Basgoz and colleagues at the hospital tested the patient for chickenpox. It was negative. He was tested for syphilis. It was negative.
Doctors still treated him with antibiotics and antivirals that are used for common infections while waiting for the results of his various tests, but his condition did not improve in response to these treatments.
As the days passed, Basgoz noticed that the patient’s rash was changing in appearance. At the time, she knew she had no common ailments.
His mind raced, assembling pieces of a medical puzzle.
“Some of the skin lesions, called pustules, started to bleed, and this is a feature that can be seen in smallpox viruses,” Basgoz, the hospital’s chief associate and clinical director, told CNN. of the division of infectious diseases.
“The combination of not improving when it was treated for common things; the results of tests for common infections were negative; and some changes in the appearance of the rash, all raised the possibility that this could be a virus. of smallpox. “she said. That was his ah-ha moment.
The patient, whom Basgoz described as “a relatively young and healthy man,” had traveled to Canada before becoming the first person to be confirmed with smallpox in the United States this year as part of a global outbreak in progress. As of the time of the outbreak, global health officials have identified more than 1,200 patients in at least 31 countries as of Friday.
Why the symptoms of the current outbreak seem more subtle
Monkeypox “was initially not on our radar screen,” Basgoz said of the treatment of the first case in the United States.
As the monkeypox virus spreads, some doctors and public health officials have noticed that patients have milder symptoms that could be mistaken for other diseases. Two factors could help explain why the disease sometimes presents itself in more subtle ways, Basgoz said.
“One of the main reasons is that the main strain associated with this outbreak is the West African clade, and this is associated with a milder disease,” said Basgoz, compared to the other, which is the clade of West Africa. Central Africa.
“The second is that so far, of the patients who have been reported, there are a large number of relatively young and healthy people,” Basgoz said. “When you see an infection in relatively young, healthy people, it’s often milder than when you see it in the elderly or people with other medical conditions.”
The monkey’s smallpox is spread by direct contact with body fluids or sores in the body of someone who has been infected, or by direct contact with materials that have touched body fluids or sores, such as sheets or clothing, according to the CDC. The spread of monkeypox through small virus particles that remain in the air “has not been reported,” the CDC said in a guide released Thursday. It can spread through “saliva or respiratory secretions” during face-to-face contact, but these secretions “get out of the air quickly” and this method of transmission seems uncommon.
The CDC has said the risk to the general public remains low, but health care providers should be alert for patients who have rash or monkeypox-compatible diseases.
“Historically, people with smallpox have reported flu-like symptoms, such as fever, body aches and swollen glands, before a characteristic rash that often spreads to multiple parts of the body, often the face, arms and thighs. But during the current outbreak, some patients have developed a localized rash, often around the genitals or anus, before experiencing any flu-like symptoms, and some have not even developed these similar symptoms. to the flu, “CDC Director Dr. Rochelle Walensky said in a statement. information session on Friday.
He added that for some patients, the rash does not always extend beyond its initial location to other parts of the body, or may appear only in some parts of the body.
“This might seem like a lot of different things: fevers, chills, body aches, headaches we’ve talked about with Covid-19 can also happen like the prodrome, the first signs or symptoms, of the monkey’s smallpox.” , said Dr. Christina Wojewada, chair of the microbiology committee at the College of American Pathologists and director of clinical microbiology at the University of Vermont Medical Center, who did not participate in the CDC guide, told CNN.
“The lesions themselves can be confused with the lesions of herpes or chickenpox or syphilis, so sexually transmitted disease clinics may be seeing more of these patients because of this, because they may present with similar to these diseases, “Wojewada said. “So I think it’s important for both patients and doctors to provide a complete history of your potential exposures so that, if necessary, tests can be done for monkeypox.”
Smallpox testing needs to be increased
The 45 monkeypox patients so far identified in the United States are in 15 states and Washington, DC, and the virus does not appear to be spreading to “a specific area” of the country, an official said. of the CDC in the news on Friday. information session.
“We don’t have any areas now identified in the United States that appear to have an urban outbreak, such as the one reported in Montreal and some other places. We don’t have an area where there seems to be a lot of community transmission,” he said. Dr. Jennifer McQuiston, a veterinarian and deputy director of the CDC’s Division of Pathogens and High Consequences Pathology, at the briefing.
The majority of cases in the United States, 75% or more, still report that they may have been exposed to the virus during international travel, McQuiston said. Some other patients have reported contact with a known case of monkeypox and were identified by contact tracking.
But there are also some patients who are unsure of how they acquired monkeypox, “and this could suggest that there is some community transmission at levels that are below what is drawing the attention of public health officials.” said McQuiston.
“There are rare cases where they are unsure of how they acquired monkeypox,” he added. “Most likely, they bought it from someone who has recently traveled, but they’re not sure, and that’s the situation we’re in now in the United States. That could change. We could start spreading the word to the community. , and I think we need to make sure that our tests increase and that we can detect when it happens. “
CDC researchers and health officials released a report last week describing how among the 17 cases described in the report in nine states, all experienced rashes as a sign of disease and most cases have been reported. diagnosed in men who identify as gay, bisexual, or men who have sex with men (MSM).
“The high proportion of initial cases diagnosed in this outbreak in people who identify as gay, bisexual or other MSM could simply reflect an early introduction of monkeypox into interconnected social media; this finding could also reflect a bias of determination due to strong and established relationships between some MSM and clinical providers with strong ITS services and a broad knowledge of infectious diseases, including rare conditions, “the CDC researchers wrote in the report.
“However, infections are often not limited to certain geographies or population groups; because close physical contact with infected people can spread monkeypox, anyone, regardless of gender or sexual orientation, can acquire and spread the smallpox of the monkey “.
Basgoz of Massachusetts General Hospital hopes that while people are aware of the symptoms of monkeypox in this outbreak, they understand that the risk is low and does not stigmatize the disease.
After all, viruses are all around us, he said, and even billions of microorganisms live in our bodies without us realizing it, with viruses outnumbering bacteria.
“They’re everywhere,” Basgoz said. “Most of them don’t make us sick, but every now and then they do, and so I really like to put that in context for people.”
CNN’s Michael Nedelman contributed to this report.