Smallpox differential diagnosis: Difference between revisions

Jump to navigation Jump to search
m (Changes made per Mahshid's request)
 
(19 intermediate revisions by one other user not shown)
Line 4: Line 4:


==Overview==
==Overview==
Prior to its eradication, [[smallpox]] would need to be differentiated from other diseases that cause a [[vesicular]] [[rash]] and a [[fever]] including [[chickenpox]] (which was often mistaken for smallpox), [[herpes zoster]] and [[erythema multiforme]].
Prior to its eradication, [[smallpox]] would need to be differentiated from other diseases that cause a [[vesicular]] [[rash]] and a [[fever]] including [[chickenpox]] (which was often mistaken for smallpox), [[herpes zoster]] and [[erythema multiforme]].<ref name=CDC>{{cite web | title = Smallpox disease overview | url = http://www.bt.cdc.gov/agent/smallpox/overview/disease-facts.asp }}</ref>


==Differentiating Smallpox from other Diseases==
==Differentiating Smallpox from other Diseases==
Different [[rash]]-like conditions may be misdiagnosed with [[smallpox]], particularly during the initial [[maculopapular]] phase, including:<ref name="MooreSeward2006">{{cite journal|last1=Moore|first1=Zack S|last2=Seward|first2=Jane F|last3=Lane|first3=J Michael|title=Smallpox|journal=The Lancet|volume=367|issue=9508|year=2006|pages=425–435|issn=01406736|doi=10.1016/S0140-6736(06)68143-9}}</ref>


*[[Insect bite]]s - In an [[insect bite]], the insect injects [[formic acid]], which can cause an immediate [[skin]] reaction often resulting in a rash and swelling in the injured area, often with formation of [[vesicles]].
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
 
|+
*[[Kawasaki disease]] - commonly presents with high and persistent [[fever]], red [[mucous membranes]] in mouth, "[[strawberry tongue]]", [[swollen lymph nodes]] and [[skin rash]] in early disease, with peeling off of the [[skin]] of the [[hands]], [[feet]] and [[genital area]].
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}}
 
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
*[[Measles]] - commonly presents with high [[fever]], [[coryza]] and [[conjunctivitis]], with observation of [[oral mucosa|oral mucosal]] lesions ([[Koplik's spots]]), followed by widespread [[skin rash]].
|-
 
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Insect bite]]s'''
*[[Monkeypox]] - presentation is similar to [[smallpox]], although it is often a milder form, with [[fever]], [[headache]], [[myalgia]], [[back pain]], [[swollen lymph nodes]], a general feeling of discomfort, and exhaustion. Within 1 to 3 days (sometimes longer) after the appearance of [[fever]], the patient develops a papular [[rash]], often first on the face. The lesions usually develop through several stages before crusting and falling off.
| style="padding: 5px 5px; background: #F5F5F5;" | In an [[insect bite]], the insect injects [[formic acid]], which can cause an immediate [[skin]] reaction often resulting in a [[rash]] and swelling in the injured area, often with formation of [[vesicles]]
 
|-
*[[Rubella]] - commonly presents with a facial [[rash]] which then spreads to the [[trunk]] and [[limbs]], fading after 3 days, low grade [[fever]], swollen [[glands]], [[joint pain]]s, [[headache]] and [[conjunctivitis]]. The [[rash]] disappears after a few days with no staining or peeling of the [[skin]]. ''[[Forchheimer's sign]]'' occurs in 20% of cases, and is characterized by small, red [[papules]] on the area of the [[soft palate]].
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Kawasaki disease]]'''
 
| style="padding: 5px 5px; background: #F5F5F5;" | Commonly presents with high and persistent [[fever]], red [[mucous membranes]] in mouth, "[[strawberry tongue]]", [[swollen lymph nodes]] and [[skin rash]] in early disease, with peeling off of the [[skin]] of the [[hands]], [[feet]] and [[genital area]]
*Atypical [[measles]] - symptoms commonly begin about 7-14 days after infection and present as [[fever]], [[cough]], [[coryza]] and [[conjunctivitis]]. Observation of [[Koplik's spots]] is also a characteristic finding in measles.
|-
 
