ER doctor says he’s fed up with seeing patients misdiagnosed as monkey pox, then goes to hospital with excruciating pain

photo of Dr. Walker with peels on a surgical mask

Dr. Graham Walker, an emergency medicine physician, treats patients with monkey pox in San Francisco.Courtesy of Graham Walker

  • Experts from San Francisco, Miami and the UK say many cases of monkey pox have been “overlooked”.

  • Some patients are given false-negative monkey pox tests, while others are misdiagnosed.

  • Fear, stigma, misunderstandings and misunderstandings contribute to this.

In the United States, more than 7,100 patients with monkey pox have been diagnosed since the outbreak started with one case in mid-May.

But Dr. Graham Walker, an emergency medicine physician in San Francisco, says many more monkey pox patients are not getting the care and attention they deserve to successfully prevent, diagnose, and treat this infectious disease.

Walker says he saw “a few patients” whose diagnosis of monkey pox was “overlooked” by another provider before landing in his emergency room with excruciating pain.

“I had a patient who, I saw, from another facility, said,” lesions only in the genitals, so unlikely to be monkey pox, “he told Insider.

Other clinicians and scientists in the US, UK, and West Africa say the same thing: monkey pox is commonly underdiagnosed.

Some poorly diagnosed patients experience so much pain that they cannot wear clothes

Dr. Lilian Abbo, an infectious disease specialist at the University of Miami, says she noticed the same problem all over the country.

“We saw patients visiting seven centers: three different urgent care centers, dermatologists and an ER to try to find out what was going on,” she said in a recent telebriefing by the Society for Infectious Diseases in America, highlighting the need for greater awareness of what smallpox might present. monkeys.

Increased awareness can have enormous implications for both treating and containing the disease. It is possible that if close contacts find out early enough in the course of their infection (i.e. within the first 4 days after exposure), Jynneos smallpox vaccine can be used to completely prevent infection with monkey pox.

But “by the time the many misdiagnosed patients arrive,” they “may be cured and some of them may have disease progression,” Abbo said. This progress can be painful.

Patients in this epidemic, in some of the most severe cases, were unable to use the toilet because the pain around the anus and genitals becomes so severe. “One of my patients said,” I can’t even wear pants or underwear without pain, “said Walker.

The “textbook” descriptions of symptoms are not always accurate

Matt Ford shows monkey pox stains

Matt Ford underestimated the pain of monkey pox.Matt Ford

One of the reasons monkey pox is not diagnosed is because the monkey pox epidemic does not act like “textbook” presentations of monkey pox from the past, with the classic fever, enlarged lymph nodes in the neck, and headache appearing in front of the pox surface on the surface of the face and hands.

Instead, monkey pox lesions may be stuck in the rectum, swollen lymph nodes may only be in the groin, and it is not uncommon for a single lump to be the only marker of a person’s entire infection.

The July 21 New England Journal of Medicine compilation of 528 case reports from 16 countries around the world sets some clear patterns in this epidemic. Almost two-thirds of the patients studied had lesions in the anogenital (private) area, with the majority of patients having less than 10 lesions all over their body.

Patients “showed symptoms that were not part of the case definition,” NEJM study author Chloe Orkin told Insider. “It’s important to help doctors recognize this.”

Fever, fatigue, muscle aches and headaches were among the most common pre-rash symptoms associated with budding monkey pox, which also makes it easier for people to initially mistake the disease for COVID.

“Every patient I spoke to took a COVID test when he had a fever and said,” oh, it’s not COVID, “said Walker.

Other times, diagnoses are overlooked because suppliers are not getting “good, aggressive scrub” changes, he said.

“I’ve seen this before when people tested negative and I say,” you have literally every symptom of monkey pox, this looks just like all the other monkey pox cases that I watch and we do. ” I ruled out other things like cold sores, syphilis, whatever. “

Some people avoid a monkey monkey diagnosis as it can be stigmatizing, painful, and lonely

Early treatment is key to stopping monkey pox infection and preventing the excruciating pain it causes. The antiviral drug Tecovirimat (TPOXX) can help, as well as prescription pain relievers that are stronger than Motrin and Advil.

However, many patients, fearing stigma and lack of information, do not seek help.

One of Walker’s patients was self-medicating his lesions for a full two weeks, when he finally opted for treatment.

“He just wanted to deal with it at home. He was worried about the stigma, said he had never had a sexually transmitted disease before. But the pain was so bad it finally started, ”Walker explained. “There’s a lot of fear, there’s a lot of anxiety, and to be honest, there are probably a lot of people who haven’t been diagnosed yet,” he added.

Dr. Jason Zucker, an infectious disease specialist at the New York Presbyterian Hospital, said that “even patients with mild disease have a hard time” when they receive a monkey pox diagnosis.

“In addition to this stigma, patients diagnosed with the diagnosis isolate themselves at home for up to four weeks,” Zoom told reporters Friday. “It is important to make sure that we are all aware of this, that we are all working together to reduce stigma, and that we offer patients mental health and other support after their diagnosis.”

A Nigerian doctor noticed this type of monkey pox in 2017. He hopes people will eventually start funding research on this virus.

In Nigeria, where Dr.Dimie Ogoina has been investigating sexual contact-related monkey pox outbreaks since 2017, he says he faces similar problems of confusion and stigma that make it difficult to understand the true extent of each epidemic.

He suspects that often patients with “genital lesions” do not come to the hospital to be properly diagnosed, instead they simply go to the pharmacy for treatment for sexually transmitted diseases.

“There are many things that are still unknown about monkey pox,” because “it was a neglected disease,” Ogoina told Insider. “Since global north has cases right now, I’m sure there will be research investment and we’ll be able to discover most of the unknowns.”

Read the original Insider article

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