The first signs of smallpox or smallpox. Natural smallpox Black smallpox and its structure

Smallpox

What is Smallpox -

Smallpox(lat. Variola, Variola vera) or, as it was also called earlier, smallpox is a highly contagious (infectious) viral infection that only affects people. It is caused by two types of viruses: Variola major (mortality rate 20-40%, according to some data - up to 90%) and Variola minor (mortality rate 1-3%). People who survive smallpox may lose some or all of their vision, and almost always have numerous scars on the skin where the former ulcers were.

Smallpox only affects people; experimental infection of laboratory animals is difficult. The causative agent of smallpox is a filterable virus, antigenically related to vaccinia, the cowpox virus, the fine structure and patterns of reproduction of which have been well studied. The incubation period for smallpox lasts from 8 to 14 days, usually approx. 11–12. Patients are contagious to others throughout the entire period of the rash and, apparently, even several days before the rash appears, for a total of about three weeks. The virus is released from bursting and drying blisters on the skin, from the oral cavity and is found in the patient’s urine and feces. The infectious agent is transmitted through direct contact, by airborne droplets, from healthy carriers and animals, and can remain viable on clothing and bedding. All unvaccinated people are susceptible to infection; There is no natural immunity to smallpox. Although the disease can occur at any age, children under four years of age are especially vulnerable.

What provokes / Causes of Smallpox:

The causative agent of smallpox belongs to the viruses of the family Poxviridae, subfamily Chordopoxviridae, genus Orthopoxvirus; contains DNA, measures 200-350 nm, multiplies in the cytoplasm to form inclusions. The variola virus has an antigenic affinity with red blood cells of group A in human blood, which causes weak immunity, high morbidity and mortality in the corresponding group of people. It is resistant to environmental influences, especially drying and low temperatures. It can be preserved for a long time, for a number of months, in crusts and scales taken from pockmarks on the skin of patients; in a frozen and lyophilized state it remains viable for several years.

Pathogenesis (what happens?) During Smallpox:

In typical cases, smallpox is characterized by general intoxication, fever, peculiar rashes on the skin and mucous membranes, successively passing through the stages of spot, vesicle, pustule, crust and scar.

Smallpox is an anthroponotic disease and is a highly contagious, especially dangerous infection. All people are susceptible to smallpox unless they have immunity from previous illness or vaccination. Smallpox was widespread in Asia and Africa. It is an airborne infection, but inoculation of the virus is possible through direct contact with the affected skin of the patient or objects infected with it. The infectiousness of the patient is observed throughout the entire disease - from the last days of incubation to the rejection of the crusts. The corpses of those who died from smallpox also remain highly infectious.

When inhaling contaminated air, viruses enter the respiratory tract. Infection through the skin during variolation and transplacentally is possible. The virus enters the nearest lymph nodes and then into the blood, which leads to viremia. The epithelium becomes hematogenously infected, where the virus multiplies, which is associated with the appearance of enanthema and exanthema. Weakening of the immune system leads to the activation of secondary flora and the transformation of vesicles into pustules. Due to the death of the germinal layer of the epidermis, deep suppurative and destructive processes, scars are formed. Infectious-toxic shock may develop. Severe forms are characterized by the development of hemorrhagic syndrome.

Symptoms of Smallpox:

In the typical course of smallpox, the incubation period lasts 8-12 days.

The initial period is characterized by chills, increased body temperature, severe tearing pain in the lower back, sacrum and limbs, severe thirst, dizziness, headache, and vomiting. Sometimes the onset of the disease is mild.

On the 2-4th day, against the background of fever, an initial rash appears on the skin either in the form of areas of hyperemia (measles-like, roseolous, erythematous), or a hemorrhagic rash on both sides of the chest in the area of the pectoral muscles to the armpits, as well as below the navel in the area inguinal folds and inner thighs (“Simon’s triangle”); hemorrhages look like purpura and even like ecchymoses. A spotted rash lasts for several hours, a hemorrhagic rash lasts longer.

On the 4th day, a decrease in body temperature is observed, the clinical symptoms of the initial period are weakened, but typical pockmarks appear on the scalp, face, torso and extremities, which go through the stages of spots, papules, vesicles, pustules, crust formation, rejection of the latter and scar formation. At the same time, pockmarks appear on the mucous membrane of the nose, oropharynx, larynx, trachea, bronchi, conjunctiva, rectum, female genital organs, and urethra. They soon turn into erosions.

On the 8-9th days of the disease, in the stage of suppuration of the vesicles, the patients’ well-being deteriorates again, signs of toxic encephalopathy appear (impaired consciousness, delirium, agitation, and in children - convulsions). The period of drying and falling off of the crusts takes about 1-2 weeks. Numerous scars form on the face and scalp.

The change in the blood is characterized by leukocytosis; in severe forms there is a sharp shift to the left with the release of myelocytes and young cells into the blood.

