Monkeypox history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Bassel Almarie M.D.[2]

Overview

The significant information in the patient's history include recent travel to endemic area of monkeypox or possible contact with infected person, animal, or contaminated material. Initial symptoms include fever, chills, lymphadenopathy, headache, and myalgia, followed by skin rash of multiple lesions that develop and evolve at the same time. The evolvement of the lesions progresses as follows: macular (1−2 days), papular (1−2 days), vesicular (1−2 days), pustular (5-7 days), lastly scab (7-14 days).

History

The significant information in the patient's history include:

• Recent travel to endemic area
• Recent contact with person with similar complains or infected person with monkeypox

Symptoms

After infection, the incubation period lasts 7-14 days. Initial symptoms develop at the beginning of the prodromal period include:

• Fever
• Chills
• Lymphadenopathy (distinctive feature of monkeypox)
• Headache
• Myalgia

Following the prodromal period, a rash develops with the following characteristics:

• Lesions develop and evolve at the same time
• Lesions progresses from macular (1−2 days), papular (1−2 days), vesicular (1−2 days), to pustular (5-7 days), then scab (7-14 days)
• Common anatomical sites for lesions include the anogenital area (73%); the trunk, arms, or legs (55%); the face (25%); and the palms and soles (10%)

In certain cases, monkeypox may be asymptomatic.

Diagnostic Criteria

Clinical, laboratory and epidemiologic criteria for case classification — U.S. Monkeypox Response, May 2022

Clinical and laboratory classification	Criteria
Suspected	New characteristic rash* OR
	Meets one of the epidemiologic criteria and has high clinical suspicion† for monkeypox
Probable	No suspicion of other recent orthopoxvirus exposure (e.g., Vaccinia virus in ACAM2000 vaccination) AND demonstration of the presence of
	•     Orthopoxvirus DNA by polymerase chain reaction testing of a clinical specimen OR
	•     Orthopoxvirus using immunohistochemical or electron microscopy testing methods OR
	•     Detectable levels of antiorthopoxvirus IgM antibody during the period of 4–56 days after rash onset
Confirmed	Demonstration of the presence of Monkeypox virus DNA by polymerase chain reaction testing or next-generation sequencing of a clinical specimen OR
	Isolation of Monkeypox virus in culture from a clinical specimen

(*)The characteristic rash associated with monkeypox lesions involve the following: deep-seated and well-circumscribed lesions, often with central umbilication; and lesion progression through specific sequential stages: macules, papules, vesicles, pustules, and scabs. The rash can sometimes be confused with other diseases that are more commonly encountered in clinical practice (e.g., secondary syphilis, herpes, and varicella zoster). Historically, sporadic accounts of patients co-infected with Monkeypox virus and other infectious agents (e.g., varicella zoster, or syphilis) have been reported, therefore patients with a characteristic rash should be considered to receive testing, even if other test results are positive. † Clinical suspicion can exist if initial signs and symptoms are consistent with illnesses confused with monkeypox (e.g., secondary syphilis, herpes, and varicella zoster).