Signs and Symptoms

  • Fever
  • Muscle Rigidity
  • Shivering
  • Headaches
  • Vomiting
  • Rash, Which Develops into Pustular Lesions
Smallpox was a systemic viral disease that generally presented with a characteristic skin eruption. Onset was sudden, with fever, malaise, headache, prostration, severe backache, and occasional abdominal pain and vomiting - a clinical picture that resembled influenza. After 2 to 4 days, the fever began to fall and a deepseated rash developed in which individual lesions containing infectious virus progressed through successive stages of macules, papules, vesicles, pustules, and crusted scabs, which fell off after 3 to 4 weeks. The lesions were first evident on the face and extremities and subsequently on the trunk. Two epidemiologic types of smallpox were recognized during the twentieth century: variola minor (alastrim), which had a case-fatality rate of less than 1 percent, and variola major (ordinary) with a fatality rate among unvaccinated populations of 20 to 40 percent or more. Fatalities normally occurred in 5 to 7 days, occasionally as late as the second week.
Clinical manifestations begin acutely with malaise, fever, rigors, vomiting, headache, and backache. Two to 3 days later, lesions appear which quickly progress from macules to papules, and eventually to pustular vesicles. They are more abundant on the extremities and face, and develop synchronously.
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