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Monkeypox]]'''
*[[Coxsackievirus]] - most commonly caused disease is the [[Coxsackie A]] disease, presenting with ''hand, foot and mouth disease''. It may be [[asymptomatic]] or cause mild [[symptoms]], or it may produce [[fever]] and painful [[blisters]] in the mouth (herpangina), on the palms and fingers of the hand, or on the soles of the feet. There can also be [[blisters]] in the throat, or above the tonsils. Adults can also be affected. The rash, which can appear several days after high temperature and painful sore throat, can be itchy and painful, especially on the hands/fingers and bottom of feet.
| style="padding: 5px 5px; background: #F5F5F5;" | Presentation is similar to [[smallpox]], although it is often a milder form, with [[fever]], [[headache]], [[myalgia]], [[back pain]], [[swollen lymph nodes]], a general feeling of discomfort, and exhaustion. Within 1 to 3 days (sometimes longer) after the appearance of [[fever]], the patient develops a papular [[rash]], often first on the face. The lesions usually develop through several stages before crusting and falling off.
 
|-
*[[Acne]] - typical of teenagers, usually appears on the [[face]] and upper neck, but the [[chest]], [[human back|back]] and [[shoulder]]s may have acne as well. The upper [[arm]]s can also have acne, but lesions found there are often [[keratosis pilaris]], not acne. The typical [[acne]] lesions are comedones and inflammatory [[papules]], [[pustules]], and [[nodules]]. Some of the large [[nodules]] were previously called "[[cyst]]s"
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Rubella]]'''
 
| style="padding: 5px 5px; background: #F5F5F5;" | Commonly presents with a facial [[rash]] which then spreads to the [[trunk]] and [[limbs]], fading after 3 days, low grade [[fever]], swollen [[glands]], [[joint pain]]s, [[headache]] and [[conjunctivitis]]. The [[rash]] disappears after a few days with no staining or peeling of the [[skin]]. ''[[Forchheimer's sign]]'' occurs in 20% of cases, and is characterized by small, red [[papules]] on the area of the [[soft palate]]
*[[Syphilis]] - commonly presents with gneralized systemic [[symptoms]] such as [[malaise]], [[fatigue]], [[headache]] and [[fever]]. [[Skin]] eruptions may be subtle and asymptomatic Classically described as 1) non-pruritic bilateral symmetrical mucocutaneous [[rash]]; 2) non-tender regional [[lymphadenopathy]]; 3) condylomata lata; and 4) patchy [[alopecia]].
|-
 
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Coxsackievirus]]'''
*[[Molluscum contagiosum]] -  lesions are commonly flesh-colored, dome-shaped, and pearly in appearance. They are often 1-5 millimeters in diameter, with a dimpled center. Generally not painful, but they may itch or become irritated. Picking or scratching the lesions may lead to further [[infection]] or scarring. In about 10% of the cases, [[eczema]] develops around the lesions. They may occasionally be complicated by secondary [[bacterial infections]].
| style="padding: 5px 5px; background: #F5F5F5;" | The most commonly caused disease is the [[Coxsackie A]] disease, presenting as ''hand, foot and mouth disease''. It may be [[asymptomatic]] or cause mild [[symptoms]], or it may produce [[fever]] and painful [[blisters]] in the mouth ([[herpangina]]), on the palms and fingers of the hand, or on the soles of the feet. There can also be [[blisters]] in the [[throat]] or above the [[tonsils]]. Adults can also be affected. The [[rash]], which can appear several days after high temperature and painful sore throat, can be itchy and painful, especially on the hands/fingers and bottom of feet.
 
