Monkeypox: Important Clinical Differences Between Current and Previous Outbreaks Interview with:
Dr Aatish Patel

Guy’s and St Thomas’ NHS Foundation Trust  What is the background for this case series?   

Response: This case series was based on observations we made whilst treating patients with monkeypox, and the request of many of these patients for better public health messaging surrounding signs and symptoms to be aware of.  What are the main findings?


This 1997 image was created during an investigation into an outbreak of monkeypox, which took place in the Democratic Republic of the Congo (DRC), formerly Zaire. Pictured here, was the right arm and torso of a patient, whose skin displayed a number of lesions due to what had been an active case of monkeypox. You’ll note how this rash resembles smallpox. 
CDC/ Brian W.J. Mahy, BSc, MA, PhD, ScD, DSc

Response: At the time of writing, one in seven patients in this cohort diagnosed with monkeypox by PCR did not fit the UKHSA case definition for probable monkeypox infection. Common signs and symptoms outside those recognised from previous outbreaks included rectal pain (36%) and penile oedema (15.7%). All patients presented with mucocutaneous lesions, most commonly on the genitals and perianal area. We also observed patients presenting with solitary lesions and tonsillar signs which were not previously typical of monkeypox infection. What should readers take away from your report?

Response: We identified important differences in clinical manifestations between the current outbreak and previous outbreaks in endemic regions, which colleagues in the wider healthcare setting, including primary care and clinics specialising in genitourinary medicine; ear, nose, and throat conditions; and infectious diseases should be aware of to facilitate early diagnosis of monkeypox infection. Understanding these findings will have major implications for contact tracing, public health advice, and ongoing infection control and isolation measures. What recommendations do you have for future research as a result of this work?

Response: There needs to be continued research to inform infection control and isolation policies and guide the development of new diagnostics, treatments, and preventive measures.


Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series 

BMJ 2022378 doi: (Published 28 July 2022)Cite this as: BMJ 2022;378:e072410[wysija_form id=”3″]


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Last Updated on August 5, 2022 by Marie Benz MD FAAD