Here’s how to differentiate monkeypox lesions from those caused by other diseases

The appearance of skin lesions is a relevant symptom for the diagnosis of monkeypox cases. When noticing the emergence of them, close contact with other people should be avoided and seek a health service, experts indicate.

Wounds can, however, generate confusion. After all, was the lesion that appeared on the skin caused by the disease that caused an outbreak of worldwide proportions or did it originate from another health condition?

The doubt arises because the vesicles –bubbles with liquid inside– common to monkeypox are manifestations similar to those related to other health problems, says Egon Daxbacher, coordinator of the department of infectious and parasitic diseases at the Brazilian Society of Dermatology (SBD).

“This presentation is not rare in dermatology”, he adds.

Confusions are even more likely to occur because there are recent reports of monkeypox cases in which the lesions appear only in the genital region. In patients documented in previous infections, the vesicles usually appeared in other parts of the body as well.

Dexbacher says that the more concentrated the vesicles are, the more likely they are to be confused with other clinical conditions. One of them is herpes, an infection that mainly affects the lips and genitals.

“Herpes is more localized and presents a group of lesions of water blisters that later evolve into sores. So, it is a disease subject to confusion”, says the dermatologist.

The different manifestations of monkeypox and the misunderstandings that this can generate also draw the attention of Jamal Suleiman, an infectious disease specialist at Hospital Emílio Ribas, a reference in the care of cases of the disease. “We’ve seen people here with a single lesion on the head of the penis,” he says.

He cites the case of a patient with a lesion in the mouth that could easily be confused with monkeypox. The person had actually been infected by the monkeypox virus. But the mouth sores were the result of a simultaneous infection with syphilis in its primary stage, at which point the disease causes one or a few sores located in the region where the bacterium has accessed the human body.

“We don’t just have monkeypox. There are several other diseases, not least because there can be concomitance with other infections”, says Suleiman.

Secondary syphilis can also raise doubts. At this time of bacterial infection, lesions appear on different parts of the body. As monkeypox can cause the vesicles in other limbs of the patient, confusion is likely to happen.

Chickenpox can also raise doubts in patients, as well as herpes zoster, a condition caused by the same chickenpox virus that remains dormant during the infected individual’s life and then can be reactivated.

The symptoms of monkeypox can still be confused, in rarer cases, with bacteria of the staphylococcus genus. Dexbacher explains that these microorganisms cause skin blisters similar to those seen in monkey pox.

avoid misconceptions

An important way to avoid confusing monkeypox with other diseases is to watch for other symptoms to develop. One of them is the inguas, protuberances caused by the enlargement of the lymph nodes.

“Wags are a well-described feature of monkeypox,” says Dexbacher. According to him, the condition is not very common in the other diseases that can be confused with monkeypox.

The development of fever and malaise are also recurrent symptoms in cases of monkeypox that do not necessarily recur in other complications. “When you put everything together – fever, dermatological presentation and sores –, the suspicion becomes very high for monkeypox”, says the dermatologist.

Suleiman says it is difficult to differentiate the diseases because the conditions caused by monkeypox are so variable. “There’s no pattern that you’re going to have a fever or swollen nodes.”

He explains that it is important to understand the history of the suspected patient for monkeypox. One point, for example, is to identify whether the person has had close contact with someone infected with the virus.

“Most likely we will have some situations [da varíola dos macacos] that we hadn’t seen. We are now learning about the evolution of the disease,” she says.

Therefore, the infectologist says that the most important thing is to be attentive to observe the appearance of monkeypox symptoms. If so, it is necessary to take measures of social isolation and seek medical assistance to access the exact diagnosis.

“This knowledge is under construction and we all have to have the resilience to seek correct information. In the meantime, the recommendation is, when you have suspicion, already do isolation and seek a health service”, he concludes.