January 13, 2024
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Key takeaways:
- During a 2022 mpox outbreak in a Nigerian facility, cases deviated from the typical presentation.
- Experts expressed concern that these atypical presentations could lead to a delayed diagnosis.
During a 2022 mpox outbreak in a Nigerian tertiary care facility, several confirmed cases presented atypically, according to a recent assessment of cases.
“Having managed cases of mpox previously, I became amazed at the gradual drift of the clinical presentation from the usual, previously documented, and observed pattern of presentation to some forms I considered atypical,” Nneka M. Chika-IgwenyiMD, an infectious diseases physician at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, told Healio. “This spored me into highlighting some of the observed atypical presentations.”
During a 2022 mpox outbreak in a Nigerian facility, cases deviated from the typical presentation highlighting the need for further evaluation of unusual skin lesions and increased mpox screening. Image: CDC.
Chika-Igwenyi and colleagues assessed clinical and epidemiological data of PCR-confirmed mpox cases reported during the 2022 outbreak to gather information on unusual presentations.
Of 17 suspected cases reported during the outbreak, 13 were PCR confirmed. Among these 13 patients, there were several atypical presentations.
According to Chika-Igwenyi, these cases occurred among young adults and were more common in males (64.3%), which is in contrast to previously documented occurrence in children and young females. Additionally, among these patients, there was a lack of prodromal symptoms (reported among only three or 23.1% of cases) that usually indicate the onset of skin lesions. When patients did have prodromal symptoms, symptoms persisted for longer than a week in 38.5% of cases.
All 13 patients experienced rash of “various distribution.” Skin lesions were polymorphic in six cases (46.2%) with solitary skin lesions reported in three patients (23.1%). Chika-Igwenyi added that contrary to previous outbreaks where skin lesions followed typical stages and were synchronous, some cases had asynchronous lesions with rashes occurring at different stages of development. According to the study, significant genital lesions were reported in both genders and in six (46.2%) cases. Perianal lesions were also reported atypically among heterosexuals and non-men who have sex with men population patients (71.1%) with one case (7.7%) being severe.
Based on these assessments, Chika-Igwenyi said that moving forward there needs to be screening and evaluation of genital skin lesions presumed to be sexually transmitted infections. There should also be a revision of clinical case definition to include the reported atypical presentations.
“[There should be a] high index of suspicion among clinicians and public health interventions using a one-health approach,” Chika-Igwenyi concluded.
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