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. 2004 Jul 29;2(3):81–86. doi: 10.1016/j.dmr.2004.06.013

Table 3.

Clinical presentation, transmission, and treatment of smallpox9., 10., 11., 12., 13.

Syndrome Rash Transmission
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.
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.
The rash distribution begins in the mouth and throat spreads to face, arms, and legs, then to hands/palms and feet/soles.
Within 24 hours of onset, rash usually spreads to cover the body.
Once the rash starts the patient is now contagious
As the rash appears, the fever usually abates and the patient “feels better.”
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.
By the end of the second week after the has rash appeared, most of the sores have scabbed over.