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A DEAD DISEASE
Dr.T.V.Rao MD
Origin of Smallpox
The name Variola was first used in the 6th
century. Derived from the Latin word varius
(spotted) or varus (pimple).
Anglo-Saxons in the 10th century used the
word poc or pocca (bag or pouch) to describe
an exanthemous disease, possibly smallpox.
In the 15th century, the English used the
prefix small to distinguish variola the
smallpox from syphilis, the great pox.
Species
Animals Infected
Host Range
Geographic Range
Variola
Human
Narrow
Formerly worldwide
Vaccinia
Broad
Worldwideb
Cowpox
Broad
Europe
Monkeypox
Broad
Ectromelia
Mouse, mole
Narrow
Europe
Camelpox
Camel
Narrow
Taterapox
Gerbil
Narrow
Western Africa
Volepox
Vole
United States
Raccoonpox
Raccoon
United States
Skunkpox
Skunk
United States
Uasin Gishu
Horse
Medium
Eastern Africa
Primary host.
Secondary to vaccination; no known natural host.
a
b
http://books.nap.edu/html/variola_virus/ch2.html#TopOfPage
SMALLPOX
Genus Orthopoxviruses
Smallpox, monkey pox,
cowpox,vaccinia
DNA Virus
200 nm brick
shaped
Smallpox-person to
person spread via
respiratory
secretions/direct contact
Spread best in low
humidity/temperature
CHARACTERISTICS SHARED BY
SPECIES OF ORTHOPOXVIRUS :
- The largest and most complex viruses
Guarnieri's bodies or
Elementary bodies
Inclusion bodies:
type A and type B
Virions have a
brick-like shape
and are present
in
2
forms, both are
infectious
Variola virus
Brick shaped,cosists
of double layered
membrane which
surrounds
Biconcave Nucleoid
congaing DNA core
Either side lens
shaped lateral body
300 x 200 x 100 nm
Physical characters
Remain viable for months at
room temperature
Resists 50% Glycerin and 1 %
phenol
Inactivated by formalin and
oxidizing agents
Antigenic structure
Nearly 20 antigen
Heat liable and stable antigens
Cultured on Chorioallontoic membrane of 11
13 days old chick embryo
Variola pocks are small shiny, white convex
non necrotic, non hemorrhagic
Variola pocks are larger irregular flat grayish
necrotic lesions some are hemorrhagic
Tissue culture on Monkey kidney, Hela cells
Variola (Smallpox)
Smallpox is an acute exanthematous disease caused
by infection with the poxvirus variola.
The significant clinical features include:
Three-day prodromal illness characterized by
fever, headache, backache, and vomiting.
Generalized centrifugal rash that follows prodrome
Begins centrally then spreads to the
extremities and face
Rapid succession of papules, vesicles, pustules,
umbilication, and crusting over a 14-day period.
Prior vaccination may alter the clinical presentation
of smallpox. The following description applies to the
classic presentation in unvaccinated individuals.
Variola (Smallpox)
Vie
Variola (Smallpox)
Vi
Variola (Smallpox)
View Table
Variola (Smallpox)
Vi
Small pox
Last case Saiban Bibi Assam 24 may
1977
Patients are source of infection
Close contacts
Single crop centrifugal distribution
Macules Papules Vesicles
Pustules
Pathogenesis of Smallpox
The portal of entry for smallpox is the
respiratory tract or inoculation on the skin
Excretions from the mouth and nose, rather
than scabs, are the most important source of
infectious virus
Studies have shown that primary infection in
the nose or mouth do not produce a primary
lesion that ulcerates and releases virions
onto the surface
Clinical Features
Rash stages of development
All lesions in one region at same stage
Starts macular, then papular
Deep, tense vesicles by Day 2 of rash
Turns to round, tense, deep pustules
Pustules dry to scabs by Day 9
Scabs separate
Clinical Features
Scarring
From separated scabs
Fibrosis, granulation in sebaceous
glands
Pink, depressed pock marks
Prominent on face, usually >5 lesions
Permanent
Clinical Features
Complications
Sepsis/toxemia
Usual cause of death
Associated with multiorgan failure
Usually occurs during 2nd week of illness
Encephalitis
Occasional
Similar to demylination of measles, Varicella
Clinical Features
Complications
Secondary bacterial infections uncommon
Staphylococcus aureus cellulitis
Responds to appropriate antibiotics
Corneal ulcers
A leading cause of blindness before 20th Century
Conjunctivitis rare
During 1st week of illness
A disfiguring Disease
Epidemiology
Infectious Materials
Saliva
Vesicular fluid
Scabs
Urine
Conjunctival fluid
Possibly blood
Epidemiology
Infectious Materials
Saliva
Vesicular fluid
Scabs
Urine
Conjunctival fluid
Possibly blood
Diagnosis
Clinical diagnosis
Sufficient in outbreak setting
>90% have classical syndrome
Prodrome followed by rash
Diagnosis
Traditional confirmatory methods
Electron microscopy of vesicle fluid
Rapidly confirms if orthopoxvirus
Relatively rapid
Can distinguish orthopox viruses from other viral agents
Cannot differentiate between variola and vaccinia viruses
May not be as sensitive as PCR-Based methods
Diagnosis
Differential Diagnosis
Chickenpox (varicella)
Vesicles shallow, in crops, varied stages
Centripetal, spares palms/soles
Prevention
Vaccination - History
Introduced by Jenner
Inoculated boy with pustular fluid from cowpox
1st immunization using virus of similar disease
Initially passed arm-to-arm
Also passed syphilis, hepatitis
Prevention
Vaccine modern times
Vaccinia virus
Jenner vaccinating
Email
doctortvrao@gmail.com