Human monkeypox disease

Abstract

There has been an alarming rise in human monkeypox cases during these past few months in countries where the disease is not endemic. The recent COVID-19 pandemic and the connection of the monkeypox virus with the smallpox-causing variola virus makes it highly likely to be a candidate for another human health emergency. The transmission mode is predominantly via sexual contact, especially among men who have sex with men (MSM); anogenital lesions are the most typical presentation. Although it is a disease with a self-limiting course, some patients require admission for severe anorectal pain, pharyngitis, eye lesions, kidney injury, myocarditis, or soft tissue superinfections. Antiviral therapy has been advocated, of which tecovirimat is promising in patients with comorbidities. Vaccines will be the mainstay for the present and future control of the disease.

Fig. 1

A 7-year-old girl with monkeypox from Equateur Region, Zaire. Front view, during day 8 of rash.

Fig. 2

Rear view.

Fig. 3

The old scar on the arm is not due to vaccination.

Fig. 4

Heavy concentration of lesions on the hands, inguinal lymphadenopathy, and pustules on genitalia.

Fig. 5

Swollen lower face and neck due to cervical and submandibular lymphadenopathy.

Fig. 6

Lesions on lips, tongue, and eyelids.

Fig. 7

Same patient, 16 months after the initial illness. Hyperpigmentation of lesions with shallow pitting scars, most prominent over the bridge of the nose.

Fig. 8

(A) Oral lesions (right tonsil) visible already at the patient's first presentation. (B-D) Both patients developed 10 to 12 initially vesicular, later pustular skin lesions distributed over the entire body. Many of these lesions were umbilicated, and all were at the same general stage of development. The typical septate structure of pox lesions became apparent upon opening the lesions.

Fig. 9

Photographs of the penile ulcer and the skin lesions. Non-tender ulcer on the dorsum of the penile shaft, measuring 7 mm in diameter with central umbilication. Erythematous, maculopapular lesions appeared on the upper back and proceeded down the body. The red-colored line indicates the period of fever (≥37.5°C).