Thread by @guerreroespejo

Clinical features and novel presentations of human #monkeypox of 197 patients in a #London centre during the 2022 #outbreak

Median age: 38 years
All 197: men, &
196 identified as gay, bisexual, or other men who have sex with men
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bmj.com/content/378/bm…
#IDtwitter #MedTwitter

Concomitant infection:
- 35.9%: HIV
- 31.5%: a concomitant sexually transmitted infection.

All presented with mucocutaneous lesions, most commonly on the genitals (n=111 participants, 56.3%) or in the perianal area (n=82, 41.6%).
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#Doctor #MedStudentTwitter

86.3% participants reported systemic illness:
✔️ fever 61.9%),
✔️ lymphadenopathy (57.9%), and
✔️ myalgia (31.5%).
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#monkeypox #resident

✔️61.5%: systemic features before the onset of mucocutaneous manifestations
✔️13.7%: exclusively with mucocutaneous manifestations without systemic features
✔️36.0%: rectal pain
✔️16.8% sore throat, and
✔️15.7% penile oedema.
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#monkeypox #medicine

Penile edema
A 34-YO, Crohn’s disease receiving adalimumab: multiple penile lesions with clinically significant associated oedema
On day 5 of symptoms: erythema & swelling that extended from the mid-penile shaft to the glans (admission).
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#monkeypox #dermatology #MedEd

Secondary bacterial coinfection of penis due to Staphylococcus aureus & Streptococcus dysgalactiae.

A 47-YO🧔‍♂️(HIV <200 copies/mL on antiretroviral therapy, CD4 755 cells/μL): extensive #monkeypox genital lesions, penile swelling, & purulent penile discharge
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#microbiology

Rectal perforation in a 46-YO man (HIV <200 copies/mL on antiretroviral therapy, CD4 1200 cells/μL), with severe rectal pain
T2 MR: a 3.5 cm cavity in L mesorectum, adjacent to the rectal wall representing an area of localised perforation (arrow)
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#radiology #monkeypox

11.2% participants: with a #monkeypox solitary lesión

A 53-YO👨‍🦳(HIV <200 cps/mL on antiretroviral therapy), with a single skin lesion on his thigh: a 4×2 cm, tender area of induration with a central area of crusting was noted, along with bilateral inguinal lymphadenopathy
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35.5% with #monkeypox cutaneous manifestations at different stages of evolution:
a 48-YO man, on day 3 he developed pustular lesions with an erythematous base. By day 17 the genital lesions had crusted over; however, the patient developed new pustular lesions on his hands.
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13.7% participants: an maculopapular rash of varying distribution & rapid onset, separate to areas of blistering or pustules

A 36-YO man (HIV <200 cps/mL on antiretroviral therapy, CD4 >400 cells/μL), with progressive rash soon after perianal vesicles
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#dermatologia #MedEd

13.7%: oropharyngeal lesions & nine (4.6%) had tonsillar erythema, pustules, oedema, or abscess
A 25-YO man: with erythematous maculopapular rash on back & arms, with areas of confluent erythema (Left) & R tonsillar abscess (pustular lesion & yellow-green exudate) (right)

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#MonkeyPox confluent lesions: a 40-YO man (HIV <200 copies/mL on antiretroviral therapy, CD4 >500 cells/μL), first presented with vesicular lesions at the base of his penis. Multiple lesions progressed to become confluent, subsequently forming a large ulcer
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#dermatology

10.2%: admitted to hospital for the management of symptoms, most commonly rectal pain & penile swelling
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#MonkeypoxVirus #IDtwitter

These presentations should be included in public health messaging mainly among gay, bisexual, and other men who have sex with men seen in the non-endemic countries to aid early diagnosis and reduce onward transmission.
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bmj.com/content/378/bm…
#MonkeypoxVirus