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ROSEOLA INFANTUM an OUTBREAK in a MATERNITY HOSPITAL by URSULA JAMES, M.B., M.R.C.P., and A

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ROSEOLA INFANTUM an OUTBREAK in a MATERNITY HOSPITAL by URSULA JAMES, M.B., M.R.C.P., and A Arch Dis Child: first published as 10.1136/adc.24.117.54 on 1 March 1949. Downloaded from ROSEOLA INFANTUM AN OUTBREAK IN A MATERNITY HOSPITAL BY URSULA JAMES, M.B., M.R.C.P., and A. FREIER, M.B., B.S. (From the General Lying In Hospital, London) Roseola infantum was first described by Zahorsky onset, but generally there is remarkably little (1910), and since this time cases have been recorded constitutional disturbance. Conte et al. (1944) by many writers both in America and Europe but describe eighteen cases occurring in hospital over the disease has received little recognition in England. a ten-month period, and among these nine had It has been labelled exanthem subitum and sixth one to six convulsions at the onset. Most other disease but Zahorsky (1947) and others have put writers record fits much less often. forward a plea for the retention of the name roseola Glandular enlargement is described but does not infantum or the 'rose rash of infancy '. seem to be a constant finding, although Jennings The infectious nature of the disease was discussed (1940) stated that enlargement of the posterior by Barenberg and Greenspan (1939), who report cervical glands, without apparent cause in the scalp, it to be periodically epidemic in an institution for in an infant with a high temperature and with no children and describe an epidemic of twenty-seven other clinical findings should suggest the diagnosis cases occurring over a period of three months, the of roseola infantum, and in fact this sign led him to incidence of infection in the respective wards being diagnose 80 per cent. of his cases of this disease 35 per cent. and 45 per cent. The incubation period prior to the eruption. was five to fifteen days with an average of twelve Examination of the blood on the second or copyright. days. Cushing (1927) describes an epidemic in subsequent days may reveal leucopenia. In the Montreal with incubation periods between eight and cases described by Barenberg and Greenspan (1939) fourteen days. 50 per cent. showed leucopenia on the third day, Most cases occur during the first two years of life, 64 per cent. on the fourth day, and only 25 per cent. and the maximum incidence seems to be between on the seventh day. A relative lymphocytosis was six and eighteen months of age. Conte et al. (1944) present in 66 per cent. on the third day and in all two the cases on the fourth day. Zahorsky (1947) and found 95 per cent. of cases to be under years http://adc.bmj.com/ of age, and in the series described by Barenberg others stress that the lymphocytosis is only relative and Greenspan (1939) 93 per cent. were under this and that the important factor is the decrease in the age, the youngest being four months. Dickey (1945) polymorphonuclear cells. has seen one case at six weeks old, another at nine The mortality rate is nil, and the recovery is rapid weeks, and his oldest patient was a boy offour years. and complete. Zahorsky (1910) and Greenthal (1941) both cite The etiology has been discussed by Conte et al. cases aged eighteen years, and Cutts (1938) records (1944), who put forward three possibilities: a case aged thirty-one years which he regarded as (1) allergy, (2) grippe-like infection, (3) virus on September 28, 2021 by guest. Protected undoubtedly one of roseola infantum. infection. Most writers incriminate the virus Roseola infantum is characterized by an abrupt although Breese (1941) tried and failed to demon- onset with a rise oftemperature up to 103 or 104° F., strate a filterable virus in throat swabs from three which persists for two to five days and falls by of his cases. crisis. A rash appears usually as the temperature An Maternity Hospital falls but may be delayed for a few days. It is Epidemic in a from the The following description of an epidemic in a macular, rose pink in colour, and spreads maternity hospital of a disease conforming to trunk to the limbs and face, but is most profuse over descriptions of roseola infaptum is thought to be of the trunk; it reaches its maximum in twenty-four interest because such cases have not been recorded hours and fades during the next twenty-four hours, in England or in such young infants, and also usually without desquamation. because a proportion of the nurses, mothers, and The child may 1,5 fretful and irritable as the fathers were also affected. temperature rises, there may be convulsions at the The outbreak occurred between June 26 and 54 Arch Dis Child: first published as 10.1136/adc.24.117.54 on 1 March 1949. Downloaded from ROSEOLA INFANTUM 5.5 Ar.F IN DAYS T. (06 105 104 103 102 101 100 99 98 977 FIG. 1.