Dear Editor,

We would like to share ideas on the publication “Ocular manifestations of monkeypox: a case report⁽¹⁾.” In this report, Nogueira Filho et al. described a patient with monkeypox who had ocular complaints (eye irritation and conjunctivitis) and identifiable conjunctival lesions on biomicroscopy and fluorescein tests⁽¹⁾. According to the authors, the ophthalmological signs are still not well understood⁽¹⁾. We believe that the key to controlling monkeypox is early diagnosis. The present monkeypox outbreak is difficult for doctors to control. Laboratory testing is typically used to determine the presence of monkeypox. However, clinicians must first make a provisional clinical diagnosis or identify a suspicious case before the laboratory analysis can have any effect. The alleged clinical diagnosis might make things less dangerous. Skin lesions, which are exceptional in any manner, are rare unless specific conditions are met. Thus, it is critical to realize that certain people, such as those who have neurological or digestive problems, only display particular symptoms^(2,3). Another crucial element is the quality control of laboratory diagnostics. It remains a problem because laboratory diagnosis for monkeypox could lead to inaccurate epidemiological data⁽⁴⁾. The current case has an ocular presentation. Surely, the issue has been raised and might be conveniently ignored⁽⁵⁾. However, other complications and comorbidities are significant issues. Other sexually transmitted diseases, such gonorrhea, may sometimes co-occur but go unrecognized⁽⁶⁾. The ocular manifestation may be a clinical issue related to monkeypox or other unnoticed concomitant medical conditions.

REFERENCES

1. Nogueira Filho PA, Lazari CD, Granato CF, Shiroma MA, Santos AL, Campos MS, Freitas D. Ocular manifestations of monkeypox: a case report. Arq Bras Oftalmol [Internet]. 2022[cited 2022 Nov 24];85(6):632-5. Available from: SciELO - Brasil - Ocular manifestations of monkeypox: a case report Ocular manifestations of monkeypox: a case report

2. Joob B, Wiwanitkit V. Monkeypox: revisit of the old threat and emerging imported cases. Med J DY Patil Vidyapeeth [Internet]. 2022[cited 2022 Nov 21];15(4):457-9. Available from: Monkeypox: Revisit of the old threat and emerging imported cases Joob B, Wiwanitkit V - Med J DY Patil Vidyapeeth (mjdrdypv.org)

3. Wiwanitkit S, Wiwanitkit V. Atypical zoonotic pox: acute merging illness that can be easily forgotten. J Acute Dis [Internet]. 2018[cited 2022 Nov 7];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)

4. Niedrig M, Meyer H, Panning M, Drosten C. Follow-up on diagnostic proficiency of laboratories equipped to perform orthopoxvirus detection and quantification by PCR: the second international external quality assurance study. J Clin Microbiol [Internet]. 2006[cited 2022 Sep 15];44(4):1283-7. Available from: Follow-Up on Diagnostic Proficiency of Laboratories Equipped To Perform Orthopoxvirus Detection and Quantification by PCR: the Second International External Quality Assurance Study - PMC (nih.gov)

5. Mungmunpuntipantip R, Wiwanitkit V. Conjunctivitis can be a possible clinical presentation of monkeypox. Arq Bras Oftalmol[Internet] . 2022[cited 2022 Nov 10];85(5):539. Available from: SciELO - Brasil - Conjunctivitis can be a possible clinical presentation of monkeypox Conjunctivitis can be a possible clinical presentation of monkeypox 6. De Baetselier I, Van Dijck C, Kenyon C, Coppens J, Michiels J, de Block T, Smet H, Coppens S, Vanroye F, Bugert JJ, Girl P, Zange S, Liesenborghs L, Brosius I, van Griensven J, Selhorst P, Florence E, Van den Bossche D, Ariën KK, Rezende AM, Vercauteren K, Van Esbroeck M; ITM Monkeypox study group. Retrospective detection of asymptomatic monkeypox virus infections among male sexual health clinic attendees in Belgium. Nat Med. 2022[cited 2002 Nov 24];28(11):2288-92. Available from: Retrospective detection of asymptomatic monkeypox virus infections among male sexual health clinic attendees in Belgium - PMC (nih.gov)

Submitted for publication: November 9, 2022.
Accepted for publication: November 10, 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.