Monkeypox — Past as Prologue

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Abstract
In this issue of the Journal, Thornhill et al. report on 528 persons with monkeypox in a cohort spanning 16 countries on five continents.1 The authors provide important demographic, epidemiologic, and clinical details on the largest reported cohort of patients in the latest emerging infectious disease outbreak of global importance. Diagnosis relied on polymerase-chain-reaction (PCR) assays of swab specimens taken from lesions, predominantly in the skin, anogenital region, nose, or throat. The authors note a diverse set of dermatologic and oropharyngeal clinical manifestations that in many instances could be confused with a variety of other illnesses, including several sexually transmitted infections. Most of the patients had 10 or fewer lesions, with 10% having a single genital lesion, findings consistent with other early reports. Lesions ranged in appearance from maculopapular to vesiculopustular to crusted, with the anogenital region the most common site. The Supplementary Appendix of the article (available with the full text of the article at NEJM.org) contains an excellent array of images of lesions to aid in case recognition. Although there were no fatalities within the cohort, 13% of the persons with infection were hospitalized for management of pain or secondary infections.

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