Monkey pox: better understand the skin lesions caused by the disease

On July 23, 2022, the Director General of theWHO said he had “ decided that the outbreak of smallpox of the monkey represents a public health emergency of international concern “. Indeed, more than 3,000 cases have been confirmed worldwide and the health measures to contain the virus (prevention, isolation of confirmed cases, ring vaccination) have not been effective in reducing the spread of the virus. In France, 1,567 cases have been identified most of which in Ile-de-France, consequently François Braun, Minister of Health, announced the opening of a vaccinodrome capacity in the Paris region to administer vaccines anti-smallpox, effective against monkeypox.

A wide variety of skin lesions

Researchers are continuing their work to characterize as best as possible the symptoms monkeypox specific to this outbreak outside Africa. The latest scientific publication on this subject appeared in The New England Journal of Medicineon July 21 and followed 528 people infected with the monkeypox virus in 16 different countries, all located outside the African continent.

The cohort of patients is essentially made up of men belonging to the LGBT community and of whom a non-negligible proportion (41%) carry the HIV and therefore immunocompromised. Skin lesions were observed in most patients but their location may vary; thus, the anogenital sphere (the anus and the penis) is the most affected, followed by the arms, the legs and the trunk, then the face and finally, the palms of the hands and the soles of the feet. Other common symptoms are feverfatigue, muscle aches and headaches. No death was observed among the 528 people but 13% of them had to be hospitalized because of pain that was difficult to bear and a bacterial infection of the pimples. Scientists note that ” rare and severe complications have been observed (myocarditis and epiglottitis)”.

The changing appearance of the buttons can make it difficult to establish the diagnostic. Depending on when the patient presents to the hospital and the location of the lesions, these have different aspects that can delay diagnosis and adequate management. Scientists also looked for monkeypox virus in the sperm of 32 patients; his DNA was identified for 29 of them. Most of the patients followed here believe they have become infected through sexual intercourse. The hypothesis of a sexual transmission route is still relevant but not yet confirmed, the presence of DNA in the seminal fluid of infected people does not mean that virions infectious are present.

Monkey pox: the symptoms of this epidemic do not resemble those we knew

Article published on July 6, 2022 by Julie Kern

The first study of the current strain of monkeypox virus shows that patients are showing different symptoms than previously seen. Doctors fear the disease is being confused with others, including STI the most common.

The first study conducted on the current monkeypox epidemic put in light disease-induced symptoms – symptoms that differ in frequency and location from those seen in previous outbreaks. This conclusion was made following the follow-up of 54 men infected with monkeypox between May 14 and May 25, 2022 (60% of cases identified over this period) and belonging to the gay community. The study appeared in The Lancet Infectious Diseases.

Define the exact origin of the contamination is always a headache for doctors. In this case, it seems that the patients were contaminated during sexual intercourse, since 47 out of 52 said they had had sexual intercourse in the three weeks preceding the onset of their symptoms. Despite everything, they also indicated that they were not aware of being in contact with people who were already sick.

Skin rashes in the genital area and less frequent fevers

” The most common symptom is skin lesions in the anal and penile regions. The fact that a quarter of patients tested positive for gonorrhea or the chlamydia at the same time suggests that transmission of monkeypox virus in this cohort occurred during close contact, such as in the context of sexual intercourse says Dr Ruth Byrne of the NHS (National Health Service).

The study highlights important differences in the clinical picture presented by this cohort. Feelings of weakness or fatigue and fever are less common here than in previous studies of monkeypox symptoms. In addition, 18% of patients in this group reported no symptoms before the appearance of the first skin lesions. Doctors in England are concerned that monkeypox is being mistaken for common STIs (sexually transmitted infections) that cause symptoms likeherpes or the syphilis. To prevent cases of monkeypox from falling by the wayside, they suggest that the list of symptoms of monkeypox, presented as an acute infection with fever, be adapted to the new observations.

In addition, these data have a certain limit: they were only obtained on patients from the gay community and cannot necessarily be generalized to the entire population. Men who have sex with men were the first to be affected by the virus, but it infects everyone, without distinction. Public health France indicates that there are now three infected women ; the origin of their contamination is under investigation. The new WHO report shows 5,322 confirmed cases of monkeypox worldwide, mainly in North America and Europe.