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* Mental status may be altered
* Mental status may be altered


This is a chart that describes a patient with a a generalized vesicular or [[pustular rash]]. It is also based upon the risk of smallpox to the patient.
[[Image:Smallpox rash.jpg]]
===Presentation===
The first general symptom of smallpox will be small red spots on places such as the [[face]], [[mouth]], etc. These spots will eventually turn into vesicles and then pustules. A [[rash]] will then begin forming on the skin around the face which will eventually move down the body to the feet. After having the rash for approximately 3 days, raised pustules will begin to form. These pustules will be filled with an opaque fluid with a depression in the middle. This is one of the signature characteristics of smallpox.
For diagnosing smallpox, there are some major and minor criteria needed during the physical examination.
====Major====
*On any singular part of the body, there needs to be [[lesions]] in the same stage of development
*Characteristic pustules:
**Well circumscribed and round
**[[Confluent]] or they will have a depression in the middle
*[[Fever]] occurring approximately 1-4 days before rash begins.
**The fever is usually > than 102 degrees Fahrenheit.
*With fever, have at least one of the following symptoms.
**[[Abdominal pain]]
**[[Chills]]
**[[Backache]]
**[[Headache]]
====Minor====
*Patient appears [[toxic]] or near death
*Initial lesions will be on the [[face]], [[forearms]], and oral palate
*There will be lesions on the palms and soles
*Most of the lesions will be on the [[distal]] extremities and face (greatest concentration)
*Evolution of rash from [[macules]] to [[papules]] to [[pustules]] to [[scabs]] is a slow process


===Images===
===Images===

Revision as of 23:26, 10 July 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Physical Examination

Appearance of the Patient

Depending on the stage of the disease, the smallpox patient might have different appearances. These may range from

  • Asymptomatic, if the patient had contact with someone with smallpox, got the infection and is currently in the incubation period
  • Extremely ill, if it is someone who is in the prodromal period, who appears extremely ill, vomiting and fatigued

Vitals

Temperature

Rate

Blood Pressure

Skin

  • A rash is often present
  • Lesions may be present

Eyes

  • Icteric sclera may be present
  • Nystagmus may be present.
  • Extra-ocular movements may be abnormal
  • Pupils may not react to light
  • Ophthalmoscopic exam may be abnormal with findings of ___

Throat

  • The throat may be erythematous
  • There may be exudate in the throat
  • There may be petechiae seen in the throat

Abdomen


Extremities

Neurologic

  • Mental status may be altered


Images

  • Man with smallpox
    Man with smallpox
  • Smallpox lesions on skin of trunk. Picture taken in Bangladesh, 1973.
    Smallpox lesions on skin of trunk. Picture taken in Bangladesh, 1973.
  • These smallpox pustules are round, smooth, deep, and all at the same stage.
    These smallpox pustules are round, smooth, deep, and all at the same stage.
  • Smallpox eruptions on arm and palm.
    Smallpox eruptions on arm and palm.
  • This photograph depicted a male smallpox patient whose skin displayed the characteristics of late-stage maculopapular scarring on his face, arms and chest.
    This photograph depicted a male smallpox patient whose skin displayed the characteristics of late-stage maculopapular scarring on his face, arms and chest.

References

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