Variola vera

Variola; real smallpox, leaves.

Highly contagious, often lethal disease caused by Variola vera virus (= Paschen's elementary body). Extermination by the WHO was announced in 1979. If a new outbreak is suspected, it must be reported. 

• Incubation period: approx. 14 days, but infectivity already exists without symptoms.

• The host is man.

• Fever 40-41 °C, vomiting, headache, tachycardia, macular initial exanthema on face and extremities. In the course (approx. on the 5th day) a generalized, monomorphic exanthema occurs. In summary, maculae first appear, then papules, vesicles, pustules and finally crusts. The axils and inner sides of the thighs are usually omitted. The pustules show the typical depression (pockennabel), which are surrounded by an erythematous court.

• Vaccinates may have a weakened, incomplete course (Variola minor or Variolois). A further attenuated course can be seen when a modified wild-type virus (Alastrim or white pox) is infected.

• Clinic 
• Biopsy
• Light microscopy
• Electron microscopy (negative training)
• Civilization 

• Serology (specific complement binding hemagglutination inhibiting antibody).

Entire integument, especially face, extremities, acra. Some mucous membranes are also affected.

Reticular epidermal degeneration, multi-chamber intraepidermal pustules, reticulatory degeneration of the stratum spinosum, intracellular edema with the reaction products of the smallpox virus (Guarnieri body).

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

• Mortality up to 80%.

• If the disease has been overcome, lifetime immunity and cross-immunity against vaccinia, variola minor and cowpox exists.

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