As if rising sea levels, freak weather systems and forest fires weren’t enough now we have global warming to thank for the possibility of smallpox making a comeback!
 
Researchers in Siberia have reported that rising temperatures are causing permafrost to melt thereby exposing mass graves of people who died in smallpox epidemics back in the 1890s. This is not the first time melting permafrost has given rise to modern illness. One child was killed and thousands of reindeer slaughtered due to an outbreak of the bacterium anthrax which was thought to be the result of infected bodies being released from the permafrost.
 
So far the smallpox virus itself has not been found but the bodies bear skin lesions consistent with those caused by smallpox and fragments of viral DNA have been found in tissue samples. Scientists are saying it’s possible that the virus could still be alive in these circumstances and therefore that smallpox could make a comeback! Okay, it sounds a bit unlikely but the scientific community hadn’t expected Ebola to be on the scale it was two years ago so maybe it’s time for a refresher…better to be to be safe than sorry. 

​The patient was a 42 year old man who presented to his GP with a fever and severe pain in his axilla. On examination there was tender lymphadenopathy with overlying erythema; the largest lymph node measured 4cm. Further questioning elicited that the patient had a crop of painful, erythematous vesicles distally on the same arm. The GP wondered if this might be a localised skin infection with something like Staphylococcus aureus, the most common cause of skin infections; the lymph node involvement might represent regional lymphatic spread e.g. lymphangitis. The GP prescribed Flucloxacillin and suggested that the patient should return if there was no improvement in a few days.
 
Three days later the patient was no better and returned to his GP. The GP re-examined the patient and noted some minor scratches on the patient’s hands and arms. The patient explained that he had adopted a female kitten who liked to play with his hands, batting him without always remembering to retract her claws. As a result the patient had sustained a few nasty scratches when the play became a little “rough”.

​A sheep farmer presented to the hospital with a persistent cough and fever. A chest x-ray showed minor patchy consolidation but as the patient was otherwise fit and well he was quite rightly allowed to go home with a course of PO Amoxicillin (1st line treatment for community acquired pneumonia). A week later the patient was still feeling unwell so he went to his GP who changed him to PO Co-amoxiclav…just in case the bacteria were resistant. Five days later the patient returned to the hospital and was changed again to IV Piptazobactam as he was still no better and the doctors thought the oral antibiotics weren’t working.