Severe forms include confluent form (Variola confluens), pustular-hemorrhagic (Variola haemorrhagica pustulesa) and smallpox purpura (Purpura variolosae).

In those vaccinated with the smallpox vaccine, smallpox is mild (Varioloid). Its main features are a long incubation period (15-17 days), moderate symptoms of malaise and other signs of intoxication; true smallpox rash is not abundant, pustules do not form, no scars remain on the skin, recovery occurs after 2 weeks. There are mild forms with short-term fever without a rash and severe discomfort (Variola sine exanthemate) or only in the form of a mild rash (Variola afebris).

Possible complications include encephalitis, meningoencephalitis, pneumonia, panophthalmitis, keratitis, iritis, sepsis.

Diagnosis of Smallpox:

Clinical manifestations of the disease are the basis for specific studies. For analysis, the contents of vesicles, pustules, crusts, smears of mucus from the oral cavity, and blood are taken. The presence of the virus in samples is determined using electron microscopy, microprecipitation in agar using the immunofluorescence method, and PCR. A preliminary result is obtained after 24 hours; after further research, the virus is isolated and identified.

Treatment of Smallpox:

To treat this disease, antiviral drugs are used (metisazone 0.6 g 2 times a day for 5-6 days), anti-smallpox immunoglobulin 3-6 ml intramuscularly. To prevent bacterial infection, antiseptic preparations are applied to the affected areas of the skin. In the presence of bacterial complications, patients are prescribed broad-spectrum antibiotics (semi-synthetic penicillins, macrolides, cephalosporins). Measures are taken aimed at detoxifying the body, these include the introduction of colloid and crystalloid solutions, in some cases ultrafiltration and plasmaphoresis are carried out.

Forecast depends on the clinical form of the disease, age and premorbid condition. Mortality ranges from 2% to 100%. With a mild course and in those vaccinated, the prognosis is favorable. Convalescents are discharged from the hospital after complete clinical recovery, but not earlier than 40 days from the onset of the disease. After mild forms, patients are discharged without changing their fitness category. After severe forms, suitability for military service is decided by the Military Military Commission depending on residual phenomena (visual impairment and others) or they are granted sick leave for up to 1 month.

Prevention of Smallpox:

Variolation(vaccination with an early, unsafe vaccine) was known in the East at least from the early Middle Ages: in India there are records of it from the 8th century, and in China from the 10th century. This vaccination technique was first brought to Europe from Turkey by the wife of the British ambassador in Istanbul, Mary Wortley Montagu, in 1718, after which the British royal family was vaccinated.

In Russia, variolation was introduced after the death of 14-year-old Emperor Peter II from smallpox.

At the end of the 18th century, the English physician Edward Jenner invented a smallpox vaccine based on the cowpox virus, which was widely vaccinated in Europe.

The first people vaccinated against smallpox in Russia were Catherine II the Great, Grand Duke Pavel Petrovich, Grand Duchess Maria Feodorovna, and a few days later Catherine’s grandchildren Alexander and Konstantin Pavlovich. The peasant boy Markov, from whom the empress was vaccinated with smallpox, was given nobility, the surname Ospenny and a coat of arms.

In America, Asia and Africa, smallpox persisted for almost two hundred years. In the 18th century, every 7th child in Russia died from smallpox. In the 20th century, the virus claimed the lives of 300-500 million people. In the late 1960s, smallpox affected 10-15 million unvaccinated people.

In 1967, WHO decides to eradicate smallpox through mass vaccination of humanity.

The last case of natural smallpox infection was described in Somalia in 1977. In 1978, the last case of laboratory infection was recorded. The eradication of smallpox was officially announced in 1980 at the WHO Assembly, which was preceded by a corresponding conclusion of a commission of experts issued in December 1979.

Smallpox is the first and so far the only infectious disease defeated through mass vaccination. Vaccinations against smallpox in the USSR stopped in 1978-1980.

Smallpox is a particularly dangerous infection. Patients and those suspected of this infection are subject to strict isolation, clinical examination and treatment in special hospitals. Medical personnel work in type III anti-plague clothing with a mask. A thorough ongoing and final disinfection of the room where the patient is (was), household items and common areas is carried out with a 5% Lysol solution. The dishes are soaked in a 3% chloramine solution, then boiled. All garbage and waste are burned.

Quarantine for persons who were in contact with a patient (suspicious) with smallpox, it is set to 17 days. All of them are vaccinated against smallpox, regardless of the date of the previous vaccination. They are administered a single dose of donor gamma globulin in the amount of 3 ml and prescribed metisazone orally: adults 0.6 g 2 times a day, children - a single dose at the rate of 10 mg per 1 kg of child’s body weight for 4-6 days in a row.

