• Medical Author:
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

What are smallpox symptoms and signs?

Fever is the most common initial symptom and can be quite high. This is accompanied by body aches, chills, and headache. Often, the patient is too unwell to get out of bed (malaise). Within 24-48 hours, a rash begins to appear everywhere on the body but especially on the legs, arms, mouth, and face. Pharyngitis (sore throat), abdominal pain, back pain, and occasionally vomiting may also develop. The eyes may also be affected, leading to potential blindness among survivors. Symptoms in children are similar to those in 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 and 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.

Picture of smallpox in a young child.
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 of death. 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.

Medically Reviewed by a Doctor on 9/7/2016

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