| Fever of 101 °F or greater occurs 1-4 days before the rash appears. |
Maculopapular rash progresses to vesicles, pustules, crusts, scar. |
Generally, transmission takes direct and fairly prolonged face-to-face contact or direct contact with infected bodily fluids or objects (linens). |
| Concurrent with fever, at least 1 of the following occurs: prostration, headache, backache, chills, vomiting, or severe abdominal pain. The fever may drop with rash onset. |
The lesions in smallpox tend to appear monomorphic (all one stage). |
Not infectious until rash develops. |
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Classic smallpox lesions are deep seated, firm to touch, round, and well circumscribed vesicles or pustules; umbilicated appearance. |
Infectious until all lesions have scabbed over. |
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The rash distribution begins in the mouth and throat spreads to face, arms, and legs, then to hands/palms and feet/soles. |
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Within 24 hours of onset, rash usually spreads to cover the body. |
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Once the rash starts the patient is now contagious |
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As the rash appears, the fever usually abates and the patient “feels better.” |
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On the third day, the rash becomes raised lesions; by the fourth day, the lesions fill with a thick opaque fluid and often have a depression in the center. After approximately 5 days, a pustular rash develops. |
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By the end of the second week after the has rash appeared, most of the sores have scabbed over. |
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