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Patient Case: Smallpox

Patient Case: Smallpox

Discussion

A 30-year-old male presents to the hospital with a high fever, severe headache, and profound fatigue for the past three days. He also complains of muscle pain and a sore throat. On examination, his temperature is 39.5°C (103.1°F), and he appears acutely ill. Within 24 hours of admission, he develops a rash, beginning on his face and spreading to his arms, legs, and trunk. The lesions progress from macules to papules, then to vesicles filled with thick, opaque fluid, eventually forming pustules. The rash distribution is dense on the extremities and face, with some lesions appearing on the palms and soles.

Over the next several days, the pustules become firm, deeply embedded in the skin, and begin to scab over. The patient is placed in isolation, and supportive treatment is initiated. Despite aggressive care, he remains critically ill. Laboratory testing confirms the presence of the variola virus, consistent with smallpox.

Questions
  1. Which clinical feature is most characteristic of smallpox?
    a) Rash that starts on the trunk and spreads outward
    b) Vesicular lesions at different stages of development
    c) Synchronous rash progressing from macules to pustules
    d) Rash that spares the palms and soles
  2. What is the primary mode of transmission of smallpox?
    a) Contaminated water
    b) Direct contact with infected animals
    c) Respiratory droplets and contact with contaminated materials
    d) Vector-borne transmission by mosquitoes
  3. Which of the following distinguishes smallpox from chickenpox?
    a) Smallpox lesions appear in crops with different stages present
    b) Smallpox rash is more concentrated on the trunk than the extremities
    c) Smallpox lesions are deep-seated, firm, and develop synchronously
    d) Smallpox causes mild illness with rapid recovery
  4. What is the most appropriate infection control measure for a suspected smallpox case?
    a) Standard precautions with contact isolation
    b) Immediate vaccination and home quarantine
    c) Strict airborne and contact isolation in a negative-pressure room
    d) Routine antibiotic therapy to prevent secondary infections
Reveal answers

Answers

  1. (c) Synchronous rash progressing from macules to pustules
    • Smallpox lesions develop at the same rate across the body, progressing in a synchronized manner from macules to pustules before scabbing over.
  2. (c) Respiratory droplets and contact with contaminated materials
    • Smallpox spreads primarily through respiratory droplets from infected individuals and through direct contact with contaminated bedding or clothing.
  3. (c) Smallpox lesions are deep-seated, firm, and develop synchronously
    • Unlike chickenpox, where lesions appear in different stages at the same time, smallpox lesions are deeply embedded, firm, and develop uniformly.
  4. (c) Strict airborne and contact isolation in a negative-pressure room
    • Smallpox is highly contagious, requiring immediate airborne and contact precautions in a negative-pressure room to prevent transmission.