PSA to all PCPs, ED docs, hospitalists, and anyone else who may be interested
—> Coming soon to a city near you…so soon in fact, it’s probably already there and unrecognized and/or underreported : monkey pox
Hey all. I’m in D.C. We’re drowning in this mess, so I figured I’d put together a few quick hits to help people out. Bc this damn thing is a mimicker and burning us all left and right. Everything I am posting is via firsthand experience from myself, or from one of my colleagues in my dept (total of 6 physicians including myself). All cases are confirmed pox.
Classic presentation : viral prodrome with fevers, followed by the development of multiple/diffuse pustules and inguinal LAD
Other presentations :
• Few tiny scattered pustules resembling folliculitis. Then after 72h, developed into full-blown pox. No prodrome or LAD
• painless penile chancre resembling primary syphilis. No prodrome or LAD
• Single lip lesion resembling oral herpes. No prodrome or LAD
• small cluster of painful vesicular lesions resembling shingles. No prodrome or LAD
• severe anal pain. Came to urgent care for possible perianal abscess – found to have multiple pustules on exam.
• Severe sudden onset chest pain concerning for ACS. Confirmed myocarditis
• severe, painful, unilateral conjunctivitis with extreme injection. Developed pustule in the eye and in the groin after 72h
Bottom line : if the pt is high-risk or otherwise has known exposure + any sort of rash/pustules/weird lesions —> assume it’s the pox, test for it along with any other indicated work-up to evaluate for other causes, instruct the pt to isolate until dx is confirmed one way or the other, and if pt *must* go out (ie doctor’s appt, etc) then needs to wear an N95 mask
Isolation
• Pt must isolate at home *at least* until the pustules have completely crusted over. Can take 2-3 weeks.
• Pt is considered no longer contagious once the scabs have begun to lift and there is clear evidence of new skin underneath. Until then, the recommendation is to have pt in a neg pressure room
Treatment
• Tpoxx is great. It works in all stages of viral infection. ETA: but, must get it from DOH, and Tpoxx is in low supply, so PLEASE reserve for severe cases. This means : organ involvement that is not the skin (ie eye, heart, severe proctitis, lung causing resp failure)
• if pt takes Tpoxx, please note it is BID-dosing. It is lipophilic, so needs to take with high-fat meal. My chief joked that he may start rx’ing McDonalds or Shake Shack to go with it
• most pts that take Tpoxx begin to experience relief in associated sx after 24h
• if ocular involvement : trifluridine eye drops do in fact work
• AVOID STEROIDS!!! It makes everything worse!!!!
And there you go. Hope this helps someone, and I hope everyone now keeps the pox on their differential.
C-19
7-26
ready
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Your no-hype southeastern New England weather blog!
I give up. I’m not sure what Riley and others expected when they put kids in a Petri dish but it seems they have yet to figure it out.
https://www.nbcboston.com/news/local/chronic-absences-in-mass-public-schools-soar-during-pandemic-report/2788154/?amp=1
Joshua….how often did you say we are ignoring monkey pox?
https://twitter.com/scottgottliebmd/status/1551208796072157190?s=21&t=2-b6NNOS37dW0eKo_m88vg
This was sent to me by a doctor I know in DC:
PSA to all PCPs, ED docs, hospitalists, and anyone else who may be interested
—> Coming soon to a city near you…so soon in fact, it’s probably already there and unrecognized and/or underreported : monkey pox
Hey all. I’m in D.C. We’re drowning in this mess, so I figured I’d put together a few quick hits to help people out. Bc this damn thing is a mimicker and burning us all left and right. Everything I am posting is via firsthand experience from myself, or from one of my colleagues in my dept (total of 6 physicians including myself). All cases are confirmed pox.
Classic presentation : viral prodrome with fevers, followed by the development of multiple/diffuse pustules and inguinal LAD
Other presentations :
• Few tiny scattered pustules resembling folliculitis. Then after 72h, developed into full-blown pox. No prodrome or LAD
• painless penile chancre resembling primary syphilis. No prodrome or LAD
• Single lip lesion resembling oral herpes. No prodrome or LAD
• small cluster of painful vesicular lesions resembling shingles. No prodrome or LAD
• severe anal pain. Came to urgent care for possible perianal abscess – found to have multiple pustules on exam.
• Severe sudden onset chest pain concerning for ACS. Confirmed myocarditis
• severe, painful, unilateral conjunctivitis with extreme injection. Developed pustule in the eye and in the groin after 72h
Bottom line : if the pt is high-risk or otherwise has known exposure + any sort of rash/pustules/weird lesions —> assume it’s the pox, test for it along with any other indicated work-up to evaluate for other causes, instruct the pt to isolate until dx is confirmed one way or the other, and if pt *must* go out (ie doctor’s appt, etc) then needs to wear an N95 mask
Isolation
• Pt must isolate at home *at least* until the pustules have completely crusted over. Can take 2-3 weeks.
• Pt is considered no longer contagious once the scabs have begun to lift and there is clear evidence of new skin underneath. Until then, the recommendation is to have pt in a neg pressure room
Treatment
• Tpoxx is great. It works in all stages of viral infection. ETA: but, must get it from DOH, and Tpoxx is in low supply, so PLEASE reserve for severe cases. This means : organ involvement that is not the skin (ie eye, heart, severe proctitis, lung causing resp failure)
• if pt takes Tpoxx, please note it is BID-dosing. It is lipophilic, so needs to take with high-fat meal. My chief joked that he may start rx’ing McDonalds or Shake Shack to go with it
• most pts that take Tpoxx begin to experience relief in associated sx after 24h
• if ocular involvement : trifluridine eye drops do in fact work
• AVOID STEROIDS!!! It makes everything worse!!!!
And there you go. Hope this helps someone, and I hope everyone now keeps the pox on their differential.
C-19
7-26
ready