title: The predictive value of uvulo-palatoglossal junctional ulcers as an early clinical sign of exanthem subitum due to human herpesvirus 6.
abstract: BACKGROUND
  The clinical sign of uvulo-palatoglossal junctional (UPJ) ulcers was first noted in 1983 in a 5.5-month-old baby with exanthem subitum (ES). An earlier prospective clinical study showed that there was a strong association of UPJ ulcers and occurrence of ES with a positive predictive value of 95.3% and negative predictive value of 100%.
  
  
  OBJECTIVE
  To determine the value of uvulo-palatoglossal junctional (UPJ) ulcers as an early clinical sign of exanthem subitum (ES) due to human herpesvirus 6 (HHV 6) infection.
  
  
  METHODS
  A case-control study of 20 febrile children with UPJ ulcers versus 26 febrile children without UPJ ulcers. These children were followed up for any development of ES and investigated for human herpesvirus 6 (HHV 6) as the causative agents of the febrile episodes.
  
  
  RESULTS
  In this study, 20 out of 46 febrile children aged 3 months to 3 years with UPJ ulcers were virologically and/or serologically confirmed to be due to primary HHV 6 infection. The rest of the 26 children without ulcers did not have HHV 6 infection. Of the 20 children with UPJ ulcers, only 17 of the 19 children with adequate follow-up till subsidence of fever developed ES. None of the 26 children without UPJ ulcers developed ES.
  
  
  CONCLUSIONS
  Statistically, there was a significant association of UPJ ulcers as an early sign of ES with a positive predictive value of 89.5% and negative predictive value of 100%. This finding also suggests that the presence of UPJ ulcers is a useful pathognomic clinical sign of symptomatic primary HHV 6 infection.
authors.affiliation: Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. chuakb@medicine.med.um.edu.my
authors.forename: K B
authors.initials: KB
authors.lastname: Chua
authors.forename: S K
authors.initials: SK
authors.lastname: Lam
authors.forename: S
authors.initials: S
authors.lastname: AbuBakar
authors.forename: S T
authors.initials: ST
authors.lastname: Lim
authors.forename: M
authors.initials: M
authors.lastname: Paranjothy
authors.forename: M T
authors.initials: MT
authors.lastname: Koh
authors.forename: W S
authors.initials: WS
authors.lastname: Lee
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D016022:Case-Control Studies; D002675:Child, Preschool; D004279:DNA, Viral / Q000235:genetics; D005077:Exanthema Subitum / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D005260:Female; D015654:Herpesvirus 6, Human / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D007963:Leukocytes, Mononuclear / Q000821:virology; D008297:Male; D019226:Oral Ulcer / Q000821:virology*; D010159:Palate; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D012698:Serologic Tests; D014060:Tongue Diseases / Q000821:virology*; D014609:Uvula
chemical_list: D000914:Antibodies, Viral; D004279:DNA, Viral