**Background:**
- Mpox is a viral disease causing a distinctive rash (generalised maculopapular becoming pustular/vesicular rash involvingface, hands, feet, oral mucous mucosa, genitalia, cornea) andviral syndrome (lethargy, fever, headache, myalgia, arthralgia, lymphadenopathy).
- Most cases occur in men who have sex with men (MSM)
**Incubation Period:** typically 7-14 Days (5-21 days)
**Infectious period:**
- From first symptoms until lesions crust, dry and fall off and a layer of new skin forms underneath.
**Transmission:**
- Mpox does not spread easily between people and close contact is required
- Close contact with rashes, blisters, or sores on the skin, including intimal physical contact (sex)
- Bodily fluids, including respiratory droplets
- Contaminated objects such as linen and towels.
**Signs and symptoms:**
- Initial febrile prodrome (day 0-5)
- Fevers, chills, headache, sore throat, lymphadenopathy, myalgias, lethargy
- Rash (begins day 1-3 after fever)
- Typically, synchronous lesions but may appear at different stages at diagnosis
- Typically starts/concentrates on the face with peripheral spread to limbs > trunk but may start on the genital region.
- Can affect palms/soles, oral mucous membranes, conjunctiva/cornea
- Starts as macules → papules → vesicles → pustules → crusting
- Some cases present with urethritis or proctitis
- Self-limited lasting 2-4 weeks
**Complications**
- Pneumonia, sepsis, encephalitis and vision loss
**Investigations**
- Mpox PCR
- Dry swab (‘e-swab’) of skin lesions in viral transport medium for Mpox PCR
- 2-4 scabs (separate from intact skin with needle) sent in specimen container for mpox PCR
- Nasopharyngeal swab for Mpox PCR
- Serology (for confirmed cases)
**DDx for rash**
- chickenpox
- HSV
- disseminated zoster
- syphillis
- chancroid
- gonococcal
- lymphogranuloma venereum
- hand-foot-mouth
- drug rx
- eczema / eczema herpeticum
- erythema multiforme
- measles
- behct's
- molluscum contagiosum
- scabies
- ricetsia
- smallbox