Given that a bulging fontanel is a well described physical finding in
viral conditions such as roseola (see below),
has anyone heard of managing entirely well-appearing febrile kids
without LP in this scenario? I have to believe
that some docs in their third decade of practice have gotten tired of
doing this procedure on kids who are
104 rectal, have a bulging fontanel with normal venous pulsations, and
appear to be auditioning for a Gerber
commercial during your exam (ie - smiling, cooing, laughing, flirting).
I think the LP I did tonight on such a 9 month
old brings my total number with this scenario to about seven.

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

Y Asano, T Yoshikawa, S Suga, I Kobayashi, T Nakashima, T Yazaki, Y
Kajita and T Ozaki

Department of Pediatrics, Fujita Health University School of Medicine,
Toyoake, Japan.

OBJECTIVE. To clarify clinical features of patients with primary human
herpesvirus 6 (HHV-6) infection (roseola infantum,
exanthem subitum) in a large-scale study. SUBJECTS AND METHODS. Clinical
signs and symptoms were analyzed in 176 infants in whom exanthem subitum
initially suspected and primary HHV-6 infection was later confirmed. The
infection was proved by isolation of the virus from blood, a significant
increase in the
neutralizing antibody titers to the virus, or both. RESULTS. The primary
HHV-6 infection, which occurred throughout the year, was observed in 94
boys and 82
girls (mean age, 7.3 months). Fever developed in 98% (mean maximum
fever, 39.4 degrees C) and lasted for 4.1 days. Macular or papular
rashes appeared in 98%,
on face, trunk, or both, mostly at the time of subsidence of the fever,
and lasted for 3.8 days. Other clinical manifestations occurred as
follows: mild diarrhea in 68%,
edematous eyelids in 30%, erythematous papules in the pharynx in 65%,
cough in 50%, and mild cervical lymph node swelling in 31%. Twenty-six
percent had
bulging of the anterior fontanelle and 8% had convulsions. CONCLUSIONS.
Clinical features of patients with virologically confirmed exanthem
subitum were
comparable with those described before discovery of HHV-6.

Volume 93, Issue 1, pp. 104-108, 01/01/1994

Jay Fisher MD

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