Smallpox physical examination
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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
- A fever is often present
Pulse
Rate
- Tachycardia is often present
Blood Pressure
- Hypotension may be present
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
- Abdominal distention may be present
- Abdominal tenderness may be present
- Hepatomegaly may be present
- Splenomegaly may be present
Extremities
- Edema may be present
Neurologic
- 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.
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.
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
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Man with smallpox -
Smallpox lesions on skin of trunk. Picture taken in Bangladesh, 1973. -
These smallpox pustules are round, smooth, deep, and all at the same stage. -
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.
