Display Settings:


Send to:

Choose Destination
See comment in PubMed Commons below
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.



Because the cause of death in smallpox remains controversial, the human pathology record was examined.


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.


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.


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.

[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Loading ...
    Write to the Help Desk