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Measles and rubella misdiagnosed in infants as exanthem subitum (roseola infantum)

BMJ 1996; 312 doi: (Published 13 January 1996) Cite this as: BMJ 1996;312:101

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  1. Dereck R Tait, senior registrara,
  2. Katherine N Ward, senior lecturer/honorary consultanta,
  3. David W G Brown, consultant virologistb,
  4. Elizabeth Miller, consultant epidemiologistc
  1. a Department of Virology, Royal Postgraduate Medical School, University of London, London W12 0NN
  2. b Enteric and Respiratory Virus Division, Virus Reference Division, Public Health Laboratory Service Central Public Health Laboratory, London NW9 5HT
  3. c Immunisation Division, PHLS, Communicable Disease Surveillance Centre, London NW9 5EQ
  1. Correspondence to: Dr Ward.
  • Accepted 5 October 1995

Human herpesvirus-6 is widespread throughout human populations, with primary infection usually occurring in infants aged 40-60 weeks.1 Primary infection may be asymptomatic but where there is disease the classic presentation is of the common childhood illness exanthem subitum (roseola infantum).2 This begins with a sudden fever of about 40°C perhaps accompanied by febrile convulsions; the child appears surprisingly well with few other clinical findings apart from leucopenia. The fever resolves after three to five days coincident with the sudden appearance of a finely macular rose rash that may be transient but usually persists for two days. The exanthem is prominent over the thighs and buttocks, where each macule is sometimes surrounded by a fine halo. Despite detailed descriptions, however, exanthem subitum tends to be confused with measles and rubella.3 Two recent studies have shown that measles and rubella are themselves commonly misdiagnosed,4 5 with only 11% of clinical cases …

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