疹：麻疹様の全身性発疹で癒合せずに色素沈着を残さず2-3日で消退(NDE.440)　←　むしろ風疹ぽくない？
軟便～下痢
軽度の咳
少数例で発熱時に熱性痙攣

合併症

まれに脳炎、肝障害

経過

全経過は4-6日
発熱(38-39℃)→3-4日持続
解熱後、顔面と体幹に麻疹様発疹を呈する　→　2-3日で消退

治療

対症療法

予後

良好

参考

1. [charged] Roseola infantum (exanthem subitum) - uptodate [1]
2. 症状 - 写真

http://www.nct9.ne.jp/kodomo-c/newpage48.htm

国試

105I054

「exanthema subitum」

　　[★]

突発性発疹、突発性発疹症

関: exanthem subitum、roseola、roseola infantum

「小児ばら疹」

　　[★]

ラ: roseola infantum
関: 突発性発疹

「infantum」

　　[★]

adj.

(children)小児の

関: child、children

「roseola」

　　[★]

関: exanthem subitum

関: exanthem subitum

[pmid15728809-0] Zerr DM, Meier AS, Selke SS, et al. (February 2005). "A population-based study of primary human herpesvirus 6 infection". N. Engl. J. Med. 352 (8): 768–76. doi:10.1056/NEJMoa042207. PMID 15728809. http://content.nejm.org/cgi/content/abstract/352/8/768.

[1] "exanthema subitum" at Dorland's Medical Dictionary

[2] Universal childhood virus is inherited in DNA, newscientist.com

[3] Flamand, Louis. "Review, part1:Human herpesvirus-6-basic biology, diagnostic testing, and antiviral efficacy". Journal of medical virology 82 (9): 1560.

[4] Lymphohistiocytic activation syndrome and Burkholderia cepacia complex infection in a child revealing chronic granulomatous disease and chromosomal integration of the HHV-6 genome.

[5] Roseola – Topic Overview, webmd.com

[pmid10774474-6] 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. http://arjournals.annualreviews.org/doi/abs/10.1146/annurev.med.51.1.423?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dncbi.nlm.nih.gov.

[7] What is the role of aspirin?, reyessyndrome.org

[8] Zerr, Danielle M. et al. A population-based study of primary human herpesvirus 6 infection., N Engl J Med 2005; 352:768-776

[Nakano_2009-9] Nakano (2009). Detection and identification of U69 gene mutations encoded by ganciclovir-resistant human herpesvirus 6 using denaturing high-performance liquid chromatography.

[10] Flamand, Louis (2010). "Review, part 1: Human herpesvirus-6-basic biology, diagnostic testing, and antiviral efficacy". journal of medical virology 82 (9): 1560.

[11] Jaworska J, Gravel A, Flamand L. Divergent susceptibilities of human herpesvirus 6 variants to type I interferon PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA 107 (2010): 8369-8374.

[12] Nylander, Gro (2009) "Lille venn, hva nå?"

匿名

検索

案内

案内

roseola infantum