San Antonio Express-News (Sunday)
Monkeypox symptoms can vary, experts say
As the still-rare monkeypox crops up around the world, symptoms may not always include the typical patterns and blisters.
The rash is there, but experts say it may be subtle, even unnoticed, and it doesn’t always start on the face. The more recent disease may present with or without the flu-like symptoms of traditional monkeypox.
“The rash is similar in some senses, and different in others, to what we know about ‘textbook’ monkeypox,” University of California San Francisco infectious disease expert Peter Chin-Hong said last week.
“The major difference in this current outbreak is that the rash appears to start in the genital area and the anus rather than the face or trunk. From the genitals, it can move to the arms and palms of the hands, and sometimes the face, including the mouth.”
Humans usually contract monkeypox through the bite or scratch of an infected animal. But because this latest global outbreak is so widespread,
human-to-human contact is suspected. Monkeypox can be spread through lesions, bodily fluids, respiratory droplets and intimate or sexual contact, but it is not a sexually transmitted disease.
Symptoms usually begin with a fever, headache, swollen lymph nodes, muscle aches, chills and fatigue. Smallpox, a cousin of monkeypox, is more severe and does not include swollen lymph nodes,
according to the Centers for Disease Control and Prevention.
The characteristic rash develops in one to three days in the form of pus-filled blisters that typically have begun on the face and then moved to other parts of the body. But in many recent cases the blisters start in different areas and are localized to one region.
Many patients have a rash isolated to just the genital or anal area, said Chin-Hong, with “fewer lesions than in textbook cases.”
“The type or nature of the rash is the same: it starts off as a red spot which evolves to fluid or pus-filled blisters which can then evolve into ulcers then scab off,” he wrote in an email to the San Francisco Chronicle. “They can be extremely painful, but not always.”
Another difference from “textbook” monkeypox is that flu-like symptoms do not always show up after the rash develops, although in some cases they do. Therefore monkeypox may be mistaken for other illnesses.
“The current presentation of the rash and blisters is more subtle than in previous outbreaks so infected individuals may not even notice they have them,” Chin-Hong said. “Early on it may look like a boil or a staph infection; later on it may look like herpes or syphilis ulcers. When it scabs off, it may even resemble how chicken pox scabs off.”
But if the blisters start in the genital area and move to the face or another part of the body, it is “highly suggestive of monkeypox especially if there has been sexual contact for this particular outbreak,” ChinHong added.
More than 30 countries are reported to have logged recent monkeypox outbreaks, with the majority in Europe. The CDC early last week reported 31 cases across the country.
While many of the cases have been seen in gay, bisexual other men who have sex with men, the World Health Organization stressed that monkeypox is not limited to those individuals. Anyone who has been in close contact with an infected person is as at risk. Public health officials say it’s important not to demonize any group.
The CDC says the illness lasts two to four weeks. Many infected people have a “mild, self-limiting disease course.” Monkeypox has mainly afflicted Central and Western African countries, where the first human case was reported in 1970 in the Democratic Republic of Congo. The disease there has become endemic, with a death rate as high as 10 percent.