|-
*[[Mononucleosis]] - Common [[symptoms]] include low-grade [[fever]] without chills, [[sore throat]], white patches on tonsils and back of the throat, [[muscle weakness]] and sometime extreme fatigue, tender [[lymphadenopathy]], [[petechial hemorrhage]] and skin [[rash]].
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Acne]]'''
 
| style="padding: 5px 5px; background: #F5F5F5;" | Typical of teenagers, usually appears on the [[face]] and upper neck, but the [[chest]], [[human back|back]] and [[shoulder]]s may have [[acne]] as well. The upper [[arm]]s can also have [[acne]], but lesions found there are often [[keratosis pilaris]], not [[acne]]. The typical [[acne]] lesions are [[comedones]] and [[inflammatory]] [[papules]], [[pustules]], and [[nodules]]. Some of the large [[nodules]] were previously called "[[cyst]]s"
*Toxic [[erythema]] - common [[rash]] in infants, with clustered and [[vesicular]] appearance.
|-
 
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Syphilis]]'''
*[[Rat-bite fever]] - commonly presents with fever, chills, open sore at the site of the bite and rash, which may show red or purple plaques.
| style="padding: 5px 5px; background: #F5F5F5;" | Commonly presents with gneralized systemic [[symptoms]] such as [[malaise]], [[fatigue]], [[headache]] and [[fever]]. [[Skin]] eruptions may be subtle and [[asymptomatic]] Classically described as 1) non-pruritic bilateral symmetrical mucocutaneous [[rash]]; 2) non-tender regional [[lymphadenopathy]]; 3) condylomata lata; and 4) patchy [[alopecia]]
 
|-
*[[Parvovirus B19]] - the [[rash]] of fifth disease is typically described as "slapped cheeks," with [[erythema]] across the cheeks and sparing the nasolabial folds, forehead, and mouth.
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Molluscum contagiosum]]'''
 
| style="padding: 5px 5px; background: #F5F5F5;" | Lesions are commonly flesh-colored, dome-shaped, and pearly in appearance. They are often 1-5 millimeters in diameter, with a dimpled center. Generally not painful, but they may itch or become irritated. Picking or scratching the lesions may lead to further [[infection]] or scarring. In about 10% of the cases, [[eczema]] develops around the lesions. They may occasionally be complicated by secondary [[bacterial infections]]
*[[Cytomegalovirus]] - common [[symptoms]] include [[sore throat]], swollen [[lymph nodes]], [[fever]], [[headache]], [[fatigue]], [[weakness]], muscle aches and loss of appetite.
|-
 
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Measles]]'''
*[[Scarlet fever]] - common includes fever, punctate red macules on the hard and soft palate and uvula ([[Forchheimer's spots]]), bright red tongue with a "strawberry" appearance, [[sore throat]] and [[headache]] and [[lymphadenopathy]].
| style="padding: 5px 5px; background: #F5F5F5;" | Commonly presents with high [[fever]], [[coryza]] and [[conjunctivitis]], with observation of [[oral mucosa|oral mucosal]] lesions ([[Koplik's spots]]), followed by widespread [[skin rash]]
 
|-
*[[Rocky Mountain spotted fever]] - symptoms may include [[maculopapular rash]], [[petechial rash]], [[abdominal pain]] and [[joint pain]].
| style="padding: 5px 5px; background: #DCDCDC;" | '''Atypical [[measles]]'''
 
| style="padding: 5px 5px; background: #F5F5F5;" | [[Symptoms]] commonly begin about 7-14 days after infection and present as [[fever]], [[cough]], [[coryza]] and [[conjunctivitis]]. Observation of [[Koplik's spots]] is also a characteristic finding in measles
*[[Stevens-Johnson syndrome]] - symptoms may include [[fever]], [[sore throat]] and [[fatigue]]. Commonly presents [[ulcers]] and other lesions in the [[mucous membranes]], almost always in the [[mouth]] and lips but also in the genital and anal regions. Those in the mouth are usually extremely painful and reduce the patient's ability to eat or drink. [[Conjunctivitis]] of the eyes occurs in about 30% of children. A [[rash]] of round lesions about an inch across arises on the face, trunk, arms and legs, and soles of the feet, but usually not the scalp.
|-
 
