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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

Mary D. Nettleman, MD, MS, MACP

Mary D. Nettleman, MD, MS, MACP

Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.

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In this Article

• Monkeypox facts
• What is monkeypox?
• What is the history of monkeypox?
• What causes monkeypox? How is monkeypox transmitted?
• What are risk factors for monkeypox?
• What are monkeypox symptoms and signs?
• How is monkeypox diagnosed?
• What is the treatment for monkeypox?
• What is the prognosis of monkeypox?
• Can monkeypox be prevented?
• Where can people get more information about monkeypox?
• What research is being done on monkeypox?
• Monkeypox Index

The first symptoms that occur are nonspecific -- fever, sweating, malaise, and some patients may develop a cough, nausea, and shortness of breath. About two to four days after fever develops, a rash with papules and pustules develops most often on the face and chest, but other body areas may eventually be affected, including mucus membranes inside the nose and mouth. These skin and mucus membrane pox lesions can ulcerate, crust over, and then begin to heal in about 14-21 days. In addition, lymph nodes usually swell during this time. Some pox lesions may become necrotic and destroy sebaceous glands, leaving a depression or pox scar that, with monkeypox, may gradually become less pronounced over a few years. The toxemia that was seen with smallpox is not seen with monkeypox.

Figure 2: Picture of the pustules/papules of characteristic monkeypox rash; SOURCE: World Health Organization (WHO)/Brian W.J. Mahy, BSc, MA, PhD, ScD, DSc

The history (especially association with rodents or other animals) and physical exam (present of pox lesions) is presumptive evidence for a diagnosis of monkeypox. Caution is advised. Infectious-disease consultants and CDC personnel should be notified because this infection may represent two additional problems. First, in the U.S. or other countries, it may likely indicate an outbreak of monkeypox, and informed health authorities may help to identify the source of the infection and prevent its spread. The second problem is unlikely but far more serious; the early symptoms may represent a biological warfare or terrorist attack with smallpox that is mistakenly identified as monkeypox. Consequently, definitive diagnosis of this viral disease, outside of Africa, and especially in developed countries where monkeypox is not endemic, is urged. Most laboratories do not have the reagents to do this testing, so state labs or the CDC will need to process the samples to establish a definitive diagnosis. These tests are based on detecting antigenic structures (usually from skin or pox samples or occasionally serum) specific to either monkeypox virus or immunoglobulin that reacts with the virus. PCR (polymerase chain reaction), ELISA techniques (enzyme-linked immunosorbent assay), or Western blotting tests (immunoblotting) are the main tests used.