Which doctors should you contact if you have smallpox:

Interesting facts about the disease Smallpox:

The cessation of vaccination against smallpox could provoke an increase in HIV infections. According to immunologists, the smallpox vaccine reduced the likelihood of the immunodeficiency virus entering cells.

The authors of the study, American scientists from the University of California and several other research centers, described in the pages of the journal the results of experiments on cell cultures taken from people who had been vaccinated. The researchers found that in cells from people previously vaccinated against smallpox, HIV multiplied more slowly than in the same cells from people who had not been vaccinated.

Caution won't hurt
However, one should not assume that the smallpox vaccine protects against HIV and immediately run to get vaccinated: scientists emphasize that the experiment was carried out on a cell culture, and not on a whole organism, and a fivefold reduction in the rate of spread of the virus was obtained not for any type of HIV, but only for certain strains. These strains are quite common and play an important role in the development of the epidemic, but they are far from the only ones. And slowing down the spread of the virus by five times is still not equivalent to its complete destruction.

Another thing is that until the 1970s, when smallpox vaccinations were administered en masse, the risk of infection could be less, and for a long time the virus simply could not spread beyond a limited area in Central Africa. Even now, the probability of HIV transmission through sexual contact does not exceed tenths of a percent, and a decrease in this value by several times, coupled with poor development of transport, could well prevent the pandemic from spreading. Now that the number of carriers of the virus is about 40 million people worldwide, there is no hope of eradicating HIV, even if the results of preliminary experiments are fully confirmed. But any promising approach to reducing the risk of transmission of the virus is certainly worth considering.

How it works?
A key role in the potential protective mechanism is played by receptors like CCR5 - protein molecules located inside the cell membrane. It is these molecules that HIV interacts with when entering a cell, and virologists know that people with a mutant form of CCR5 receptors for HIV are much less vulnerable.

Windows and doors

CCR5 is not the only molecule that the virus uses to enter cells. Equally important are the CD4 receptors. Using an analogy, we can compare receptors to the “windows” and “doors” of a cell. Burglars enter through both doors and windows, so installing safety glass or secure locks separately only reduces, but does not eliminate, the risk of theft.

By the way, the analogy between receptors and windows is also noteworthy in that the cell itself needs receptors for selective interaction with other cells.

The vaccinia virus, which is the basis of the vaccine (the similarity in the names is not accidental; the virus is named precisely for its noble function) against smallpox, can change the expression of the CCR5 gene. This means that the gene responsible for the synthesis of receptor proteins can be “turned off,” and over time, the CCR5 receptors simply disappear in a vaccinated patient.

How exactly this happens, how long the effect lasts (scientists conducted experiments on cells from people vaccinated three and six months before the experiment) and whether it can also be enhanced is still unclear. But what is clear is that smallpox vaccinations are safe enough for mass use: they were given to every child on the planet at one time, and many were left with a tiny scar on their shoulder.

Only in the 1980s, when smallpox disappeared from the face of the Earth and remained only in a few microbiological laboratories, vaccinations were abandoned, since the risk of side effects began to many times exceed the risk of contracting smallpox itself. But if it is proven that smallpox vaccinations also help against HIV (even if not absolutely), it will not be difficult to return to smallpox vaccination.

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From the article you will learn what smallpox is and what types of viruses can cause it. You will be able to familiarize yourself with historical facts about the eradication of the disease. The article will also inform you about the symptoms, methods of diagnosis and treatment of this terrible infection.

Smallpox

People have not been able to get rid of the smallpox virus for thousands of years. Only in 1980, the WHO (World Health Organization) announced the elimination of this virus in all corners of the planet and allowed the end of vaccination against it.

Smallpox is an acute infectious disease. It can be caused by two types of virus: Variola major and Variola minor. They are also known as variola or variola vera. The names are derived from varius (“spotted”) or varus (“pimple”).

For reference! At one time, V. major caused the death of 40% of people infected with smallpox. V. minor caused a mild form of the disease, alastrim (small/white smallpox), which killed about 1% of those infected.

Scientists suggest that the first infection of the human body with the smallpox virus occurred approximately 10 thousand years BC. Proof of this is the pustular rashes found on the mummy of the Egyptian pharaoh Ramses V, characteristic of this type of disease.

Historical facts

At the end of the 18th century, smallpox claimed about 400 thousand human lives in Europe, including 5 ruling monarchs.
A third of infected people became victims of blindness.
In the 18th - 19th centuries, about 60% of adults and more than 80% of children died from infection.
In the 20th century, smallpox caused the death of approximately 500 million people.
In 1967, 15 million people were infected, of whom 2 million died.
After the start of vaccination (19-20 century), only in 1979 the WHO confirmed the need for large-scale vaccinations, which led to the victory over smallpox.

Development mechanism

The virus enters the human body through the mucous membranes of the mouth and nose, then through the lymph nodes, in which it multiplies, enters the blood.