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Mononucleosis]]'''
*[[Varicella-zoster virus]] - commonly starts as a painful [[rash]] on one side of the face or body. The [[rash]] forms blisters that typically scab over in 7-10 days and clears up within 2-4 weeks.
| style="padding: 5px 5px; background: #F5F5F5;" |Common [[symptoms]] include low-grade [[fever]] without [[chills]], [[sore throat]], white patches on [[tonsils]] and back of the throat, [[muscle weakness]] and sometime extreme [[fatigue]], tender [[lymphadenopathy]], [[petechial hemorrhage]] and [[skin rash]]
 
|-
*[[Chickenpox]] -
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Erythema toxicum]]'''
 
| style="padding: 5px 5px; background: #F5F5F5;" | Common [[rash]] in infants, with clustered and [[vesicular]] appearance
*[[Influenza]]
|-
 
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Rat-bite fever]]'''
*[[Meningococcemia]]
| style="padding: 5px 5px; background: #F5F5F5;" | Commonly presents with [[fever]], [[chills]], open sore at the site of the bite and [[rash]], which may show red or purple [[plaques]].
 
|-
*[[Rickettsialpox]]
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Parvovirus B19]]'''
 
| style="padding: 5px 5px; background: #F5F5F5;" | The [[rash]] of fifth disease is typically described as "slapped cheeks," with [[erythema]] across the cheeks and sparing the nasolabial folds, forehead, and mouth
*[[Poxvirus]]es
|-
 
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Cytomegalovirus]]'''
*[[Meningitis]]
| style="padding: 5px 5px; background: #F5F5F5;" | Common [[symptoms]] include [[sore throat]], swollen [[lymph nodes]], [[fever]], [[headache]], [[fatigue]], [[weakness]], [[muscle pain]] and [[loss of appetite]]
 
|-
*[[Enteroviruses]]
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Scarlet fever]]'''
 
| style="padding: 5px 5px; background: #F5F5F5;" | Commonly includes [[fever]], punctate red [[macules]] on the hard and soft [[palate]] and [[uvula]] ([[Forchheimer's spots]]), bright red [[tongue]] with a "strawberry" appearance, [[sore throat]] and [[headache]] and [[lymphadenopathy]]
*[[Malaria]]
|-
 
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Rocky Mountain spotted fever]]'''
*[[Impetigo]]
| style="padding: 5px 5px; background: #F5F5F5;" | [[Symptoms]] may include [[maculopapular rash]], [[petechial rash]], [[abdominal pain]] and [[joint pain]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Stevens-Johnson syndrome]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | [[Symptoms]] may include [[fever]], [[sore throat]]  and [[fatigue]]. Commonly presents [[ulcers]] and other lesions in the [[mucous membranes]], almost always in the [[mouth]] and lips but also in the genital and anal regions. Those in the mouth are usually extremely painful and reduce the patient's ability to eat or drink. [[Conjunctivitis]] of the eyes occurs in about 30% of children. A [[rash]] of round lesions about an inch across, may arise on the face, trunk, arms and legs, and soles of the feet, but usually not on the scalp.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Varicella-zoster virus]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | Commonly starts as a painful [[rash]] on one side of the face or body. The [[rash]] forms blisters that typically scab over in 7-10 days and clears up within 2-4 weeks.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Chickenpox]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | Commonly starts with [[conjunctival]] and catarrhal [[symptoms]] and then characteristic spots appearing in two or three waves, mainly on the body and head, rather than the hands, becoming itchy raw pox (small open sores which heal mostly without scarring). Touching the fluid from a [[chickenpox]] blister can also spread the disease.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Meningococcemia]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | Commonly presents with [[rash]], [[petechiae]], [[headache]], [[confusion]], and [[stiff neck]], high [[fever]], mental status changes, [[nausea]] and [[vomiting]].
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Rickettsialpox]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | First [[symptom]] is commonly a bump formed by a mite-bite, eventually resulting in a black, crusty scab. Many of the [[symptoms]] are [[flu]]-like including [[fever]], [[chills]], [[weakness]] and [[muscle pain]] but the most distinctive [[symptom]] is the [[rash]] that breaks out, spanning the person's entire body.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Meningitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | Commonly presents with [[headache]], [[nuchal rigidity]], [[fever]], [[petechiae]] and [[altered mental status]].
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Impetigo]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | Commonly presents with pimple-like lesions surrounded by [[erythematous]] [[skin]]. Lesions are [[pustules]], filled with [[pus]], which then break down over 4-6 days and form a thick crust. It's often associated with insect bites, cuts, and other forms of [[trauma]] to the [[skin]]
|-
|}


