The clinical manifestations of monkey pox they usually include skin lesions in the form of blisters or sores that can appear on different parts of the body, such as the face, hands, feet, eyes, mouth or genitals.
Researchers explain that this is the most common symptom of monkeypox virus infection, but warn that the current outbreak of the disease has presented different epidemiological characteristics.
The World Health Organization (WHO) states that the clinical presentation of recent cases, which affect multiple countries, has been atypical compared to previously documented reports of the infection, mainly in Africa.
New studies, released this week, point to changes in the way the disease is transmitted in addition to new symptoms.
most common symptoms
The incubation period is usually 6 to 13 days, but can range from 5 to 21 days. In the most common documented form of the disease, symptoms may appear from the seventh day with a sudden and intense fever.
Signs such as headache, nausea, exhaustion, tiredness and especially the appearance of swollen glands are common, which can happen both in the neck and in the axillary region as well as in the genital part.
The manifestation on the skin occurs between one and three days after the initial symptoms. The signs go through different stages: macula (small spots), papule (small pimple-like sores), vesicle (small blisters), pustule (bubble with the presence of pus) and crust (which are the healing shells).
WHO warns of new symptoms
The WHO, which continuously monitors the epidemiological features of the current outbreak, says that many cases in newly affected areas are presenting with clinical conditions different from those classically described for smallpox.
According to the WHO, new symptoms can also appear as lesions in the genital or anus area that do not spread throughout the body, as well as sores that appear at different stages of development.
In addition, there are reports of the appearance of lesions before the onset of fever, malaise and other symptoms of the disease.
In a study published in the journal BMJ, researchers in the United Kingdom revealed two new signs of the disease: pain in the anus region and swelling of the penis.
National Health Service (NHS) experts suggest that clinical manifestations should be included in public health and professional guidance to aid in early diagnosis and reduce disease transmission.
The researchers performed an observational analysis of 197 people who had a laboratory-confirmed diagnosis of monkeypox, tested and followed up through a high-consequence infectious disease center in south London, England.
All persons with a positive molecular diagnostic test result participated in a telephone consultation to be advised of the result and to carry out a risk assessment.
According to the study, the average age of participants was 38 years. All 197 participants were men, ages 21 to 67, and 196 identified as gay, bisexual or other men who have sex with men.
All had skin lesions, most commonly on the genitals (56.3%) or perianal region (41.6%). Of the total, 170 (86.3%) participants reported systemic disease. The most common systemic symptoms were fever (61.9%), enlarged lymph nodes or lymphadenopathy (57.9%) and muscle pain (31.5%).
Among patients, 102 (61.5%) developed systemic features before the onset of skin manifestations and 64 (38.5%) afterwards. Another 27 (13.7%) presented exclusively skin manifestations without systemic characteristics.
At least 71 patients (36%) reported rectal pain, 33 (16.8%) reported sore throat, and 31 (15.7%) reported penile swelling (edema). At least 27 (13.7%) had oral lesions and 9 (4.6%) had signs of alteration in the tonsils.
“Rectal pain and penile swelling were the most common presentations requiring hospital admission in this cohort, but these symptoms are not currently included in public health messages. We recommend that clinicians consider monkeypox infection in those who have these symptoms,” the study reads.
Discrete lesions can make diagnosis difficult
Another study, carried out in Spain, points out that instead of the traditional manifestation on the skin in the form of blisters or large lesions that can appear in different parts of the body, the disease can cause smaller sores, called papules or pseudopustules, which can be concentrated in the where the infection occurred, such as the genital region.
The research, conducted by specialists from several Spanish hospitals, had the participation of 185 patients. The analysis shows that most cases started with homogeneous papules, and not pustules that are larger and with pus, located in the probable area of infection, which may be cutaneous or mucosal, including single lesions.
The study suggests that the most discreet manifestation of the disease can lead to a lack of adequate and early diagnosis.
“Most cases start with lesions on the genitals, face, arms and hands and perianal region. These early lesions, although pustule-like in appearance, are not pustules but solid whitish papules with no liquid content,” the article reads.
Over time, the center of the lesion becomes necrotic and may present with pain and clustering into large plaques (see images ).
In some patients, small generalized pustules appeared as the disease progressed – 11% had a single lesion. In this phase, heterogeneous wounds were also identified. Less common lesions included mucosal ulcers, such as in the pharynx, tonsil, and rectum.
The researchers suggest that contact during sex was the most likely transmission mechanism in the cases analyzed.
According to the study, all patients had systemic symptoms, mainly enlarged lymph nodes (56%), fever (54%), muscle pain (44%), weakness and lack of energy (44%) and headache (32%). %). In 98% of the patients the symptoms appeared on the same day or a few days before the appearance of the skin signs.
In all, four patients were hospitalized and no deaths were recorded.
Source: CNN Brasil