The spread of the virus throughout the body occurs approximately 3-4 days after infection. Its strain (genus, pure culture) penetrates the bone marrow and spleen, where it multiplies again. But even during this period, the symptoms of the disease practically do not manifest themselves.

Note! From the moment the virus enters the body, with the typical development of smallpox, the incubation period is about 12 days.

After the incubation period, the virus, once again entering the blood, provokes an increase in temperature in the infected person and worsens the general state of health. A maculopapular rash appears on the patient’s skin (the rash consists of dense papules of light purple or dark burgundy color), within 2-3 days the papules fill with liquid.

Consequences

Complications that could be caused by the smallpox virus manifested themselves:

scars on the skin, most often on the face (occurred in 65-85 percent of survivors);
blindness - occurred due to inflammation of the cornea of the eyes;
deafness – the infection provoked the appearance of purulent otitis media, damaging the epithelium of the inner and middle ear;
deformation of the limbs - which is a consequence of arthritis and osteomyelitis caused by the smallpox virus (observed in approximately 2-5% of cases).

Classification and clinical features

In addition to the above-mentioned clinical forms of smallpox, Variola major is the most severe and common, Variola minor is rare, less severe, there are other types of this infection, differing in varying degrees of severity.

Smallpox without rash (variola sine eruptione)

Subclinical (without obvious symptoms) infection can be detected in vaccinated people. This form of the disease is characterized by the appearance of fever after the incubation period. During this period of time the patient experiences:

general intoxication of the body;
myalgia (pain in the muscles of the whole body, from head to toe);
mild pain in the sacrum (bone in the lower back, base of the spine);
subfebrile body temperature (37.1 – 38 0 C).

Confirmation of infection of the body can only be done by studying the composition of the blood for antibodies or by isolating the virus in tissue cultures taken from the patient.

Ordinary

Common smallpox accounts for 90% of all cases of the disease, it is divided into confluent, semi-confluent and discrete:

Drain rash– forms on the skin of the face and the folds of the limbs in the form of large spots; on other parts of the body, papules are located separately. Mortality: 62% among unvaccinated and 26.3% among vaccinated patients.
Semi-drained– papules merge together on the face, individual pimples cover the skin of the body and limbs. The mortality rate among unvaccinated people is 37%, among patients who received the vaccine 8.4%.
Discrete– smallpox papules are scattered throughout the body, with clean skin between them. The fatal outcome among vaccinated patients is 0.7%, among patients who did not receive the vaccine – 9.3%.

Modified (varioloid)

Modified smallpox is characterized by a milder course of the disease than the ordinary type of pathology. It is also available as drain, semi-drain and discrete. Develops in previously vaccinated individuals. At the first stage of the disease, symptoms are almost invisible. During the first 3-5 days, the patient has a low-grade fever (increased body temperature 37.1 - 38 0 C).

Skin rashes appear on days 2-4, initially in the form of spots, which then turn into regular and watery pimples. Pustules (pimples with purulent contents) do not appear in this form of the disease.

The course of the disease is characterized by intensity and the absence of symptoms of intoxication. The mortality rate among vaccinated and unvaccinated people is 0%.

Flat pox

Severe form of the disease. Most often it occurs on the skin of unvaccinated people in the form of flat elements, as if recessed into the skin. A flat rash happens:

Drain– papules merge and form areas with purulent blisters.
Semi-drained– acne on the face as in the confluent form of the disease; on other parts of the body, papules appear separately.
Discrete– flat elements of rashes appear on any part of the body, all over the skin, with clean skin between them.

Manifestations on the skin are accompanied by severe intoxication of the body. Mortality rate among unvaccinated patients is 96.5%, among vaccinated patients – 66.7%.

Hemorrhagic (fulminant)

It is a rare but very severe form of the disease, in which hemorrhages develop in the mucous membranes and skin. Hence the name of the disease - hemorrhage (bleeding).

The disease is divided into two stages:

Early– hemorrhage in the skin and mucous membranes occurs at the prodromal (initial) stage of the disease, before the rash appears. The mortality rate among unvaccinated people, as well as among patients who received the vaccine, is 100%.
Late– hemorrhages become noticeable on the patient’s skin after a rash, during the period of suppuration of pustules.

Alastrim (minor/white pox)

Alastrim is caused by the V. minor virus. The initial stage of the pathology is characterized by increased body temperature, nausea and vomiting, and headache. On the third day, after the onset of the disease, body temperature returns to normal, general health stabilizes, but a light blistering rash appears on the skin.

The blisters burst over time, and the ulcers formed in their place epithelialize (the skin wound closes). There is no second stage of the disease.

Diagnostics

Mild forms of smallpox are similar to chickenpox, which requires differential diagnosis, which will allow you to accurately establish the diagnosis and prescribe the correct treatment.

