Monkeypox can « mask » like other conditions, with a wide range of symptom severity

As global monkeypox outbreaks made headlines, Dr. Antoine Cloutier-Blais’ Montreal clinic began seeing patients with unusual and often painful bodily injuries.

At the beginning of June, the family doctor and his colleagues had treated about fifteen patients with confirmed infections, out of the hundred laboratory-confirmed cases reported so far in Quebec. People suspected of infections soon began showing up at the clinic almost daily.

Cloutier-Blais began to notice some interesting trends.

The smallpox lesions, he discovered, did not look exactly like what he had seen in photos circulating online of infected people in parts of Africa, where the virus had been found for decades. .

“The lesions are much smaller and usually very localized,” he said, adding that there is also “a very wide range of different types of presentations.”

In some cases, lesions appear on or within various body areas, including patients’ mouth, genitals, or anal region, sometimes extending to the limbs or torso or appearing all over the body.

But for other patients, the visible symptoms were much more subtle – even a single mark on the skin.

Medical experts from several countries are noticing similar trends. In this unprecedented outbreak – which is giving many clinicians around the world their first real experience with this disease – there is a clear range of severity, from classic rashes all over the body requiring hospital stays and painkillers, up to to cases where monkeypox presents as a mild infection that can be easy to miss or easy to confuse with other conditions.

And while these infections are generally treatable, there is also growing concern that this virus could spread to vulnerable populations at higher risk of life-threatening illness.

The rash may be the first warning sign

Monkeypox often appears as a flu-like illness, characterized by symptoms such as fever, chills, and muscle stiffness that may precede the telltale lesions.

Yet for recent patients in the United States, the appearance of a rash was often the first warning sign that they were sick.

“In these new cases, what we hear is that those [pre-rash] the symptoms can be really mild or even not noticed at all,” said Dr. Agam Rao, a poxvirus and rabies branch physician at the US Centers for Disease Control and Prevention, in an interview with the medical journal JAMA.

For clinicians unfamiliar with the virus, it can also be difficult to differentiate some monkeypox infections from chickenpox – or some sexually transmitted infections like herpes and syphilis.

« Monkey pox can masquerade as other diseases, » said Dr Rosamund Lewis, Canadian physician and technical lead for the monkey pox outbreak at the World Health Organization (WHO).

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Body damage from this virus is also thought to usually begin around the head, before progressing to the arms and legs, but Rao said US patients first experienced rashes in the genital or perianal regions. , including some people who have suffered from rectal inflammation.

A case study published in the medical journal of infectious diseases Eurosurveillance examined the experience of an HIV-positive man in his 30s who was diagnosed with monkeypox in May after traveling and engaging in sexual activity in Europe.

The man’s first symptoms were painless pustules on his penis, which quickly worsened. The lesions became painful and itchy, then the man developed a fever three days later, with the rash spreading to his torso, face and limbs in the days that followed, necessitating two visits to his home. doctor and a brief stay in hospital.

« When examined in hospital, the penile lesions were largely crusted, and the lesions on the hands and lower extremities were painless papular pustules, » the case study authors wrote.

« Monkey pox can affect anyone »

Monkeypox is not known to be a sexually transmitted infection, but it can be spread through various forms of close contact with others. This includes skin-to-skin contact, even if someone has only minimal lesions in their genital areas, or through respiratory droplets if someone has a lesion inside their mouth, noted Lewis from the l WHO.

Although there are reports of recently infected women around the world, the bulk of infections in this global outbreak – now at around 1,000 confirmed cases and counting – have been among men who have sex with men. , which prompted awareness campaigns by and for members of this community.

« Of course, monkeypox can affect anyone, any gender, any sexual orientation, » said Dane Griffiths, director of the Gay Men’s Sexual Health Alliance in Ontario, where a dozen cases have been reported. reported, primarily in Toronto.

« But given the current cases we’re seeing and the outstanding questions about the dynamics of monkeypox transmission in our community, we’re letting people know. »

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Cloutier-Blais stressed the importance of rapid community mobilization, including an « impressive » turnout for monkeypox vaccination clinics in Montreal.

Since the launch in late May, more than 1,600 doses have been provided to members of the public who may be at higher risk of contracting monkeypox through sexual contact or for occupational reasons.

« Anyone could eventually experience symptoms, » Cloutier-Blais said.

‘Stay isolated’ if lesions appear

When it comes to mild cases, the Montreal doctor said his patients don’t need much medical support.

“We simply suggest that individuals cover their lesions and stay isolated as much as possible, with a mask if they need to meet other people, and if not stay home and cover their lesions until they recover. ‘they are completely healed,’ he explained.

More severe cases, however, have required hospitalization, with patients suffering from « fever or very severe pain that is difficult to manage with oral medication alone ».

So far, no one has died in this recent global outbreak outside of Africa, WHO Director-General Tedros Ghebreyesus said at a press conference on Wednesday. But the disease can be fatal in some cases, especially for high-risk groups such as pregnant women, children, and people with weakened immune systems.

Tedros called on countries to make serious efforts to stop transmission of the virus to prevent monkeypox from spreading more widely and spreading among these vulnerable populations.

« The risk of monkeypox becoming established in non-endemic countries is real, » he said.