OBJECTIVE: Because the cause of death in smallpox remains controversial, the human pathology record was examined. METHODS: The surviving case series of smallpox pathology in humans as well as other review articles from English language journals written during the last 200 years were reviewed. RESULTS: The skin lesions in smallpox developed as a result of viral damage and inflammation. Secondary bacterial infection did not occur until the scabs started shedding. During the papular stage of skin eruption, a secondary viremia caused focal lesions in the pharynx, larynx, tongue, trachea, and esophagus in descending frequency. The virus also caused potentially lethal interstitial pneumonitis as well as tubulointerstitial nephritis. CONCLUSIONS: The cytopathic effects of smallpox cause death. The data did not support previously promulgated theories attributing death to a bacterial sepsis syndrome seeded from the pustules or immune complex deposition. In a future outbreak, antibiotic therapy would minimally influence mortality.
OBJECTIVE: Because the cause of death in smallpox remains controversial, the human pathology record was examined. METHODS: The surviving case series of smallpox pathology in humans as well as other review articles from English language journals written during the last 200 years were reviewed. RESULTS: The skin lesions in smallpox developed as a result of viral damage and inflammation. Secondary bacterial infection did not occur until the scabs started shedding. During the papular stage of skin eruption, a secondary viremia caused focal lesions in the pharynx, larynx, tongue, trachea, and esophagus in descending frequency. The virus also caused potentially lethal interstitial pneumonitis as well as tubulointerstitial nephritis. CONCLUSIONS: The cytopathic effects of smallpox cause death. The data did not support previously promulgated theories attributing death to a bacterial sepsis syndrome seeded from the pustules or immune complex deposition. In a future outbreak, antibiotic therapy would minimally influence mortality.
Authors: Julie Dyall; Reed F Johnson; Dar-Yeong Chen; Louis Huzella; Dan R Ragland; Daniel J Mollura; Russell Byrum; Richard C Reba; Gerald Jennings; Peter B Jahrling; Joseph E Blaney; Jason Paragas Journal: J Infect Dis Date: 2011-10-19 Impact factor: 5.226
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Authors: Amanda D Rice; Mathew M Adams; Bernhard Lampert; Scott Foster; Alice Robertson; George Painter; Richard W Moyer Journal: Viruses Date: 2011-02 Impact factor: 5.048
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Authors: Reed F Johnson; Srikanth Yellayi; Jennifer A Cann; Anthony Johnson; Alvin L Smith; Jason Paragas; Peter B Jahrling; Joseph E Blaney Journal: Virology Date: 2011-08-15 Impact factor: 3.513