Differential diagnosis is carried out with a number of diseases, the symptoms of which coincide with the signs of smallpox, including hemorrhagic diathesis (hemorrhage under the skin and mucous membranes), toxicoderma (acute inflammation of the skin) and herpes (lifelong infection of the skin and mucous membranes).

A simple diagnosis of the disease involves:

Examination of the skin for the presence of a characteristic rash.
Conducting a virological study of scrapings (taken from elements of the rash, the contents of papules, from the mucous membrane of the mouth and nasopharynx).
MRI of the brain (to detect swelling).
Donating blood for a general analysis.

Note! If you suspect infection with the Variola virus, it is very important to immediately consult an infectious disease doctor.

Because The smallpox virus has been destroyed, then the risk of contracting it is extremely low. Currently, chickenpox is a fairly common pathology. So watch the video below and learn all about its treatment methods.

General principles of therapy

Treatment of smallpox begins with hospitalization of the patient. Quarantine should last 40 days, from the first symptoms of the disease. The patient is credited with:

Bed rest - lasts until the rash disappears.
Air baths help reduce the feeling of itching.
Drug treatment - drugs are prescribed for intramuscular, oral and external use (antimicrobial antibiotics, immunoglobulin, ointments for itching - see examples below).
Gentle dietary nutrition - prescribed without fail, is table No. 4.

Drug treatment

First of all, the infected patient is given etiotropic treatment (allows to eliminate the cause of the disease, in this case we are talking about the V. major and V. minor viruses). The list of prescribed drugs includes:

"Metisazon" is a drug in tablet form.
Human smallpox immunoglobulin - intramuscular injection. (An artificial protein compound recognizes and neutralizes the virus in the body).
Semi-synthetic penicillins are antimicrobial antibiotics (“Methicillin”, “Oxacillin”, “Nafcillin”).
Macrolides are antimicrobial antibiotics with a low level of toxicity (“Azithromycin”).
Cephalosporins are antibacterial drugs (Cefixime, Ceftibuten).

To block the mechanism of disease development, pathogenetic treatment is prescribed using vitamins, cardiovascular and antiallergic drugs, which the doctor chooses, taking into account the characteristics of the patient’s body.

In order to dry the rash, a 3-5% solution of potassium permanganate is prescribed, for treating the oral mucosa - a solution of sodium bicarbonate, for eye drops - 15% "Sodium Sulfacyl". Itching is relieved with 1% menthol ointment (after crusts have formed).

Table number 4 - sample menu

8:00 Liquid oatmeal, non-acidic cottage cheese, herbal tea from burdock root, chamomile, marigold.
11:00 Blueberry compote (unsweetened).
13:00 Chicken soup with semolina, steamed beef meatballs, rice porridge, fruit jelly.
15:00 Rosehip compote (drink warm for better digestibility).
18:00 Steamed omelette, buckwheat porridge, herbal tea.

With diet number 4, porridge should be cooked in water and consumed grated. Prohibited foods: eggs in any form, fatty broth, milk, all berries and fruits, coffee, chocolate, any flour products.

Question answer

Are smallpox vaccinations given today?

Today, such vaccinations are not performed in most countries, including the CIS, since they became optional after the disease was completely eradicated from the planet. Routine vaccination has been maintained in Cuba and Israel, and newborn children are vaccinated in Egypt.

Is there a risk today of becoming infected with the Variola major or Variola minor virus?

In general, no. But scientists continue to consider smallpox as a potentially dangerous disease. Explaining this by the fact that strains of these viruses are still stored in laboratories located in Russia and the United States. If they are used as biological weapons, then refusal to vaccinate will result in a massive defeat for humanity.

Why do scientists store virus strains?

Firstly, the strains can serve science, and secondly, it was found that proteins produced by the smallpox virus can be used to make medicines for septic shock and acute Marburg viral disease.

What to remember:

Smallpox is a dangerous infectious disease with serious consequences.
Diagnosis of the disease must necessarily include a differential analysis, which will accurately determine the causative agent of the disease and prescribe the necessary treatment.
Therapy for smallpox includes not only the use of medications, but also adherence to dietary nutrition.

Smallpox is a disease that is a highly contagious infection caused by the herpes virus. Most often, an unnatural rash, red spots and unbearable itching all over the body are observed.

The disease mainly affects children aged 1 to 15 years. 90% of the country's adult population had chickenpox in childhood or adolescence. The mild (classic) form of chickenpox dominates throughout the world. A complex form is observed in 2-5% of cases. The disease can be dangerous for pregnant women, children and adolescents, and people with weakened immune systems when the body has difficulty fighting infection.

The patient is infected from the moment the first blisters appear on the skin. This period usually lasts three weeks. In the initial stage, the chickenpox virus spreads to the lymph nodes, bone marrow and spleen.

