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What are smallpox symptoms and signs?
Symptoms develop seven to 17 days after exposure. Fever is the most common initial symptom and can be quite high. This is accompanied by body aches. Often, the patient is too unwell to get out of bed. Within 24 to 48 hours, a rash begins to appear everywhere on the body but especially on the legs, arms, mouth, and face. The eyes may also be affected, leading to potential blindness among survivors. Symptoms in children are similar to adults. The rash also appears on the palms and soles and goes through stages as the disease progresses. At the beginning, the rash consists of red dots that become raised. The lesions (see Figure 1) rapidly fill with fluid resembling a blister or cold sore and are known as "vesicles." The fluid in the vesicles may turn yellow, resembling pus. Rarely, the rash may start to fill with blood (hemorrhagic smallpox), which is a poor prognostic sign. After one to two weeks, the lesions scab over and eventually fall off, leaving deep scars. One of the defining features of smallpox is that all the lesions on the body are always at the same stage of development. This is in contrast to chickenpox where new lesions form while old ones are healing.
Figure 1: Picture of smallpox in a young child. SOURCE: Dr. Michael Schwartz/CDC
Approximately one-third of people with smallpox died from the infection. People who had an extensive rash were at higher risk to die. People who had only a few lesions or a milder rash had a lower risk of death. Infections caused by the variola minor strain were less severe and death occurred in only approximately 1% of cases.