[vannrox]

"...What doctors are seeing on many of the Marsteller students is a rash made up of little red bumps..."

Penetration is usually through the respiratory tract and local lymph nodes and then the virus enters the blood (primary viremia).


Internal organs are infected; then the virus reenters the blood (secondary viremia) and spreads to the skin. (As a rash).


These events occur during the incubation period, when the patient is still well.


Smallpox is characterised in its classical form by the sudden onset of fever, headache, backache, vomiting, marked prostration and even delirium. At this early stage the patient may be very ill and compelled to take to his bed. Early in the illness there may appear in about 10% of patients a fleeting rash in the form of a reddening of the skin, not unlike the rash of German Measles. This is the so-called prodromal rash and, in the absence of a history of exposure to a source of infection, there is nothing about htis rash to arouse suspicion of smallpox. The incubation period from exposure to the onset of this feverish illness is nearly always 12 days with very little variation either way.


About two to three days after the onset of illness the true smallpox rash appears. At this time any prodromal rash will be fading. This true or so-called focal rash is normally diagnostic of smallpox and is characteristic both in its evolution and distribution on the body. It begins as tiny discrete pink spots, macules, which enlarge and become slightly raised papules. Each of these progresses by the third day to become a tense blister, vesicle, 6mm in diameter, deep in the skin. After two more days the fluid inside becomes turbid and the lesions are not described as pustules or by the older term of pocks. In the following days these shrink and dry up to become hard lentil-like crusts ni the skin. Eventually they separate leaving a sunken scar. The hard material which comes away contains smallpox virus in its substance


The distribution of this focal rash is characteristic, affecting the head and extremeties much more than the trunk. These features make classical smallpox easy to diagnose clinically when once the thought of the disease has entered the mind.


Mild smallpox naturally occuring - or more likely modified in this direction by residual immunity resulting from an old vaccination - also presents great difficulties in clinical diagnosis, so much so that it was described by one witness as "the clinicians nightmare". For example, a patient with only a single skin lesion on the wrist caused an outbreak of smallpox involving some 40 patients and several deaths in 1973. The extreme form of this modification is known as variola sine eruptione in which no rash follows the onset of illness. Even those patients may very occasionally be infectious through droplets from the mouth.


There is no treatment recognised as effective once the illness has started. Depending on the strain, 1% - 30% mortality is likely.

[lilsparky]

Source please?