Smallpox history and symptoms

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

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.

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]

• Duration approximately 12 – 14 days
• Asymptomatic
• Noncontagious

Commonly patients feel very ill during this period.

• Duration approximately 2 – 4 days
• Sometime contagious
• Abrupt onset of fever
• Malaise
• Muscle pain and headache
• Abdominal pain
• Vomiting

• 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

• Duration approximately 5 days
• Contagious
• Bumps turn into pustules

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

• 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

• 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.

• Malaise
• Nausea
• Fever
• Backache
• Headache
• Delirium
• Diarrhea
• Fatigue
• Fever
• Rash:

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

• Pharyngitis

• Manic depression

• Hallucinations

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