Fever and headache should be considered a warning sign.
Typically, the symptoms of monkeypox are similar to those of viral fever, such as high fever, headache, body ache, and profound weakness. The infectious period begins 1-2 days before the rashes start to appear. Once the rashes appear, infectivity begins and it takes another 2 days for crusting to occur. When skin lesions appear, the patient remains contagious at least until the crusts fall off. According to Dr Neha Patel Nakshiwala, Consultant, Infectious Diseases, Bhailal Amin General Hospital, “Mpox, previously known as monkeypox, begins with a prodromal phase that resembles common viral diseases. Symptoms in this phase include fever, body aches, fatigue, headache, and sometimes sore throat. A notable feature is lymphadenopathy, which may manifest in areas such as the cervical, axillary, or inguinal regions. This phase usually lasts for 1-4 days.”
The most prominent symptom of Mpox is the appearance of a skin rash, which usually starts on the face, hands, and legs and spreads inward. The rash can also appear on mucous membranes, such as the tongue, and even on private parts. It is important to note that this rash can be extremely painful and can last for a long period of time, typically 2-4 weeks, making it a key distinguishing feature from other viral rashes, which tend to resolve more quickly.
According to Dr Shailaja Mane, Head, Department of Paediatrics, DPU Pimpri Super Speciality Hospital, Pune, “In monkeypox, the most noticeable feature is the appearance of lesions which usually start on the face. Patients may have fever with chills, profuse sweating, muscle pain, sore throat, mild cough and 2-3 days after the fever, skin lesions or rash start. These are more painful and may also start itching. The first lesions may appear on the tongue or mouth and spread slowly. In almost 98% of the cases, the face is affected and then the rash spreads to the palms, soles, oral cavity, mucous membranes and genitals. Sometimes, the conjunctiva or eyes may also be affected which is a major feature of monkeypox.”
The rash progresses from an erythematous (redness) stage to raised macules, then papules, and finally fluid-filled vesicles. After that, pustules (pus-filled lesions) form. The entire process may take up to a week. Children are more prone to this infection, as well as immunocompromised people, including those undergoing chemotherapy for cancer treatment, immunotherapy for certain diseases, or those with compromised immunity due to malnutrition or other infections. These groups are at higher risk.
Mpox Transmission
In terms of transmission, Mpox can spread from animals to humans and from humans to humans. During the early prodromal phase, when the rash has not yet appeared, it is difficult to identify and diagnose the disease. Once the rash appears, it becomes easier to recognize. Transmission can occur through direct contact, fomites (e.g. furniture or bedding), and even sexual contact, particularly in high-risk populations.
Subtle Mpox signs to watch out for
Lymphadenopathy: Swollen lymph nodes (in areas such as the neck, armpits, and groin) can be an early indicator of Mpox, even before the rash appears. This is a subtle but significant sign that can help with early identification.
Persistent rash: While viral rashes usually disappear within a few days, the rash caused by Mpox is distinguished by its prolonged duration, typically lasting between two and four weeks. This prolonged duration of the rash can serve as an important clue to distinguish Mpox from other viral illnesses.
Precautionary measures
To minimize the risk of contracting Mpox, people should avoid crowded places and refrain from touching contaminated surfaces, especially in regions where there is an increase in cases. It is important to be careful when handling objects such as furniture and bedding in areas with a high prevalence of Mpox.
Monkeypox Infection: When to Seek Medical Help