Smallpox, caused by the variola virus, is a highly invasive and potentially fatal disease that was eradicated in the 1980s. Due to the threat of biological warfare, research is being conducted to better understand the virus and potential treatment options. Symptoms include flu-like signs and a telltale rash that can be fatal. Treatment focuses on managing symptoms and eradicating underlying bacterial infections.
Variola virus is a self-replicating pathogen that induces the onset of smallpox. Uniquely a human-oriented disease, the variola virus was considered eradicated for three decades, yet portions of the pathogen still exist for research purposes only. In the absence of a cure, vaccination is the only method of preventing variola virus. Due to the threat of its use in biological warfare, the variola virus is being revisited to better understand its nature, transmission, and potential treatment options.
Commonly known as smallpox, this member of the Poxviridae virus family is extremely invasive. Once an individual is exposed through inhalation of infected airborne droplets, the virus uses the individual’s cells as a transport medium to the lymphatic system before settling in the bloodstream. Depending on the severity of the infection, a common presentation of ordinary smallpox or a more pronounced hemorrhagic form of the dermal-based virus may develop. Individuals who have received a smallpox vaccination can still develop the infection when exposed to the variola virus, a presentation known as modified smallpox. The major forms of the smallpox virus, including flat and hemorrhagic presentations, carry a significantly high mortality rate.
Due to widespread vaccination and confirmed eradication of smallpox in the 1980s, a confirmed case of variola virus today could cause the issuance of a global health emergency and ignite fears of a pandemic. If someone were to become infected with the variola virus and show signs of a smallpox rash, a tissue sample would be taken and sent to the Centers for Disease Control and Prevention (CDC). The symptomatic person would be immediately hospitalized and placed in isolation pending confirmation of a diagnosis from the CDC.
Considering that the symptoms of smallpox can mimic those of other conditions, including chickenpox and monkeypox, a thorough medical history of the individual should be taken and a thorough physical exam performed. Healthcare professionals are trained to recognize the characteristic smallpox rash and other signs and symptoms of the disease. In addition to a tissue sample, laboratory tests, including a viral culture, in which fluid samples are obtained for analysis, may be done to confirm a diagnosis.
The incubation period for smallpox is usually just over two weeks. Individuals will usually develop flu-like signs, including fever, persistent headache, and pronounced fatigue. Following the development of initial symptoms, individuals will develop the telltale rash of smallpox which initially appears as flat lesions before forming blisters and pustules. The smallpox rash usually forms on the face and upper torso before moving down the trunk and lower extremities. Rupture of smallpox blisters and pustules can induce extreme pain, and the overall progression of lesion development can be fatal for some people.
Treatment for variola virus usually focuses on managing symptoms and eradicating any underlying bacterial infections. Those who show signs of secondary infection may be aggressively administered antibiotic medications. In some cases, prescribed pain relievers may be given to ease the discomfort. Supportive care, including supplemental oxygen, can be given to those with impaired breathing. Extensive scarring generally exists in the wake of healed lesions that have lost their scabs.
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