Pox, orthopox viruses and general symptoms

Q: Systemic symptoms are more common in? (select one)

A) poxvirus (Molluscum contagiosum virus-MCV) 

B) monkeypox (orthopox virus)

Answer: B

There has been a renewed interest in pox and orthopox viruses since the outbreak in mid-2022. Clinical exams and knowing the characteristic dermal appearances play an important role in differentiating different pox and orthopox viruses. 

Molluscum contagiosum generally causes "hard bumps," whereas monkeypox lesions are usually pus-filled. But frequently, it is hard to differentiate monkey pox from molluscum contagiosum just based on dermal appearance but systemic symptoms like fever, chills, and myalgias are more frequently present in monkeypox infection.

Other dermal appearances that require differential diagnoses are warts, condyloma acuminatum, condylomata lata, pyogenic granuloma, adnexal tumors, Langerhans cell histiocytosis, basal cell carcinoma, and amelanotic melanoma. A skin biopsy may be required to establish these clinical conditions.

Also, dermal lesions due to cryptococcosis, histoplasmosis, and Talaromyces marneffei infections may resemble molluscum lesions, particularly in immunosuppressed patients. 

#ID

#dermatology

References:

1. Hussain A, Kaler J, Lau G, Maxwell T. Clinical Conundrums: Differentiating Monkeypox From Similarly Presenting Infections. Cureus. 2022 Oct 4;14(10):e29929. doi: 10.7759/cureus.29929. PMID: 36348880; PMCID: PMC9634140.

2. De Clercq E, Jiang Y, Li G. Therapeutic strategies for human poxvirus infections: Monkeypox (mpox), smallpox, molluscipox, and orf. Travel Med Infect Dis. 2023 Mar-Apr;52:102528. doi: 10.1016/j.tmaid.2022.102528. Epub 2022 Dec 17. PMID: 36539022; PMCID: PMC9758798.