As a result of the presence of cases of monkeypox in Spain and the rest of the European countries, Spanish dermatologists were invited to participate in the data collection of the disease from May 28 to July 14, 2022. For this study, only those patients who presented a positive result in any sample taken orthopoxvirus hey monkeypox virus (mpxiv). A survey was conducted through the REDCap platform in which clinical, demographic and epidemiological data were collected.
pseudopustules and severe pain
The results showed that most of the lesions started in the genital, facial, perianal or extremity areas. Only a small percentage of patients (11%) had limited or isolated lesions.
One of the most important aspects to which we contribute is the description of the underlying lesion of monkeypox. Although pustules are commonly talked about, it has been observed that these lesions form pseudopustules, given that their contents are mainly solid and white.
In addition, the lesions usually have a necrotic center and an erythematous halo which gives them their distinctive appearance. Subsequently, as these lesions develop, they may take on a more purulent, necrotic, or even ulcerated appearance. This is essential information not only by dermatologists, but also by other healthcare professionals to aid in its identification that are not used to assess skin lesions.
The symptoms of lesions reported by patients were variable, but some were very painful and associated with swollen regional nodes (lymphadenopathy).
Other symptoms: swelling, fever, fatigue…
In addition to skin lesions, other less common but relevant manifestations were: hoarseness (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 or early with skin lesions, which underscores the importance of knowing their relationship to the virus in order to make a proper diagnosis.
All patients included in the study presented systemic symptoms, mainly swollen lymph nodes (56%), fever (54%), muscle pain (44%), fatigue (44%) and headache (32%). Most of the time these symptoms appear simultaneously or 2 to 3 days before the appearance of skin lesions.
Few hospitalizations and no deaths
The need for hospitalization was almost real (only 4 cases, 2% of the total), and in some of these cases it was done to control pain or preventive monitoring for the presence of severe symptoms (severe dysphagia, conjunctivitis and suspected perforation). went. , No patient died.
All patients in our series were male. In addition, all of them reported having sex with other men (99%), and most had multiple sexual partners in the weeks preceding the onset of symptoms.
Other epidemiological data of interest observed that 54% of patients had presented a diagnosis of some sexually transmitted infection (STI) in the previous months, 34% had used some type of drug in their sexual relationship. Chemex And 42% were positive for HIV. The use of PrEP (pre-exposure prophylaxis) was also common in HIV-negative patients. In addition, in 76 percent of cases, another concomitant STI was found at the time of presentation of monkeypox.
The presence of concomitant HIV infection (with good virological control) or previous vaccination against smallpox was not associated with greater or lesser severity of the disease.
With respect to the incubation period, the average number of days from suspected exposure in our series (in patients where the timing of exposure can be accurately established) to onset of symptoms was 6 days (with an interval between 4 and 9) ) was.
What is infection like and who gets infected?
Skin lesions are a major manifestation of infection. Its onset is usually solid to pseudopustule which later becomes necrotic and can ulcerate. Systemic symptoms appear in a large proportion of infected patients and some constitute an important finding for early detection of cases; Especially those who have had close contact with another diagnosed person.
In most cases it is a mild disease. Particular attention should be paid to the most unusual symptomatology that may appear isolated or have more complex management, such as proctitis, airway injury, and leucorrhoea.
Concomitant infection with other STIs is frequently found in patients diagnosed with monkeypox, so it should be actively explored.
Although the current outbreak is mainly occurring in men who have sex with other men and engage in risky behavior, it is possible that with an increase in incidence, there may be cases of a different profile in patients or population groups. Huh.
However, with due care to avoid stigma, all control efforts (information, vaccination…) should be directed primarily at this most affected group, with the help of LGBTIQ+ groups, to protect them and provide an optimum opportunity to control the spread. the outbreak. Ignoring the importance that all health professionals, regardless of expertise, know the disease and its clinical features, in order to diagnose the pathology in anyone susceptible to contagion.
At this time, our main weapon for control of the outbreak is to encourage and urge patients who have received a diagnosis to adhere to the recommended period of isolation. In addition, having the vaccine can help prevent exposure to confirmed cases or someone who may be at higher risk of getting the disease.
It is extremely important to continue the joint and coordinated work of the research and scientific community to advance our knowledge of this disease and to answer questions we still ask ourselves, such as fluid or mucous membranes. In the persistence of the virus, the possibility of contagion through the most appropriate management of asymptomatic people or our patients.
This article was originally published by Science Media Center Spain.
Pablo Fernandez Gonzalez, Dermatologist, Ramon Y Kajal University Hospital
This article was originally published on The Conversation. read the original.