As global outbreaks of monkeypox appeared in the headlines, Dr. Antoine Cloutier-Blais’ Montreal clinic began to see patients with unusual and often painful bodily injuries.
By early June, the family doctor and colleagues had treated about 15 patients with confirmed infections, of the approximately 100 laboratory-confirmed cases reported so far in Quebec. People with suspected infections soon started coming to the clinic almost every day.
Cloutier-Blais began to notice some interesting trends.
He found that smallpox lesions did not look exactly like what he had seen in photos circulating online of infected people in parts of Africa, where the virus had been found for decades.
“The lesions are much smaller and usually very localized,” he said, adding that there is also a “very wide spectrum of different types of presentations.”
In some cases, the lesions appear in various areas of the body or inside, such as the mouth, genitals, or anal region of patients, sometimes spread to the limbs or torso, or appear all over the body.
But for other patients, the visible symptoms have been much more subtle, even a single mark on the skin.
Medical experts in several countries are noticing similar patterns. In this unprecedented outbreak, which offers many global physicians their first real-world experience with this disease, there is a clear range of severity, from classic full-body eruptions that require hospitalization and pain medication, to in cases where smallpox is presented as a mild infection that can be easily overlooked or easily confused with other conditions.
And while these infections are usually treatable, there is also growing concern that the virus could spread to vulnerable populations with a higher risk of life-threatening illness.
The eruption may be the first warning sign
Photos taken in clinical settings show monkeypox lesions in patients in the UK during a global outbreak of cases beyond the typical endemic regions of the virus in Africa. (UK Health Agency)
Smallpox is often presented as a flu-like illness, with symptoms such as fever, chills, and muscle stiffness that may precede revealing injuries.
However, for recent patients in the U.S., the appearance of a rash was often the first warning sign that they were ill.
“In these new cases, what we are hearing is these [pre-rash] the symptoms may be very mild or not even noticeable at all, “said Dr. Agam Rao, a medical officer in the poxvirus and rabies branch of the U.S. Centers for Disease Control and Prevention. during an interview with the medical journal JAMA.
For doctors unfamiliar with the virus, it can also be difficult to differentiate some chickenpox infections from chickenpox or certain sexually transmitted infections such as herpes and syphilis.
“Monkeypox can go through other conditions,” said Dr. Rosamund Lewis, a Canadian physician and technical director of the World Health Organization (WHO) for the monkeypox outbreak.
TARGET | Quebec officials are working to contain the monkey’s smallpox outbreak:
Quebec health officials are working to contain the monkey’s smallpox outbreak
Quebec health officials are working to contain the province’s monkeypox outbreak, as the focus is on keeping people safe during summer meetings.
Body injuries linked to this virus are also thought to begin around the head, before progressing to the arms and legs, but Rao said U.S. patients have first experienced rashes in the genital or perianal regions, including some people who have suffered inflammation of the rectum.
A case study published in the medical journal of infectious diseases Eurosurveillance analyzed the experience of a 30-year-old HIV-positive man who was diagnosed with monkeypox in May after traveling and engaging in sexual activities in Europe.
The man’s initial symptoms were painless pustules on his penis, which soon got worse. The injuries became painful and itchy, then the man developed a fever three days later, and the rash spread to his torso, face and limbs in the following days, which required two trips to his doctor and a short stay in hospital.
“When examined at the hospital, the penile lesions had largely formed scabs and the lesions on the hands and lower extremities were painless papular pustules,” the authors of the case study wrote.
“Monkeypox can affect anyone”
Smallpox is not known to be a sexually transmitted infection, but it can be spread through various forms of close contact with other people. This includes skin-to-skin contact, even if someone has only minor injuries to their genital areas, or through respiratory drops if someone has a mouth injury, Lewis of the WHO noted.
Although there are some reports of women being recently infected worldwide, most of the infections in this global outbreak, now with about 1,000 confirmed and counting cases, have occurred among men who have sex. with men, which sparked awareness campaigns for and by members of that community.
“Of course, smallpox can affect anyone, any gender, any sexual orientation,” said Dane Griffiths, director of the Alliance for the Sexual Health of Gay Men in Ontario, where about a dozen have been reported. of cases, mainly in Toronto.
“But given the current cases we’re seeing and the questions that are pending about the dynamics of transmitting monkeypox in our community, we’re getting people to know about it.”
TARGET | WHO urges countries to stop transmitting monkeypox:
WHO urges nations to help stop the spread of monkeypox
The World Health Organization warns that the monkeypox virus could spread to non-endemic countries if they do not control the current outbreak.
Cloutier-Blais stressed the importance of the rapid mobilization of the community, including “impressive” participation in monkeypox vaccination clinics in Montreal.
Since its launch in late May, more than 1,600 doses have been provided to members of the public who may be at increased risk of contracting smallpox from sex or for work reasons.
“Anyone could experience symptoms,” Cloutier-Blais said.
As global outbreaks of monkeypox appeared in the headlines, Dr. Antoine Cloutier-Blais’ Montreal clinic began to see patients with unusual and often painful bodily injuries. (Guillaume Steben / CBC News)
“Stay isolated” if injuries occur
When it comes to mild cases, the Montreal doctor said his patients have not required much medical support.
“We simply suggest that people cover their injuries and stay isolated as much as possible, with a mask on if they need to meet other people, and otherwise stay home and cover their injuries until they are completely healed,” he said. explain.
The most serious cases, however, have required hospitalization, with patients suffering from “very severe fever or pain difficult to manage with oral medication alone.”
So far no one was killed in the recent global outbreak in Africa, WHO Director-General Tedros Ghebreyesus told a news conference on Wednesday. But the disease can be fatal in some cases, especially for higher-risk groups, such as pregnant women, children, and people with compromised immune systems.
Tedros called on countries to make serious efforts to stop the transmission of the virus in order to prevent the monkeypox from spreading more widely and spreading to these vulnerable populations.
“The risk of monkeypox being established in non-endemic countries is real,” he said.