Smallpox history and symptoms

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

Overview

Symptoms of smallpox progress in a typical fashion and some of its common symptoms may include high fever, rash (initially in the oral mucosa, followed by the skin), malaise, fatigue, muscle pain and vomiting.

History

In 90% of the cases, patients presented with ordinary smallpox. Commonly there is a family member, or close contact, with the disease. Ordinary smallpox progresses according to the following periods:[1][2]

Incubation period

  • Duration approximately 12 - 14 days
  • Asymptomatic
  • Noncontagious

Prodrome period

Commonly patients feel very ill during this period.

Early rash

  • Duration approximately 4 days
  • Most contagious stage
  • Rash as small red spots in the mouth, tongue and oropharynx
  • Rash turns into sores releasing the virus
  • Rash appears on the skin, starting on the face, moving towards arms and hands, eventually spreading to the rest of the body within 24-48 hours (centrifugal fashion)
  • At this time, fever usually falls and the person feels better
  • At the 3rd day of rash, it turns into raised bumps
  • At the 4th day of rash, bumps are filled with fluid, with a central depression
  • Fever will then raise again, until scabs are formed

Pustular rash

Pustules and scabs

  • Duration approximately 5 days
  • Contagious
  • Variable number of pustules, up to a few thousand
  • Pustules first form a crust and than a scab

Resolving scabs

  • Duration approximately 6 days
  • Contagious, until all scabs have fallen
  • Scabs start to fall leaving scars on the skin
  • Most scabs will have fallen 3 weeks after start of rash

Resolved scabs

  • All scabs have fallen
  • Person is no longer contagious

Throughout these stages, the skin lesions are all at the same level of development, among different parts of the body.

Common Symptoms

  • Initially in the mouth, later turning into sores
  • Followed by skin rash

Less Common Symptoms

References

  1. 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.
  2. "Smallpox disease overview".

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