In the records of the medical literature, it was injuries Caused by monkeypox (monkeypox) appears as papules, hard, slightly raised marks that often develop into blisters, with pus inside them, or vesicles, fluid-filled blisters that, when ruptured, become ulcers. With the increasing number of cases in the current outbreak, other clinical manifestations of these lesions were analyzed through studies and visualized by health professionals.
According to the dermatologist Egon Louise Rodriguez DaxbacherCoordinator of the Department of Infectious Diseases and Parasitology at Brazilian Society of Dermatology (SBD), this is expected behavior when infection cases increase or when different outbreaks are analyzed. “We are facing different cases and these pests are now beginning to be described. As more cases are identified and more tests are done, it will be possible to obtain more information about these characteristics, whether they are a new or isolated phenomenon,” he explains. .
At the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), one of the reference centers for treating cases of the disease in Brazil, characteristics that differ from the classic description of monkeypox were also observed. “It has always been said that the lesions would be in the same stage, but in practice we found them in different cases; some spots, others papules and others with blisters, which would be more similar to what happens in chickenpox or chickenpox,” represents Anna Catarina. Nasteri, an infectious disease physician and ward supervisor in the hospital’s infectious disease department.
According to doctors, some of the forms of falls that have been recorded are:
Swollen lesions in which in the middle of the height of the gallbladder there is a protrusion downward that looks like a navel
One wound on the whole body of the patient
Lesions only in mucosal areas such as the mouth
Lesions in only one part of the body
Surfaces that have a blister
In cases where contamination occurs through sexual contact, the signs are observed concentrated in the genital area, as indicated in a note before Municipal Health Administration of São PauloIt has been observed that their appearance changes in cases in which the diagnosis is made Sexually transmitted diseases (ISTs) and monkeypox mix.
The contagion scientist notes that similar observations have also been made in other countries. Scientific research conducted in the United Kingdom and published in the journal British Medical Journal She identified pain in the anal area and swelling in the penis as new symptoms associated with monkeypox. In addition to skin lesions and pains, 197 clinically analyzed patients reported fever.
A study conducted in Spain on 185 patients was published in the same journal, which recorded a new form of the lesion characterized by the formation of white pseudo-pustules in which there is no fluid or pus. After some time, they undergo a process of necrosis and ruptures in the form of wounds. The research suggests that the signs appear locally in the area of the body where virus inoculation occurred in the organism, which occurs in diseases caused by other viruses of the Orthopoxvirus genus and could, with further studies, prove a characteristic of the current outbreak of monkeypox.
How do we differentiate from other diseases?
Since the first recorded case of monkeypox was diagnosed in the capital, São Paulo, two months ago, the disease has spread to 67 municipalities in the state. With 1,370 cases recorded as of Tuesday the ninth, the capital today has 80% of its 1,636 patients. According to the clinical experience obtained so far, the signs of monkeypox can resemble those caused by other diseases..
Anna Catarina Nasteri explains that lesions appeared on the palms of patients’ hands, a characteristic usually attributed to syphilis. In terms of appearance, they can also be confused with sores caused by sexually transmitted infections, such as the red spots of disseminated gonorrhea, localized and concentrated blisters of herpes and syphilis itself, which, according to the doctor, can lead to several types. from the rash.
They can also be very similar to the invasive and persistent lesions of molluscum contagiosum – a relatively common disease in children caused by the smallpox virus, a close relative of smallpox – and even drug reactions, capable of causing, among other manifestations, red spots and blisters on the skin.
If infection is suspected, some factors to consider are the presence of contact with an infected person, even if indirect, and the presence of infections. The guiding principle is to seek medical attention to remove suspicion or make a diagnosis: “There are some characteristics that are more suggestive, such as the umbilical form, but there have already been positive disease outcomes in cases where, once we look at the lesions, we think they were not,” the infectious disease specialist explains. .
For Daxbacher, care must be taken that presentation of different types of vesicles is not a factor in the decrease in confirmed cases.. He points out, “This is the most important thing when we describe new variants of a disease; having the information that enables us to suspect and carry out a diagnosis when it is not necessarily being considered.”
According to the classification of the World Health Organization (WHO), monkeypox is considered mild, moderate or severe according to the number of lesions the patient has. Although it may not spread throughout the body or have a single wound, experts stress that this does not make the disease look less contagious. Forms of prevention, which include avoiding close contact with infected people, reducing sexual activity with multiple partners, and washing hands before eating or touching the face, remain the same.
The same applies to the need to isolate the injured and the method of treating injuries at home, because there are not many cases in which patients need to be hospitalized. It is recommended to keep wounds always clean with soap and water, without the need for dressings and without touching them often. If you need to go to the doctor, you need to cover all injuries with clothing when you leave the house, and if any secretion seeps through the fabric, the garment is considered contaminated.
The isolation period for monkeypox cases can range from 14 days to over a month, and can only be stopped when the skin has fully recovered—unlike chickenpox, for example. “As long as there is a wound, even with a dry crust, the patient is still considered a potential carrier,” the dermatologist confirms. The time it takes for wounds to go away varies, depending on factors such as how much they are covered, how much and how large they are, and whether they are on the skin or in mucosal tissue.
The Municipal Health Department explains that all patients are monitored by municipal and state health monitoring bodies and do not show any signs of worsening. Care for suspected cases is available throughout the municipal health network, such as basic health units (UBSs), emergency rooms and emergency services, and according to the SMS, the network has supplies for collecting samples of skin lesions (exudate or dry wound parts) for laboratory analysis.
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