First case report of monkeypox in Brazil: clinical manifestations and differential diagnosis with sexually transmitted infections

Abstract

In 2022, an outbreak of monkeypox is being reported in non-endemic areas, with unusual clinical manifestations. The detailed clinical description of the first patient that received the diagnosis of monkeypox in Brazil is reported here, whose clinical manifestations can easily lead to misdiagnosis of sexually transmitted infections. A 41 years old male presented to an emergency room with a vesicular rash with eight days of evolution. He had traveled to Portugal and Spain and reported non-penetrative sexual involvement with three different male individuals. On the third day of symptoms, he sought medical care and received empirical treatment directed to sexually transmitted infections. As the symptoms did not improve, he sought medical attention at an infectious disease referral center presenting, on admission, an ulcerated penile lesion with central necrotic crusts, a disseminated pleomorphic skin rash and an oropharyngeal ulcer. The monkeypox diagnosis was suspected due to the characteristics of the lesions and the history of intimate contact with casual partners, and it was later confirmed by sequencing the almost complete monkeypox genome. The patient was hospitalized for pain control, which required opiate administration. He developed a secondary bacterial infection on the penile lesions, which were treated with oral antibiotics. He was discharged after 14 days, with lesions in process of re-epithelialization. Given the current outbreak, we must consider the possibility of monkeypox in patients with suggestive lesions, anywhere on the body (including the genitals), added to an epidemiological link or history of intimate contact with strangers or casual partners.

Detection of Monkeypox Virus according to The Collection Site of Samples from Confirmed Cases: A Systematic Review

“…After the removal of duplicates ( n = 566), 456 articles were screened by the authors. After filtering the titles and reading the abstracts, 85 articles were selected for full-text reading, and 65 were considered eligible for inclusion in this systematic review ( Figure 1 ) [ 18 , 20 , 21 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ,…”

“…The review included 65 studies published between 1 January and 5 October 2022. The studies ( n = 65) reported monkeypox case reports according to the specimen collection site, the number of cases, sexual behavior-oriented risk factor, history of sexually transmitted diseases, site of specimen drawn and positive for monkeypox virus by PCR, location of skin lesions, and method of diagnosis were described in detail ( Table 2 ) [ 18 , 20 , 21 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ,…”

“…The most frequent locations of lesions in patients diagnosed with monkeypox ( n = 4537) were: 42.85% on the genitalia ( n = 1944) [ 18 , 20 , 29 , 32 , 35 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 56 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 66 , 67 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 83 , 84 , 85 ], 37.1% on the perianal region ( n = 1683) [ 18 , 20 , 26 , 34 , 41 ,…”

“…The disease evolution of the cases with monkeypox was asynchronous, with no serious or severe complications [ 18 , 20 , 21 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , …”

Epidemiologia da varíola dos macacos na Bahia em 2022: estudo observacional

“…No Brasil, a primeira notificação da varíola dos macacos se deu no dia 09 de junho de 2022, no município de São Research, Society andDevelopment, v. 11, n. 15, e384111537525, 2022 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v11i15.37525 Paulo (Lima et al, 2022). A partir de então, mesmo com as recomendações instituídas pelo Ministério da Saúde, tais como conscientização das comunidades e capacitação dos profissionais de saúde, para evitar a propagação do vírus, o país apresentou cerca de 8.652 casos da enfermidade, com 8 óbitos, até o dia 16 de outubro de 2022 (Schrarstzhaupt et al, 2022).…”