After this period (8-16 days), the patient develops a high fever, sometimes with impaired consciousness, slight malaise, migraine and back pain. The period of rash begins. A maculopapular rash appears on the mucous membrane of the mouth, throat and face, forearms and finally on the arms and legs. After 10 days, the blisters turn into scabs, which can leave ugly scars when picked off, especially in children who find it difficult to cope with the itching.

Period of "warning signs".

The first signs appear 1-2 days before the rash appears - these are flu-like symptoms - fever or chills, malaise, rhinitis, loss of appetite.

Rash period:

An itchy rash on the body - erythematous spots measuring 5-10 mm, which are small blisters filled with cloudy liquid. After 2-3 days they form into scabs, which disappear without a trace after maturation. The rash is observed on the scalp under the hair, torso, shoulders, lower extremities, and less commonly on the arms and legs. The number of rashes varies - from a few spots to hundreds. In 10-20% of cases they appear on the mucous membranes of the mouth and throat, genitals, conjunctiva and corneas.
Fever (in the first days), swollen lymph nodes, pharyngitis.

The clinical picture depends on the stage of pregnancy at which the woman was infected. The disease in the first and second trimester can lead to fetal death or congenital chickenpox syndrome in children, with various complications. Infection after the 20th week of pregnancy does not cause symptoms in the baby, but can lead to shingles at an early age.

Chickenpox in vaccinated people

It often occurs in a milder form with a small number of maculofollicular acne, similar to insect bites.

The only cause of chickenpox is a virus that passes through direct contact by airborne droplets or indirect contact with clothing, toys, bedding, etc. A patient with smallpox infects others 2-3 days before the rash appears.

Contact with the virus before the first symptoms appear can occur from the 10th to the 21st day (the incubation period is on average 14 days). Chickenpox can be contracted from patients with herpes zoster because the causative agent of both of these diseases is the same virus.

Atypical chickenpox:

Congenital chickenpox is observed during various periods of pregnancy.
Smallpox before the 20th week of pregnancy usually causes fetal death or damage in the form of cataracts, microcephaly or hydrocephalus, and scarring of the skin.
Chickenpox after the 20th week of pregnancy does not cause symptoms of congenital smallpox in the baby, but there is a risk of developing herpes zoster immediately after birth.
Smallpox in the mother within 5 days before birth and 48 hours after it usually manifests itself as severe chickenpox in the newborn, often complicated by pneumonia and liver disease, and there is a high mortality rate if not treated with antiviral drugs.
Chickenpox in vaccinated people is quite mild, with few lesions on the skin.

Many factors around us increase the risk of developing the disease, for example:

Chickenpox symptoms

The first symptoms of smallpox appear on average 14 days after contact with the sick person and resemble the symptoms associated with a cold; fever develops over time (37 ° C-40 ° C).

Chicken rash is characterized by itching that usually first appears on the torso and eventually spreads throughout the body. Pustules also occur in the nose or mouth, and less commonly on the lower legs and palms. The rash initially takes the form of red spots, which quickly turn into fluid-filled pimples. The latter dry out after a few days. This cycle lasts about 6 days.

Typical symptoms

In addition to blisters, many of the symptoms of chickenpox resemble those of a cold or flu. Other typical signs:

diarrhea;
fatigue, fever, sore throat, headache, cough;
general malaise;
itchy skin;
a rash of fluid-filled blisters on the face and torso;
runny nose and sneezing;
scabs on the formed blisters.

Serious symptoms that may indicate life-threatening illness

Sometimes the chickenpox virus can spread to other areas of the body, such as the brain and lungs, especially in adults, who are more likely to develop complications.

Children are more likely to develop a secondary infection that affects the skin, lungs, circulatory system, joints and other parts of the body. Rarely, smallpox can lead to severe dehydration, especially when accompanied by diarrhea.

You should contact your doctor immediately if you have the following life-threatening symptoms:

fainting;
high body temperature (over 40 °C);
confusion, delirium, drowsiness, hallucinations;
Strong headache;
lack of urination;
distorted or slurred speech, inability to speak;
respiratory problems such as shortness of breath, difficulty breathing, suffocation;
severe dizziness or sudden loss of balance.

Complications

Factors that increase the risk of complications: pregnancy, age over 20 years, treatment of immunosuppressive diseases caused by weakened immunity, children born to infected mothers in the perinatal period.

More common complications include:

Secondary infection of skin wounds, which can leave scars. The most common complications:

local - abscess, phlegmon, rose, scarlet fever;
invasive streptococcal infections - necrotizing fasciitis, sepsis, carbuncle.

Pneumonia:

interstitial (mainly in adults);
secondary bacterial.

Neurological complications:

inflammation of the cerebellum (cerebellar ataxia) - occurs mainly in children under 15 years of age;
inflammation of the brain - in adults, it is difficult, the course of treatment takes up to two weeks;
meningitis, transverse myelitis, Guillain-Barré syndrome, cranial nerve palsy, retinitis (may occur several weeks after infection).

