As a result of the emergence of cases of monkeypox in several countries, Spanish dermatologists were invited to participate in the collection of data on this disease from May 28 to July 14, 2022. For this study, only those patients who presented a positive result were included any of the samples taken for orthopoxviruses or Monkeypox virus (MPXIV). A study was conducted through the REDCap platform in which clinical, demographic and epidemiological data were collected.
Pseudopustules and severe pain
The results show that most of the lesions started in genital, facial, perianal or extremity area. Only a small percentage of patients (11%) had limited or isolated lesions. One of the most important aspects we contribute to is the description of the main damage of monkeypox. Although we usually talk about pustules, what is observed is that these lesions represent pseudopustules, as their contents are mostly solid and whitish.
In addition, the lesions usually have a necrotic center and an erythematous halo, which gives them their characteristic appearance. Subsequently, as these lesions develop, they may take on a more purulent, necrotic or even ulcerated appearance. This is a key piece of information that can help identify it from, not only by dermatologists but also by other health professionals who are not used to evaluating skin lesions. Symptoms of the lesions reported by patients vary, but some are very painful and are associated with swollen regional nodes (lymphadenopathy).
Other symptoms: inflammation, fever, fatigue…
In addition to skin lesions, other less common but significant manifestations are: felons (inflammation of the distal part of the fingers), direct involvement of the oral or genital mucosa, and proctitis (inflammation of the rectal mucosa). These lesions may appear isolated, associated with skin lesions, or early, which emphasizes the importance of knowing their relationship to the virus in order to make the correct diagnosis.
All patients included in the study showed systemic symptoms, mainly swollen lymph nodes (56%), fever (54%), muscle pain (44%), fatigue (44%) and headache (32%). In most cases, these symptoms appear at the same time or between 2 and 3 days before the appearance of the skin lesions.
Few hospitalizations and no deaths
The need for hospitalization was almost anecdotal (only 4 cases, 2% of the total), and in those few cases it was done to control pain or to preemptively monitor the onset of severe symptoms (severe dysphagia, conjunctivitis and suspected perforation). None of the patients died. All patients in our series were male. In addition, they all reported having had sexual relations with other men (99%), and most had multiple sexual partners in the weeks before the onset of symptoms.
Other observed epidemiological data of interest were that 54% of patients presented the diagnosis of some sexually transmitted infection (STI) in the previous months, 34% used some type of drug in their sexual relations chem-sex Y 42% are HIV positive. The use of PrEP (pre-exposure prophylaxis) in HIV-negative patients is also common. In addition, in 76% of cases, another concomitant STI was detected at the time of monkeypox presentation.
The presence of concomitant HIV infection (with good virological control) or previous smallpox vaccination was not associated with greater or lesser disease severity. Regarding the incubation period, in our series the median number of days from suspected exposure (in those patients in whom the time of exposure could be accurately determined) to onset of symptoms was 6 days (with a range between 4 and 9).
How does the infection occur and who gets infected?
Skin lesions are the main manifestation of infection. Its onset is usually solid pseudopustules that later become necrotic and may ulcerate.. Systemic symptoms occur in a large proportion of infected patients and are an important finding for the early detection of some cases; especially those who have had close contact with another diagnosed person.
In most cases, this is a mild disease. Particular attention should be paid to the most atypical symptoms that may appear isolated or require more complex treatment, such as proctitis, respiratory tract injuries and criminals. Co-infection with other STIs is a common finding in patients diagnosed with monkeypox, so it should be actively sought.. Although the current epidemic occurs mainly in men who have sex with men and with risky practices, it is possible that as the incidence increases, cases may occur in patients or population groups with a different profile.
However, with due care to avoid stigmatization, all control efforts (information, vaccination…) should be directed primarily at this most affected group, with the help of LGBTIQ+ groups to protect them and offer optimum spread control capability. outbreak. Without neglecting the importance of all health professionals, regardless of specialization, to know this disease and its clinical characteristics in order to diagnose the pathology in any person susceptible to infection.
Currently, our main weapon in controlling the outbreak is to encourage and insist that patients who have received a diagnosis adhere to the recommended period of isolation. In addition, getting the vaccine can help immunize those who have been in contact with confirmed cases or anyone who may be at higher risk of contracting the disease.
It is extremely important that we continue the research and the collaborative and coordinated work of the scientific community in order to move forward knowledge about this disease and answers to the questions we still ask such as: the persistence of the virus in fluids or mucous membranes, the possibility of infection through asymptomatic people or the most appropriate treatment for our patients.
from: Pablo Fernandez Gonzalez
Dermatologist, Ramón y Cajal University Hospital
This item was published originally from Science Media Center Spain.
Also published in The conversation