==References==
==References==
Line 69: Line 93:


[[Category:Disease]]
[[Category:Disease]]
[[Category:Infectious disease]]
 
[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Smallpox]]
[[Category:Smallpox]]

Latest revision as of 19:04, 18 September 2017

Smallpox Microchapters

Home

Patient Information

Overview

Historical Perspective

Eradication
Post-Eradication

Pathophysiology

Causes

Differentiating Smallpox from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Treatment

Medical Therapy

Primary Prevention

Outbreak Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case Studies

Smallpox differential diagnosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Smallpox differential diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Smallpox differential diagnosis

CDC on Smallpox differential diagnosis

Smallpox differential diagnosis in the news

Blogs on Smallpox differential diagnosis

Directions to Hospitals Treating Smallpox

Risk calculators and risk factors for Smallpox differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Prior to its eradication, smallpox would need to be differentiated from other diseases that cause a vesicular rash and a fever including chickenpox (which was often mistaken for smallpox), herpes zoster and erythema multiforme.[1]

Differentiating Smallpox from other Diseases

Different rash-like conditions may be misdiagnosed with smallpox, particularly during the initial maculopapular phase, including:[2]

Disease Findings
Insect bites In an insect bite, the insect injects formic acid, which can cause an immediate skin reaction often resulting in a rash and swelling in the injured area, often with formation of vesicles
Kawasaki disease Commonly presents with high and persistent fever, red mucous membranes in mouth, "strawberry tongue", swollen lymph nodes and skin rash in early disease, with peeling off of the skin of the hands, feet and genital area
Monkeypox Presentation is similar to smallpox, although it is often a milder form, with fever, headache, myalgia, back pain, swollen lymph nodes, a general feeling of discomfort, and exhaustion. Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a papular rash, often first on the face. The lesions usually develop through several stages before crusting and falling off.
Rubella Commonly presents with a facial rash which then spreads to the trunk and limbs, fading after 3 days, low grade fever, swollen glands, joint pains, headache and conjunctivitis. The rash disappears after a few days with no staining or peeling of the skin. Forchheimer's sign occurs in 20% of cases, and is characterized by small, red papules on the area of the soft palate
Coxsackievirus The most commonly caused disease is the Coxsackie A disease, presenting as hand, foot and mouth disease. It may be asymptomatic or cause mild symptoms, or it may produce fever and painful blisters in the mouth (herpangina), on the palms and fingers of the hand, or on the soles of the feet. There can also be blisters in the throat or above the tonsils. Adults can also be affected. The rash, which can appear several days after high temperature and painful sore throat, can be itchy and painful, especially on the hands/fingers and bottom of feet.
Acne Typical of teenagers, usually appears on the face and upper neck, but the chest, back and shoulders may have acne as well. The upper arms can also have acne, but lesions found there are often keratosis pilaris, not acne. The typical acne lesions are comedones and inflammatory papules, pustules, and nodules. Some of the large nodules were previously called "cysts"
Syphilis Commonly presents with gneralized systemic symptoms such as malaise, fatigue, headache and fever. Skin eruptions may be subtle and asymptomatic Classically described as 1) non-pruritic bilateral symmetrical mucocutaneous rash; 2) non-tender regional lymphadenopathy; 3) condylomata lata; and 4) patchy alopecia
