Monkeypox: how to know if a skin lesion could be a sign of the disease

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THE monkey pox It is most often a self-limiting disease, with signs and symptoms lasting two to four weeks. The incubation period, the phase in which the person does not have symptoms, lasts on average from 6 to 13 days, but can reach 21 days.

Clinical manifestations 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.

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However, the current outbreak of the disease has presented different epidemiological characteristics, with symptoms that can be quite mild, which can make it difficult and delay the proper diagnosis.

Know the main signs of the disease, the definition of a suspicious case and know who should seek the diagnostic test.

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In the most common documented form of the disease, symptoms may appear from the seventh day onwards 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).

How to tell if a skin lesion could be monkeypox

In the typical clinical picture of the disease, the skin lesions form blisters in different parts of the body. However, the symptoms caused by monkeypox in the current outbreak have varied greatly from one person to another according to infectologists.

In some patients, the sores may only appear in the genital or anus area and do not spread throughout the body. In others, it is common to identify a single lesion. Infectologists point out that in the current outbreak, unlike the initial description of the disease in Africa, the sores can also appear at different stages of development. In addition, there are reports of lesions appearing before the onset of fever, malaise and other symptoms of the disease.

“The clinical presentation of monkeypox in the current outbreak is quite varied. There are patients with a single lesion, with multiple lesions, restricted to the genital region or with lesions on the whole body. Lesions are manifesting asynchronously as well. In the previous characteristic, they were all in the same phase of evolution, when one entered the phase of forming crusts, they all entered too”, explains infectious disease doctor Mirian Dal Ben, from Hospital Sírio-Libanês, in São Paulo.

THE correlation between the symptom and the possibility of monkeypox must be performed by a professional of health. At the consultation, the doctor considers epidemiological information such as contact with suspected or confirmed cases of the disease it’s the history of intimate contact with casual partners prior to manifestation symptomatic. Based on these records collected during the consultation, the specialist will be able to order a diagnostic test.

A study carried out in Spain points out that instead of the traditional manifestation on the skin in the form of blisters or large lesions, the disease can cause smaller sores, called papules or pseudopustules (see image below ), which may be concentrated in the place where the infection occurred, such as the genital region.

The survey, conducted by specialists from several Spanish hospitals, involved 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.

Definition of suspicious case

In the face of suspicious signs of the disease, specialized care should be sought for laboratory diagnosis. The Ministry of Health recommends that the test be done on all patients suspected of having the disease and that isolation should begin even before the test results.

In a technical note with guidelines for Primary Health Care (PHC) teams released on the 5th, the ministry recommends that people with a characteristic skin lesion or who meet one or more of the epidemiological criteria defined in the concept of suspected case should be tested. .

According to the document, a A suspected case is defined by the presentation of a sudden onset of an acute rash suggestive of monkeypox . The lesion can be single or multiple, in any part of the body, including the genital region, with or without an increase in the size of the lymph nodes (adenomegaly) or fever.

In addition, healthcare professionals should consider epidemiological information that may guide the test order, such as the contact with suspected or confirmed cases or history of intimate contact with strangers or casual partners in the last 21 days preceding the start of the signals.

“I have already seen a patient in the office who had a lesion in the genital region and who reported having had contact with a patient who had visited Emílio Ribas and confirmed monkeypox. Epidemiologically, there is practically a certainty, but as these are lesions with characteristics similar to other infections, such as herpes, it is important to perform PCR to make the correct diagnosis”, says Mirian.

Isolation and care

Children, pregnant women, and people with immune deficiencies may be at risk for more severe symptoms. The Ministry of Health recommends that care aimed at this population at risk without signs of severity, including the place of isolation of this population, should be analyzed on a case by case basis.

In relation to patients with good general condition, who are not part of the population at risk, it is recommended that treatment of symptoms be prescribed. The patient must remain isolated, preferably in a home environment, until the release of laboratory results. At this point, the patient must undergo a new medical evaluation and receive guidance on treatment.

Skin lesions should be covered as much as possible, with the use of long-sleeved shirts and pants, also to minimize the risk of contact with other people. Clothes should be changed if they become damp and sanitized separately. To avoid the risk of contamination of other parts of the body, the patient should avoid touching the wounds and not take his hands to his mouth and eyes, for example.

The doctor Demetrius Montenegro, consultant of the Brazilian Society of Infectious Diseases (SBI), guides that the blisters, characteristic of the disease, should not be burst. Cleaning of the skin and lesions can be performed with soap and water.

“The patient should avoid handling the lesions. If you touch the lesion, wash your hands with soap and water and use alcohol gel to avoid contaminating other parts of your body,” he says.

The specialist recommends that patients avoid self-medication and use only the drugs prescribed by the health professional. “Self-medication has to be avoided. The patient receives analgesic recommendations in case of pain, so it is important to follow the guidelines in this regard”, he warns.

So far, according to the Ministry of Health, Brazil has 3,184 confirmed cases of the disease in the states of São Paulo (2,158), Rio de Janeiro (368), Minas Gerais (144), Federal District (116), Paraná ( 82), Goiás (120), Bahia (26), Ceará (14), Rio Grande do Norte (10), Espírito Santo (8), Pernambuco (17), Tocantins (1), Maranhão (2), Acre (1) ), Amazonas (9), Pará (2), Paraíba (1), Piauí (1), Rio Grande do Sul (47), Mato Grosso (4), Mato Grosso do Sul (10), and Santa Catarina (43) .

Source: CNN Brasil

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