Experts in San Francisco, Miami and Britain say many cases of monkeypox are “being missed.”
Some patients are getting false-negative monkeypox tests, while others are being misdiagnosed.
Fear, stigma, misunderstanding and misunderstanding are all part of it.
more than 7,100 cases of monkeypox It has been diagnosed in the US since the outbreak began with a single case in mid-May.
But Dr. Graham Walker, an emergency physician in San Francisco, says many more monkey pox patients are not getting the care and attention they need to prevent, diagnose and effectively treat this contagious disease. deserve to
Walker says he’s seen “several patients” whose diagnosis of monkeypox was “missed” by another provider before they landed in his ER in excruciating pain.
“I had a patient who, I looked at their record at another facility, and it said, ‘Only genital sores, so it’s unlikely to be monkey pox,'” she told Insider.
Other medical experts and scientists in the US, UK and West Africa say the same: Monkey pox is being widely diagnosed.
Some misdiagnosed patients are in so much pain that they cannot get dressed
Across the country from Walker’s ER, Dr. Lillian Ebo, an infectious disease specialist at the University of Miami, says she’s seen the same problem.
“We’ve seen patients going to up to seven centers: three different urgent cares, dermatologists, and ERs to try to figure out what’s going on,” he said during a recent Infectious Diseases Society meeting. . America telebriefingEmphasizing the need for better awareness of how monkeypox can present.
Better awareness could have far-reaching implications for both treatment and disease control. It is possible that if close contacts are detected early enough during their infection (ie, within the first 4 days after an exposure) they can have smallpox vaccine. It is used to completely prevent monkey pox infection..
But, “by the time they arrive,” many patients who are misdiagnosed “may have recovered, or some of them may have progressed,” Ebo said. This development can be painful.
Patients with this outbreak, in some extreme cases, have been unable to use the toilet because the pain around their anus and genitals becomes so severe. “One of my patients said, ‘I can’t even wear pants or underwear without pain,'” Walker said.
‘Textbook’ descriptions of symptoms are not always accurate.
This is one reason monkey pox is underdiagnosed. The spread of this disease is not working. Similar to past “textbook” monkeypox presentations, with classic fever, swollen lymph nodes in the neck, and headache, all appear before pox surfaces on the face and hands.
Instead, monkeypox lesions may be noted in the rectum, lymph node swelling may be present only in the groin, and it is not uncommon for a single pocket to be the only sign of a person’s entire infection. .
On July 21 New England Journal of Medicine A compilation of 528 case reports from 16 countries around the world establishes some clear patterns for this outbreak. About two-thirds of the patients studied had lesions in their anogenital (private) area, with most patients having fewer than 10 lesions on the entire body.
NEJM study author Chloe Orkin said the patients were presenting with symptoms that were not part of the case definition. internal. “The important thing is to help doctors recognize it.”
Fever, fatigue, muscle aches, and headaches were some of the most common pre-rash symptoms of an emerging monkeypox infection, making it easy for people to initially confuse the condition with COVID. becomes
“Every single patient I’ve talked to has had a Covid test when they had a fever, and they’re like, ‘Oh, it’s not Covid,'” Walker said.
Other times, the diagnosis is missed because providers don’t get a “good, aggressive scrub” of the lesions, he said.
“I’ve seen this before, where people test negative and I’m like, ‘You literally have every symptom of monkey pox, it looks exactly like what I’m seeing, and we “I’ve ruled out other things, like herpes, syphilis, whatever.”
Some people avoid a diagnosis of monkeypox because it can be stigmatizing, painful, and isolating.
Early treatment is key to preventing monkeypox infection and the excruciating pain it causes. The antiviral drug Tecovirimat (TPOXX) can help, as can prescription painkillers stronger than Motrin and Advil.
But many patients, fearing stigma and lack of information, do not seek help.
One of Walker’s patients had been managing his wounds alone for two full weeks, when he finally decided to seek treatment.
“He just wanted to manage it at home. He was worried about the stigma, he said he’d never had an STD before. But the pain was so bad that he finally came in,” Walker said. explained. “There’s a lot of fear, a lot of anxiety, and to be honest, there’s probably a lot of people who haven’t been diagnosed yet,” he added.
Dr. Jason Zucker, an infectious disease specialist at New York Presbyterian Hospital, said that “even patients with mild disease are taking it very hard” when they are diagnosed with monkeypox.
“In addition to this stigma, patients who are diagnosed are isolated at home alone for four weeks,” he told reporters on a Zoom call on Friday. “It’s important to make sure we’re all aware of it, that we all work together to reduce the stigma, and that we provide mental health and other support resources to patients after their diagnosis. “
A doctor in Nigeria saw this type of monkeypox in 2017. He hopes people will eventually start funding research into the virus.
In Nigeria, where Dr. Demi Ogweina is studying sexually transmitted outbreaks of monkeypox From 2017he says, struggles with similar problems of confusion and stigma, both of which make it difficult to gauge the true scope of any outbreak.
Often, he suspects that patients with “genital lesions” aren’t coming to the hospital for a proper diagnosis, instead, they’re just going to the pharmacy for STD treatment.
“There’s a lot that’s still unknown about monkeypox” because “it’s been a neglected disease,” Ugwina told Insider. “As cases are now occurring in the global North, I believe there will be investment in research, and we will be able to uncover many of these unknowns.”
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