Monkeypox: typical and atypical clinical presentation : Al-Azhar Assiut Medical Journal

Secondary Logo

Journal Logo

Letter to the Editor


typical and atypical clinical presentation

Sookaromdee, Pathuma,; Joob, Beuyb; Wiwanitkit, Virojc

Author Information
Al-Azhar Assiut Medical Journal 20(4):p 373-374, Oct–Dec 2022. | DOI: 10.4103/azmj.azmj_26_22
  • Open

Dear Editor, the authors want to discuss the current global problem of Monkeypox. Monkeypox is a zoonotic disease that has been linked to human-to-human transmission [1,2]. A classical presentation of this disease is a febrile illness with vesicular skin lesions. However, the disease has currently spread outside of its origin in Africa, and there are some different clinical pictures compared with those seen at its origin in Africa.

Monkeypox, which is rapidly spreading over several European nations, was initially identified in primates. The bulk of human cases in the current outbreak, however, are not caused by monkey infection. The distinctiveness of the current clinical observations among patients in Europe is a topic of some specific attention. Considering the patient’s age in Africa, they can be found from birth to 60 years of age, whereas in Europe, they can only be found at reproductive age between the ages of 20 and 50. In Africa, two out of three men and one out of three women, whereas in Europe in 2022, there will be 98–99% men and only 1–2% women. Transmission from animal to human has been seen in Africa notably with rodents like rats, but there is no proof of animal-to-human contact in Europe in 2022. Up to 30% of skin lesions are detected in the genital region, especially in Africa, where they are typically located on the hands, feet, face, and neck.

As previously stated, homosexual male cases have become the primary infected population in Europe and America. A male discovered asymptomatic skin lesions in the perianal region, which were followed by a day of headache and fever, according to Barbosa et al. [3]. He portrays himself as a man who has sex with men and has multiple partners [3]. He frequently denies any previous travel or contact with animals. The notion that the illness is a new sexually transmitted infectious disease is worsening the situation. In fact, the illness presents as a severe febrile illness with cutaneous symptoms. There is still a risk one will get an odd illness, such as a fever with no obvious symptoms. The current instance is an excellent illustration; the patient had a ‘window period’ of at least 1 day during which he had no characteristic cutaneous disease. Unusual clinical manifestations, such as atypical skin lesions or a lack of fever, can make Monkeypox diagnosis difficult [2].

The unknown risk is a recurrent concern when a new infectious disease appears [3]. Considering the fact of the well-known coronavirus disease 2019 (COVID-19) outbreak, some people were ignorant of the risk when COVID-19 initially appeared, and a surgeon in the operating theater was one of the first to become infected after coming into contact with asymptomatic COVID-19 patients. Similarly, the present Monkeypox outbreak necessitates forethought and prevention. It is worth noting that viremia is a possibility, and the patient could be afebrile and asymptomatic [1]. We must admit that we know very little about the recent Monkeypox outbreak [3]. It is time to recognize that we are only scratching the surface of the recent Monkeypox outbreak [3]. Based on the lessons learned from COVID-19, the best treatment is the highest level of preventive care. Preparedness and acceptance of the importance of the new disease, Monkeypox, are essential.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.



1. Wiwanitkit S, Wiwanitkit V. Atypical zoonotic pox: acute merging illness that can be easily forgotten J Acute Dis. 2018;7:88–89
2. Sookaromdee P, Wiwanitkit V BMJ rapid response. Available at: [Accessed 10 Aug 2022].
3. Barbosa J, Caldeira M, Fernandes C. Human Monkeypox Acta Med Port. 2022 Online ahead of print.
© 2022 Al-Azhar Assiut Medical Journal | Published by Wolters Kluwer – Medknow