-Case 7 and mother, temperature and weight. FIG. 2.-Case 15, temperature and weight. Aug. 7, 1948. During this period there were 144 infectivity rate among the babies on the affected babies in the hospital, but the epidemic was confined floor was 29 *2 per cent. to one floor of the hospital only, on which there New cases occurred at intervals of one to thirteen were sixty-five babies. Nineteen were thought to days (average two to three days), and the age of have roseola infantum, but in only sixteen was the onset was eight to twelve days (average eleven days). copyright. diagnosis definitely established by clinical findings In one doubtful case the pyrexia started on the fifth and by the typical temperature chart. In eight cases day of life, and another baby was eighteen days old (six infants and two mothers) the diagnosis was when the illness started. confirmed by the blood picture. The first two cases In addition five nurses working on the affected were at first labelled as 'pyrexia ofunknown origin', floor developed characteristic symptoms, and a and not until we had studied the disease more history of a similar illness was obtained from six closely did we include them in the series. The mothers and four fathers. Three mothers developed the disease while in hospital. http://adc.bmj.com/ AGE N DAYS All pineteen bab5ies with roseola infantum were 2 3 4 5 6 7 8 9 10 11 12 13 14 15 lb breast fed. A past history of having had rubella T. OZ. was obtained from three of their mothers, one of 13 whom developed symptoms and exanthem of 106 12 TEMPERATURE CONVULSION roseola infantum herself while in hospital. Of the 11I @- WEIGHT 1 RASHI remaining mothers, only three were able, to say 105 with certainty that they had not had rubella, and thirteen gave a history of measles and one of 104 glandular fever. on September 28, 2021 by guest. Protected 103 Clinical manifestations. The condition was characterized by high fever, rash, and glandular 102 enlargement, and in the majority of cases by an astonishing absence of any constitutional upset. 101 In the adults the clinical picture was rather different and -will be dealt with later. 100 TEMPERATURE. The temperature was an out- standing feature and indicated the onset of the 99 disease. There was a sharp rise to 1030 F. or higher (figs. 1, 2, 3); it remained up for twenty-four to 98 seventy-two hours, showing an occasional drop of 0 5 to 20, but rose again before the characteristic 97 fall by crisis. The temperature then remained FIG. 3.-Case 17, temperature and weight. normal except in ten cases, where there was a Arch Dis Child: first published as 10.1136/adc.24.117.54 on 1 March 1949. Downloaded from 56 7ARCHIYES OF DISEASE IN CHILDHOOD I -t @0 0 *I -0- SnO m 0 , ii _i I 2I5,I io -a3 ' I la 4aSr0,0 .9 es VM .1t S,a .E "I e0 I. ~o *g 0. 0) a 12 a A%. I 'c 1.1 ,o, g~~~~~-us,. 0 1.- ~.9 a l0 a I 0 a *Y g 0 § .2 0 09 i2 !S ao> .1 iis I0 0 *gal .2 I I 2 10C 0 I a +1 L + od I la I8I I i I I I -i . .+U2 I o.a N1 i-C I I I L- O'o" -4 - 0 t- @0 oo C-. NI_ I ._40 copyright. @00 z otk 0 -ot _oN , t V @0Go I .0 en t 00 ,>4- 3-R. 9.- N I' I 1@-V 9 a 00 coo http://adc.bmj.com/ -4 I a3 N N N A *Ii I i'I I I I 51i _ 10 I 0 1S0R I cis .E.. 5.4 .a3- 8§ cmI on September 28, 2021 by guest. Protected :1 9o3 O tS *So o4. .Al 0 I 08io8 8 I 0 00 :1 a Cb.. .2Q0 10I t8 g 54 01 -0 z5 3 P. co X O.Q 81 1 - 5S 04 . 0 .! 18 .42 ." N 1.! 1 0o QG1 gz -0 9 4 JI 1o *ce a . 0~ .5 L) I .i 0 0 0 _@0 a -S VI @5, I* Ir a .EO It I' g 0 0 o "C- 0 to 0o @ .w °. O N~ 0a 0 0oco - @0 I4 _I 00 co 1e 1- 4 - I -_! a I r- 1°c IO V co10 T" :2 -I Arch Dis Child: first published as 10.1136/adc.24.117.54 on 1 March 1949. Downloaded from ROSEOLA INFANTUM 57 second peak up to 100° F. about forty-eight hours Pathological investigations later which was only sustained for a few hours.
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