Otitis media.
Death (in extreme cases, in immunocompromised people, especially children).

Rare complications include:

arthritis;
glomerulonephritis;
hepatitis;
Reye's syndrome;
myocarditis;
symptomatic hepatitis;
thrombocytopenia;
dysuria.

Possible complications in the child if the virus has evolved during pregnancy:

eye defects;
brain damage;
neurological changes;
scars, hypopigmentation;
defects in other parts of the body, dysfunction of the anal sphincter and bladder, underdevelopment of the upper and lower extremities.

Why chicken pox is dangerous can be found here:

Treatment

The best treatment for chickenpox is to avoid it. A safe and effective vaccine against the disease is now available. It can be given alone or in combination with the measles, mumps, and rubella vaccine.

In case of infection, doctors prescribe mainly symptomatic treatment. In some cases, the use of antiviral drugs is necessary.

Symptomatic treatment

Antipyretics (with the exception of salicylates, for example, aspirin, since there is a risk of developing Reye's syndrome) - paracetamol;
To reduce itching, antihistamines are used (for example, fenistil, dimethidene) - drugs in the form of powders and solutions should not be used, which may increase the risk of secondary bacterial infections.
Analgesics - if necessary, you can use acetaminophen, ibuprofen, paracetamol.

Pimples that appear on the body should not be touched, otherwise this may lead to the formation of ugly scars in their place after healing.

Etiotropic therapy

Prescribed for complications caused by chickenpox infection, severe disease, or in adults who are at risk of complications. Mainly used for people with weakened immune systems, antiviral therapy is most effective at the beginning of the infection.

Antiviral drugs for chickenpox:

"Acyclovir" ("Zovirax");
"Valacyclovir" ("Valtrex").

They help not only shorten the duration of the disease, but also act as a prevention of complications.

Sometimes it happens that bacteria can get into smallpox wounds. This condition is called secondary infection. It can spread to the lungs, circulatory system, and joints. To treat a secondary infection, a course of antibiotics is prescribed.

For young people, including women in the second and third trimester - for 5-7 days. Treatment should be started within 24 hours of the first appearance of blisters.
For complications or for patients with impaired cellular immunity - every 8 hours for 7-10 days.

Although chickenpox in children is often mild, treatment must be carried out under the supervision of a pediatrician. If the disease is acute, the doctor may also prescribe medications that suppress the replication of viruses. In most cases, patients under 12 years of age are prescribed only symptomatic treatment.

How to relieve itching

To reduce the itching of formed pustules, in addition to antihistamines, doctors recommend the following procedures:

Preventive methods

Specific methods:

Vaccine protection.
Immunoprophylaxis is passive. Conducted for:

newborns whose mothers fell ill with chickenpox 5 days before birth or on the second day after birth;
patients with significant immunodeficiency after contact with the patient.

Chemoprophylaxis using acyclovir.

Non-specific methods:

Isolation (especially of people who are at risk):

people with a rash lasting 5 days or more;
for susceptible persons after contact with a patient - a period of 10 days to 3 weeks.

Serological screening - often used for health care personnel or people at risk who have not been vaccinated and have no history of chickenpox (or no medical documentation).

Chickenpox is one of the most common infectious diseases. Most often it occurs in children and is tolerated quite easily by them. In adulthood, various exacerbations are possible, so treatment must be carried out under the supervision of a doctor.

Smallpox or smallpox is an infection caused by is an orthopoxvirus with enormous virulence. The disease is caused by two types of viruses: a large form (mortality rate - 25−45%) and a small form (mortality rate - 2−4%). In the Middle Ages, smallpox was called the black death, because due to its high infectiousness and lack of understanding of sanitary science, it carried out a devastating march through many European countries.

First mentions

The disease “smallpox” has been known for a long time. This is evidenced by a study of ancient Egyptian mummies, on which ulcerative lesions were discovered using a microscope. It's strange that Hippocrates lived for six centuries later, nowhere in his writings does he mention a disease similar in symptoms to smallpox. However, the Roman physician Galen, two hundred years later, still described smallpox, which, however, did not seem to be a serious disease to the people of that time.

In 1892, Guarnieri described specific inclusions in the cells of the cornea of a rabbit suffering from smallpox, and in 1906, Paschen, using a special staining method, saw viral bodies in the fluid taken from smallpox.

The smallpox virus is the largest virus (200−300 nm), and when viewed under an electron microscope it has the shape of a brick. The virion consists of a core containing DNA along with a large number of proteins. On either side of it are oval bodies. There is a clearly defined shell between the nucleoid and lateral bodies. The outer shell contains lipids and protein-based tubular structures.

