Clinical
Effects of Smallpox: Pathophysiology of Natural Infection
Infectious
Stage
Infection
marked by high fever and progressive centripetal rash. By the 3rd
or 4th day of illness the temperature usually falls and the patient
feels somewhat better. This coincides with the first visible lesions
and the person becomes infectious.
The first visible
lesions appear in the mouth as minute red spots on the tongue and
oral and pharyngeal mucosa. This occurs about 24 hours before the
appearance of rash on skin. (19:5) Enanthem,
an eruption on a mucous membrane, are the first visible lesions.
These lesions first appear in the mouth and pharynx and ulcerate
quickly because of the absence of a stratum corneum. The ulceration
results in a release of large amounts of virus into the saliva. (9:4) Virus
titers in saliva are highest during the first week of the skin
rash, corresponding with the period during which patients are most
infectious. (9:4)

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