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Mil Med. 2002 Jul;167(7):546-51.

The cause of death in smallpox: an examination of the pathology record.

Author information

  • Francis E. Warren Air Force Base, WY 82005, USA.

Abstract

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.

PMID:
12125845
[PubMed - indexed for MEDLINE]
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