Difficult to diagnose monkeypox – expert

PHILIPPINE College of Physicians (PCP) Vice President Dr. Rontgene Solante said that the atypical presentation of monkeypox virus symptoms remains a challenge in diagnosing the disease.In a forum on Tuesday, Solante noted that people infected with classic monkeypox exhibit the following symptoms: extensive rash or lesions, fever and lymphadenopathy (swelling of lymph nodes).However, he explained that the current cases of monkeypox in non-endemic areas, including the United States and countries in Europe, differ from clinical presentation previously documented. The World Health Organization (WHO) has recorded 7,892 confirmed cases of monkeypox in non-endemic countries from January 1 to July 7, 2022."Skin lesions were a lot fewer compared to the classic monkeypox, and, in fact, there are those with a single lesion. In some cases, there is an absence of skin lesions but with anal pain and rectal bleeding. There are also lesions in the genital or perianal area that do not spread to other areas of the body," Solante said.Another atypical presentation of the virus is the appearance of the lesion at different stages of development — before fever, malaise and other systemic symptoms.He emphasized that testing is key to confirming the presence of monkeypox infection through the PCR test from samples of skin lesions, or the roof or fluid from vesicles and pustules and dry crusts.The monkeypox virus, Solante said, could be transmitted from animals to humans, particularly found in West and Central Africa, through hunting animals for food. Secondary infection from human to human could be transmitted through close contact, including respiratory contact, as well as from a pregnant mother to the fetus.He added that the major mode of transmission in the current monkeypox cases is human to human — 78 percent of infected individuals were males ages 18 to 44 years old, and 98 percent of cases were identified as men who have sex with men, 41 percent of whom are HIV-positive.Special populations at a higher risk for severe infection and complication are those living with HIV who are not on treatment and with low CD4 counts; pregnant women; extremes of age — young children and the elderly; and those with other immunocompromising conditions.In terms of treating monkeypox, Solante said that there is no available cure yet, but there is an anti-viral agent that has been used in non-endemic countries reporting monkeypox. The Philippine Food and Drug Administration (FDA) has not yet approved or authorized anti-viral treatment against monkeypox."Mainly, the treatments are supportive and are directed at relieving symptoms such as fever, body malaise, and exhaustion.... Hydration is also important," he added.However, vaccination against smallpox was observed to be 85 percent effective in preventing monkeypox.Solante said that confirmed and suspected cases of monkeypox are typically recommended to self-isolate for 21 days, noting that lesions or rashes that have come into contact with others could also be a source of infection, aside from respiratory contact."Patients, when they recover, should still be wearing a face mask to make sure that there is no spreading of the virus — the risk of infecting others is low after the third or fourth week," he added.The health expert emphasized that the keys to effective control of a monkeypox outbreak are early diagnosis, isolation, effective contact tracing, vaccination strategies, increased awareness, testing recommendations, prevention and control, and public health measures in place.