What are the symptoms of monkeypox?

Symptoms of Monkeypox

Monkeypox typically presents with fever, headache, muscle aches, back pain, lymphadenopathy (swollen lymph nodes), and a characteristic rash that progresses from macules to papules, vesicles, pustules, and finally scabs. 1

Initial Symptoms (Prodromal Phase)

The prodromal phase typically lasts 1-3 days before rash appearance and includes:

• Fever
• Severe headache
• Lymphadenopathy (swollen lymph nodes) - a distinctive feature that helps differentiate monkeypox from smallpox
• Myalgia (muscle pain)
• Back pain
• Fatigue/exhaustion
• Chills

Rash Phase

The characteristic rash typically appears 1-3 days after fever onset 2:

• Distribution pattern: The rash tends to be more concentrated on the face and extremities (including palms and soles) rather than the trunk, following a centrifugal distribution 1

• Progression: The rash evolves through several stages in a synchronized manner:

  1. Macules (flat lesions)
  2. Papules (raised lesions)
  3. Vesicles (fluid-filled blisters)
  4. Pustules (pus-filled lesions)
  5. Scabs/crusts (which eventually fall off)

• Lesion characteristics: Monkeypox lesions are typically deep-seated, firm, and well-circumscribed, often with central umbilication (depression)

Recent Clinical Presentation Changes

In the 2022-2023 global outbreak, some notable changes in clinical presentation were observed:

• Anogenital lesions became more prominent in many cases 3
• Some patients presented with fewer lesions and localized disease
• Lesions sometimes appeared at different stages simultaneously (asynchronous development)
• Some patients experienced proctitis (rectal inflammation and pain)

Duration and Severity

• Symptoms typically last 2-4 weeks 2
• Monkeypox is generally self-limiting in immunocompetent individuals
• Severe disease is more common in children, pregnant women, and immunocompromised individuals

Complications

Potential complications include:

• Secondary bacterial infections of skin lesions
• Pneumonia
• Encephalitis
• Corneal involvement with potential vision loss
• Severe scarring, especially on the face

Clinical Pitfalls and Diagnostic Challenges

• Monkeypox can be confused with other rash illnesses such as chickenpox, measles, or syphilis
• Key distinguishing features include the presence of lymphadenopathy and the evolution of lesions through all stages simultaneously
• Recent cases have shown atypical presentations with fewer lesions and localized disease, making diagnosis more challenging 4
• Laboratory confirmation through PCR testing of lesion material is recommended for definitive diagnosis

Prevention and Transmission Control

Early recognition of symptoms is crucial for isolation and preventing transmission. The virus can spread through:

• Close contact with lesions
• Respiratory droplets during prolonged face-to-face contact
• Contact with contaminated materials (fomites)

Patients should remain isolated until all lesions have crusted over and scabs have fallen off, with new skin formed underneath 1.