Dear Editor,

Smallpox and chickenpox are the two most common human pox infections. In addition to these diseases, novel zoonotic pox diseases have been a major concern in infectious medicine⁽¹⁾. Monkeypox has spread throughout Europe, thereby causing a significant public health risk⁽²⁾. It is a rare pox infection that has resurfaced and is most likely caused by zoonosis⁽¹⁾. Human-to-human transmission is currently investigated. The medical community is concerned as the number of cases reported is increasing in different countries.

Based on our experience with coronavirus disease 2019, we must respond promptly and investigate the problem appropriately in case of an epidemic. Moreover, we should act immediately to comprehensively investigate the issue and take the required management steps⁽²⁾. Conjunctivitis is a common clinical symptom. However, it can be observed in any novel infectious diseases and can be the only clinical presentation (similar to coronavirus disease 2019)⁽³⁾. In 2022, the number of new monkeypox cases in large clusters in several countries outside of Africa is rapidly increasing, thereby causing concerns on a statewide outbreak.

Monkeypox is an illness that causes fever and skin rash. The initial diagnosis is commonly made based on the presence of rash. To the best of our knowledge, no previous research has investigated the symptoms of monkeypox. Conjunctivitis was the presenting symptom in 3 of 34 patients who were evaluated. These individuals did not develop fever, and some had a rash⁽⁴⁾. Atypical characteristics and the absence of a cutaneous lesion and fever are the clinical features of monkeypox that can possibly develop but are under-reported⁽¹⁾. Conjunctivitis can be the initial symptom. Hence, emergency preparedness is important in the current clinical practice. Further, medical professionals should be alert for suspected monkeypox cases since an epidemic in a new setting can occur, and all patients with conjunctivitis must be evaluated comprehensively.

REFERENCES

1. Wiwanitkit S, Wiwanitkit V. Atypical zoonotic pox: Acute merging illness that can be easily forgotten. J Acute Dis [Internet]. 2018[cited 2020 jun 21];7(2):88-9. Available from: Atypical zoonotic pox: Acute merging illness that can be easily forgotten Wiwanitkit S, Wiwanitkit V - J Acute Dis (jadweb.org)

2. Mungmunpuntipantip V, Wiwanitkit V. Rapid Response to: Re-emerging monkeypox: an old disease to be monitored. BMJ [Internet]. 2022[cited 2022 may 21]; 377. Available from: Re-emerging monkeypox: an old disease to be monitored | The BMJ

3. Ozturker ZK. Conjunctivitis as sole symptom of COVID-19: A case report and review of literature. Eur J Ophthalmol [Internet]. 2021[cited 2022 jan 21];31(2):NP161-6. Erratum in: Eur J Ophthalmol. 2021;31(2):NP160. Available from: Conjunctivitis as sole symptom of COVID-19: A case report and review of literature - PMC (nih.gov)

4. Huhn GD, Bauer AM, Yorita K, Graham MB, Sejvar J, Likos A, et al. Clinical characteristics of human monkeypox, and risk factors for severe disease. Clin Infect Dis. 2005;41(12):1742-51.

Submitted for publication: May 25, 2022.
Accepted for publication: May 29, 2022.

Funding: This study received no specific financial support

Disclosure of potential conflicts of interest: None of the authors have any potential conflicts of interest to disclose