Variola vera

Last Updated: 2023-07-07

Author(s): Anzengruber F., Navarini A.

ICD11: 1E 70

Variola, true smallpox, smallpox.

Highly contagious, often fatal disease caused by variola verus virus (= Paschen's elementary virus). In 1979, eradication was announced by the WHO. If there is a suspicion of a new outbreak, this must be reported.

  • Incubation period: approx. 14 days, but infectiousness already exists without symptoms
  • Host is humans

  • Fever 40-41 °C
  • Emesis
  • Headache and pain in the limbs
  • Tachycardia
  • Initial macular exanthema of the face and extremities. In the course (approx. on the 5th day), a generalised, monomorphic exanthema
  • develops
  • In summary, macules appear first, then papules, vesicles, pustules and finally crusts. Axillae and inner thighs are mostly absent. The pustules show the typical indentation (pockmark) in the course, which are surrounded by an erythematous courtyard
  • Vaccinated persons may develop an attenuated, incomplete course (variola minor or variolois). Another attenuated course is seen with infection of a modified wild-type virus (alastrim or white pox)

  • Clinic
  • Biopsy
  • Light microscopy
  • Electron microscopy (negative staining)
  • Culture
  • Serology (specific complement-binding, haemagglutination-inhibiting antibody)

Total integument, especially face, extremities, acras. Partly also mucous membranes are affected.

Reticular epidermal degeneration, multichambered intraepidermal pustules, reticulating degeneration of the stratum spinosum, intracellular oedema with the reaction products of poxvirus (Guarnieri bodies).

Pneumonia, bronchitis, encephalomyelitis, toxic myocarditis, nephritis, osteomyelitis.

  • Lethality up to 80%
  • Provided the disease is survived, there is lifelong immunity and cross-immunity to vaccinia, variola minor and cowpox

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