The smallpox virus is so large that it can be seen under a light microscope (which is how it was discovered). This size is of fundamental importance in the life cycle of the virus. Its smaller brothers, having amazingly small dimensions, do not contain anything other than genetic material under their shell. In turn, the variola virus contains a large number of enzymes, which allows it, once in the body, not to waste time on “building up”: as soon as it penetrates the cell, it immediately begins the synthesis of its own proteins.

Unlike most other diseases, orthopoxvirus does not care at all in which tissues to reproduce, so it chooses the most numerous and accessible ones - skin cells.

In addition to the variola virus, the group of smallpox viruses also includes:

Alastrim;
Cow and monkey pox;
Vaccines based on them.

Pathogens enter the human body through the mucous membrane of the upper respiratory tract, then into nearby lymph nodes. After this, the pathogens enter the bloodstream, spreading throughout the body. The virus is localized in lymphoid tissue where reproduction occurs.

Smallpox is a human disease characterized by a specific lesion of the skin, which occurs after the pathogen penetrates from the bloodstream into the interstitial space, and from there into the cells of the epidermis. Small bubbles called vesicles form on the skin. If their integrity is violated, for example, by combing, accompanying bacteria (staphylococci) can easily penetrate there, which will lead to suppuration. Such purulent vesicles will be called pustules.

The causative agent of smallpox is able to remain viable for a long time in dried crusts of pustules, fluid vesicles, and also the bed linen of patients. The smallpox virus is resistant to many disinfectants.

The last case of smallpox was reported on October 26, 1977 in Somalia. After that case smallpox disease“was considered defeated, and vaccination is no longer carried out against it. Accordingly, at the moment, most of the world's population does not have immunity against orthopoxvirus, which makes humanity vulnerable to biological weapons based on the blackpox virus.

Symptoms of the disease

The incubation period of the disease ranges from 8 to 12 days. Afterwards the first symptoms of smallpox appear:

chills and low-grade fever (37.5 degrees);
acute “tearing” pain in the lower back, as well as in the sacral region;
dizziness and headache;
vomit.

On the second day, the body temperature rises to 40-41 degrees and skin lesions typical of smallpox appear. A rash occurs, which can appear as:

areas of hyperemia;
hemorrhagic rash.

In the second case, the symptom will be characterized by the fact that the rash does not disappear when pressure is applied to it, and has the appearance of small hemorrhages in the dermis and deep layers of the skin. In some cases, spots with a diameter of up to 3 mm are formed, looking like hemorrhages involving the mucous membrane.

By the fourth day fever subsides, there is an overall decrease in the severity of symptoms. However, it is at this moment that the characteristic symptoms of the disease begin to appear. sign - pockmarks, whose favorite place is the skin of the face and scalp. Pockmarks also appear on the torso and limbs, but in smaller quantities. Pockmarks on the face look very characteristic, so they cannot be confused with any other skin lesion.

In addition to the outer skin, the mucous membranes of the upper and lower respiratory tract are also affected. The conjunctival membrane of the eyes, the urethra and rectum, and the female genital organs are subject to rashes.

By 8-9 days, pockmarks suppurate, which again sharply worsens the patient’s condition, because in addition to the general picture of the disease, toxic brain damage is also added to it, which is manifested by the following symptoms:

confusion;
rave;
excited state;
Children experience seizures.

Death occurs 3-4 days after exacerbation. Almost half of the sick die, 20% of those who recover lose their vision, as the virus attacks the epithelium of the cornea. The infection leaves behind many antibodies that persist throughout life.

Complications include concomitant infections and conditions, including:

encephalitis and meningitis (meningoencephalitis);
pneumonia;
iritis;
panophthalmitis;
sepsis;
keratitis

The smallpox vaccine can alleviate the course of the disease. In this case, the incubation period increases infection period up to 18 days. General intoxication is not so pronounced. The rash is easier to tolerate and less of it forms. In general, in this situation, recovery occurs within 14 days. In addition, mild forms of infection are possible.

Diagnosis of the disease

The clinical picture of smallpox is very characteristic and recognizing it is not difficult. The problem is that there are probably no practicing doctors left in the world who have seen smallpox live. Symptoms that appear at the beginning of the disease will tell the modern doctor absolutely nothing, but it is during the first two days that the patient is most contagious. The virus is easily transmitted by airborne droplets through coughing and saliva during conversation.

Diagnosis is based on content analysis vesicles and skin elements. In addition, blood is examined. An oral swab is taken. The presence of smallpox pathogen in samples is determined using PCR, microprecipitation reaction and electron microscopy.

Treatment of infection

Treatment measures are based on the use of antiviral drugs, as well as the fight against symptoms. The first ones used are:

Metisazone (intravenously);
Anti-smallpox immunoglobulin (intramuscular).

Used to combat the spread of skin lesions antiseptics. Concomitant bacterial infections are treated with broad-spectrum antibiotics. Detoxification of the body is ensured by the use of plasmaphoresis and ultrafiltration.