Monkeypox history and symptoms

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

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)^[1].

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

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)^[1]
• 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%)^[2]

In certain cases, monkeypox may be asymptomatic^[3][4].

Clinical, laboratory and epidemiologic criteria for case classification — U.S. Monkeypox Response, May 2022^[5]

(*)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).