How are the lesions caused by monkeypox? We therefore studied

Following the appearance of cases of monkeypox in Spain and the rest of European countries, Spanish dermatologists have been invited to participate in a data collection on this disease from May 28 to July 14, 2022. This workshop only patients who tested positive in any of the samples taken for Orthopoxvirus oh Monkeypox virus (MPXIV). A survey was conducted among REDCap Platform in which clinical, demographic and epidemiological data were collected.

Pseudopustules and severe pain

The results showed that most of injuries they started in the genital, facial, perianal or extremity regions. Only a small percentage of patients (11%) had circumscribed or isolated lesions.

One of the most important aspects to which we contribute is the description of the basic lesion of monkeypox. Although we usually speak of pustules, it has been observed that these lesions constitute pseudopustules, since their contents are mostly solid and whitish.

In addition, the lesions usually show a necrotic center and a halo. erythematous which gives them their characteristic appearance. Subsequently, as they evolve, these lesions may take on a more purulent, necrotic or even ulcerated appearance. This is essential information to aid in its recognition not only by dermatologists, but also by other healthcare professionals unaccustomed to assessing skin lesions.

Patient-reported lesion symptoms were variable, but some were very painful and were associated with swollen regional lymph nodes (lymphadenopathy).

Lesions caused by monkeypox.
UK Health Security Agency

Other symptoms: inflammation, fever, fatigue…

In addition to skin lesions, other less frequent but relevant manifestations were: 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 can appear isolated, associated with cutaneous lesions or early, which underlines the importance of knowing their relationship with the virus in order to make the correct diagnosis.

All patients included in the study had systemic symptoms, mainly swollen lymph nodes (56%), fever (54%), muscle aches (44%), fatigue (44%) and headache. head (32%). Most of the time, these symptoms appeared concomitantly 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 these few cases it was a matter of controlling pain or preventively monitoring the appearance of severe symptoms (severe dysphagia, conjunctivitis and suspicion of perforation). . None of the patients died.

All patients in our series were male. In addition, all report having had sex with other men (99%), and most have had several sexual partners in the weeks preceding the onset of symptoms.

Other interesting epidemiological data observed were that 54% of patients had been diagnosed with a sexually transmitted infection (STI) in the previous months, 34% had used some type of drug in their sexual relations chemsex and 42% were HIV positive. It was also common to use Preparation (pre-exposure prophylaxis) in HIV-negative patients. In addition, in 76% of cases, another concomitant STI was found at the time of presentation of monkeypox.

The presence of a concomitant HIV infection (with good virological control) or of a previous vaccination against smallpox was not associated with a greater or lesser severity of the disease.

Regarding the incubation period, in our series, the median number of days between suspected exposure (in patients where the time of exposure could be precisely established) and the onset of symptoms was 6 days (with an interval between 4 and 9).

What does the infection look like and who is infected?

Skin lesions are a key manifestation of infection. Its onset is usually solid from pseudopustules which then become necrotic and may ulcerate. Systemic symptoms appear in a large proportion of infected patients and constitute an important observation for the early detection of certain cases; especially those who have had close contact with another diagnosed person.

It is mild illness in most cases. Particular attention should be paid to the most atypical symptoms which may appear isolated or which require more complex management, such as proctitis, lesions of the respiratory tract and paronychia.

Concomitant infection with other STIs is a common finding in patients diagnosed with monkeypox, so it should be actively sought.

Although the current epidemic is occurring primarily among men who have sex with men and with risky practicesit is possible that with the increase in incidence, cases occur in patients or population groups with a different profile.

However, taking care to avoid stigma, all control efforts (information, vaccination…) must be directed primarily towards this most affected group, with the help of LGBTIQ+ groups, to protect them and offer an optimal opportunity to control the epidemic. Without neglecting the importance that all health professionals, regardless of their specialization, know about this disease and its clinical characteristics, in order to diagnose the pathology in anyone susceptible to contagion.

At present, our main weapon in controlling the epidemic is to encourage and insist on patients who have been diagnosed to respect the recommended period of isolation. Moreover, having the vaccine You can help vaccinate contacts of confirmed cases or anyone who may be at higher risk of contracting the disease.

It is extremely important to continue research and the joint and coordinated work of the scientific community in order to advance our knowledge of this disease and to answer the questions that we still ask ourselves, such as: the persistence of the virus in fluids or mucous membranes, the possibility of contagion by asymptomatic people or the most appropriate management of our patients.


This article has been published originally by Science Media Center Spain.

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