Thread by @guerreroespejo

Clinical presentation and virological assessment of 181 confirmed human #monkeypox virus cases in #Spain
✔️92%, gay men, bisexual men, or other men who have sex with men (MSM) &
✔️8%, heterosexual men or women

(A) genital & pubic region pustules
👇
thelancet.com/journals/lance…

✔️Median age was 37 years (IQR 31–42).
✔️18% patients reported previous smallpox vaccination
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(B) Three semiconfluent pustular #monkeypox lesions with a depressed centre located on the left side of the tongue dorsum.

#MedEd

✔️40% were #HIV-positive, 11% had a CD4 cell count less than 500 cells per μL

✔️17% were diagnosed with a concurrent sexually transmitted infection

(C) Pearly acral #monkeypox vesicles embedded in the thick stratum corneum of the palmar skin, shotty on palpation
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#IDtwitter

Median incubation, 7 days

All with skin lesions:
✔️78%, in the anogenital region, &
✔️43% in the oral & perioral region

(D) Scattered papules, pustules, & umbilicated #monkeypox pustules surrounded by an erythematous halo on the lateral aspect of the chest and left arm
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39% participants had complications requiring treatment:
✔️25% had a proctitis,
✔️10% had tonsillitis,
✔️8% had penile oedema, and
✔️3% an abscess,

(E) #MonkeypoxVirus pustules circumferentially distributed on the anal margin and perianal skin.
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#ViruelaDelMono

✔️Only 2% patients required hospital admission

✔️99% of 180 swabs from skin lesions collected tested positive, as did 82 (70%) of 117 throat swabs.

(F) A pustular #monkeypox lesion with a crusted centre on the semimucosa of the lower lip
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#virueladelmono #MedEd #IDtwitter

Viral load was higher in lesion swabs than in pharyngeal specimens p<0.0001.

(G) Primary #MonkeypoxVirus inoculation site with a large, crusted lesion on the right cheek.
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#MedStudentTwitter #MedicalStudents #microbiology

✔️95% of 19 #monkeypox participants with tonsillitis reported practising oral-receptive sex.

✔️The median time from onset of lesions to formation of a dry crust was 10 days.

(H) The right palatine tonsil is reddened and enlarged and has a fibrin-covered ulcer.
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#Doctor

65% of #MSM reported anal-receptive sex (A-RS)
MSM who engaged in A-RS presented with proctitis (38% vs 7%), & systemic symptoms before the rash (62% vs 28%), more frequently than MSM who did not engage in A-RS

(I) The penis had lesions of varying sizes & stages of evolution
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