Molluscum contagiosum Lesions are commonly flesh-colored, dome-shaped, and pearly in appearance. They are often 1-5 millimeters in diameter, with a dimpled center. Generally not painful, but they may itch or become irritated. Picking or scratching the lesions may lead to further infection or scarring. In about 10% of the cases, eczema develops around the lesions. They may occasionally be complicated by secondary bacterial infections
Measles Commonly presents with high fever, coryza and conjunctivitis, with observation of oral mucosal lesions (Koplik's spots), followed by widespread skin rash
Atypical measles Symptoms commonly begin about 7-14 days after infection and present as fever, cough, coryza and conjunctivitis. Observation of Koplik's spots is also a characteristic finding in measles
Mononucleosis Common symptoms include low-grade fever without chills, sore throat, white patches on tonsils and back of the throat, muscle weakness and sometime extreme fatigue, tender lymphadenopathy, petechial hemorrhage and skin rash
Erythema toxicum Common rash in infants, with clustered and vesicular appearance
Rat-bite fever Commonly presents with fever, chills, open sore at the site of the bite and rash, which may show red or purple plaques.
Parvovirus B19 The rash of fifth disease is typically described as "slapped cheeks," with erythema across the cheeks and sparing the nasolabial folds, forehead, and mouth
Cytomegalovirus Common symptoms include sore throat, swollen lymph nodes, fever, headache, fatigue, weakness, muscle pain and loss of appetite
Scarlet fever Commonly includes fever, punctate red macules on the hard and soft palate and uvula (Forchheimer's spots), bright red tongue with a "strawberry" appearance, sore throat and headache and lymphadenopathy
Rocky Mountain spotted fever Symptoms may include maculopapular rash, petechial rash, abdominal pain and joint pain
Stevens-Johnson syndrome Symptoms may include fever, sore throat and fatigue. Commonly presents ulcers and other lesions in the mucous membranes, almost always in the mouth and lips but also in the genital and anal regions. Those in the mouth are usually extremely painful and reduce the patient's ability to eat or drink. Conjunctivitis of the eyes occurs in about 30% of children. A rash of round lesions about an inch across, may arise on the face, trunk, arms and legs, and soles of the feet, but usually not on the scalp.
Varicella-zoster virus Commonly starts as a painful rash on one side of the face or body. The rash forms blisters that typically scab over in 7-10 days and clears up within 2-4 weeks.
Chickenpox Commonly starts with conjunctival and catarrhal symptoms and then characteristic spots appearing in two or three waves, mainly on the body and head, rather than the hands, becoming itchy raw pox (small open sores which heal mostly without scarring). Touching the fluid from a chickenpox blister can also spread the disease.
Meningococcemia Commonly presents with rash, petechiae, headache, confusion, and stiff neck, high fever, mental status changes, nausea and vomiting.
Rickettsialpox First symptom is commonly a bump formed by a mite-bite, eventually resulting in a black, crusty scab. Many of the symptoms are flu-like including fever, chills, weakness and muscle pain but the most distinctive symptom is the rash that breaks out, spanning the person's entire body.
Meningitis Commonly presents with headache, nuchal rigidity, fever, petechiae and altered mental status.
Impetigo Commonly presents with pimple-like lesions surrounded by erythematous skin. Lesions are pustules, filled with pus, which then break down over 4-6 days and form a thick crust. It's often associated with insect bites, cuts, and other forms of trauma to the skin

References

  1. "Smallpox disease overview".
  2. Moore, Zack S; Seward, Jane F; Lane, J Michael (2006). "Smallpox". The Lancet. 367 (9508): 425–435. doi:10.1016/S0140-6736(06)68143-9. ISSN 0140-6736.

Template:WH Template:WS