Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series
- PMID: 35902115
- PMCID: PMC9331915
- DOI: 10.1136/bmj-2022-072410
Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series
Abstract
Objective: To characterise the clinical features of monkeypox infection in humans.
Design: Descriptive case series.
Setting: A regional high consequences infectious disease centre with associated primary and secondary care referrals, and affiliated sexual health centres in south London between May and July 2022.
Participants: 197 patients with polymerase chain reaction confirmed monkeypox infection.
Results: The median age of participants was 38 years. All 197 participants were men, and 196 identified as gay, bisexual, or other men who have sex with men. All presented with mucocutaneous lesions, most commonly on the genitals (n=111 participants, 56.3%) or in the perianal area (n=82, 41.6%). 170 (86.3%) participants reported systemic illness. The most common systemic symptoms were fever (n=122, 61.9%), lymphadenopathy (114, 57.9%), and myalgia (n=62, 31.5%). 102/166 (61.5%) developed systemic features before the onset of mucocutaneous manifestations and 64 (38.5%) after (n=4 unknown). 27 (13.7%) presented exclusively with mucocutaneous manifestations without systemic features. 71 (36.0%) reported rectal pain, 33 (16.8%) sore throat, and 31 (15.7%) penile oedema. 27 (13.7%) had oral lesions and 9 (4.6%) had tonsillar signs. 70/195 (35.9%) participants had concomitant HIV infection. 56 (31.5%) of those screened for sexually transmitted infections had a concomitant sexually transmitted infection. Overall, 20 (10.2%) participants were admitted to hospital for the management of symptoms, most commonly rectal pain and penile swelling.
Conclusions: These findings confirm the ongoing unprecedented community transmission of monkeypox virus among gay, bisexual, and other men who have sex with men seen in the UK and many other non-endemic countries. A variable temporal association was observed between mucocutaneous and systemic features, suggesting a new clinical course to the disease. New clinical presentations of monkeypox infection were identified, including rectal pain and penile oedema. These presentations should be included in public health messaging to aid early diagnosis and reduce onward transmission.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Conflict of interest statement
Competing interests: All authors have completed the ICMJE uniform disclosure form at https://www.icmje.org/disclosure-of-interest/ and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
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Comment in
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The changing face of monkeypox.BMJ. 2022 Aug 10;378:o1990. doi: 10.1136/bmj.o1990. BMJ. 2022. PMID: 35948354 No abstract available.
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Monkeypox: patients, clinicians, and the need for shared responsibility.BMJ. 2022 Sep 14;378:o2221. doi: 10.1136/bmj.o2221. BMJ. 2022. PMID: 36104032 No abstract available.
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Understanding the signs and symptoms of the 2022 monkeypox outbreak is crucial for clinicians, public health practitioners and gay, bisexual and other men who have sex with men (GBMSM).Evid Based Nurs. 2023 Apr;26(2):59-60. doi: 10.1136/ebnurs-2022-103610. Epub 2022 Oct 10. Evid Based Nurs. 2023. PMID: 36216400 Free PMC article. No abstract available.
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References
-
- Monkeypox outbreak: epidemiological overview, 12 July 2022. GOV.UK. https://www.gov.uk/government/publications/monkeypox-outbreak-epidemiolo... (accessed 29 Jun 2022).
-
- Investigation into monkeypox outbreak in England: technical briefing 2. GOV.UK. https://www.gov.uk/government/publications/monkeypox-outbreak-technical-... (accessed 29 Jun 2022).
-
- Multi-country monkeypox outbreak: situation update. https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON396 (accessed 30 Jun 2022).
-
- von Magnus P, Andersen EK, Petersen KB, et al. . A pox-like disease in Cynomolgus monkeys. Acta Pathol Microbiol Scand 2009;46:156-76. 10.1111/j.1699-0463.1959.tb00328.x. - DOI
-
- Monkeypox. https://www.who.int/news-room/fact-sheets/detail/monkeypox (accessed 29 Jun 2022).
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