Title: Smallpox- The Deadly Scourge<br/>Author: Jon Mark Hirshon<br/><a href='http://umem.org/profiles/faculty/96/'>[Click to email author]</a><hr/><p style="margin-left:.75in;">
        ·      Smallpox (<em>Variola)</em>:</p>
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        o   Only eradicated human infectious disease. </p>
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        o   Prior to the advent of vaccination, it killed an estimated 400,000 Europeans annually and was a major cause of blindness.</p>
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        ·      Major potential as a bioterrorism agent:  </p>
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        o   Now only supposed to exist in two laboratories in the world (at the CDC in Atlanta, Georgia and in the Vector Institute in Koltsovo, Russia).</p>
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        ·      Recently, previously unknown vials of active virus from the 1950s were found in a NIH laboratory in Maryland.</p>
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        ·      Clinical Presentation:</p>
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        o   Incubation is usually 10-12 days (range 7-17 days)</p>
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        o   Signs and symptoms include:</p>
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        §  Febrile (38.8-40.0C) prodome lasting 1-4 days, headache, myalgia (esp. back/spinal pain), pharyngitis, chills, abdominal pain</p>
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        §  Rash: classically round and well circumscribed.  May be confluent or umbilicated. The rash evolves slowly: macules to papules to pustules to scabs.</p>
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        ·      It is important to differentiate smallpox from chicken pox (<em>Varicella</em>): </p>
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        o   Smallpox: Significant prodrome. Centrifugal rash (trunk to extremities). Can involve soles and palms. Lesions are in the same stage of development on any one part of the body.</p>
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        o   Chickenpox: Minimal prodrome. Centripetal rash (extremities to trunk). Seldom on soles and palms. Asynchronus evolution of rash.</p>
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        Bottom Line:</p>
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        Smallpox is a global public health emergency and requires immediate reporting.  If the clinical presentation is unclear, discuss with local infectious disease experts or public health officials.</p>
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        <a href="http://www.washingtonpost.com/national/health-science/fda-found-more-than-smallpox-vials-in-storage-room/2014/07/16/850d4b12-0d22-11e4-8341-b8072b1e7348_story.html">http://www.washingtonpost.com/national/health-science/fda-found-more-than-smallpox-vials-in-storage-room/2014/07/16/850d4b12-0d22-11e4-8341-b8072b1e7348_story.html</a></p>
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        <a href="http://emedicine.medscape.com/article/237229-overview">http://emedicine.medscape.com/article/237229-overview</a></p>
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        http://www.who.int/csr/disease/smallpox/en/</p>
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