Clinical Conundrums: Differentiating Monkeypox From Similarly Presenting Infections

Abstract

Post the coronavirus disease 2019 (COVID-19) pandemic, there arises the concern of a new epidemic as cases of monkeypox are being confirmed, globally. With the initial clinical manifestation of monkeypox resembling that of the common cold or seasonal flu, recognizing alternative differential diagnoses is imperative as a medical health practitioner. The characteristic monkeypox maculopapular rash with the progression to vesicles and pustules before scabbing can be described in several other infections. Understanding the disease progression and distinct clinical presentation of monkeypox in its various stages may allow for a more expedient diagnosis among healthcare providers. Though eradicated, the clinical presentation of smallpox is the most similar to that of monkeypox; however, smallpox is no longer a concern for the general population. Other conditions such as molluscum contagiosum, syphilis, varicella zoster, measles, rickettsialpox, and scabies can present with rashes that may resemble singular or multiple states of the monkeypox rash progression. The ability to correctly diagnose an individual's condition promptly may allow healthcare providers to provide correct supportive therapies or treatments.

Keywords: disseminated rash; infection microbiology; infectious disease pathology; monkeypox virus; vesicular rash.

Figure 1. Common (Nonspecific) Symptoms of Monkeypox

Figure 2. The Progression of the Rash in Monkeypox

Figure 3. Potential Differential Diagnoses of Monkeypox

Figure 4. Proposed Timeline from Exposure to Varicella Zoster Virus to Presentation of Vesicular Rash

Figure 5. Progression of Varicella-Zoster Rash

Figure 6. Timeline from Exposure to Molluscum Contagiosum Virus to the Presentation of Lesions

Figure 7. Progression of Syphilis and Clinical Manifestation of each Stage

Figure 8. Sequential Progression of the Different Stages of Viral Replication Leading to Clinical Presentation of Smallpox

Figure 9. Proposed Timeline from Liponyssoides sanguineus Bite to Presentation of Rash and Symptoms

Figure 10. Proposed Timeline from Primary Exposure to Sarcoptes scabiei to Presentation of Symptoms