Mpox — History and Physical — Clinical Pathway: Emergency Department, Outpatient Specialty Care and Primary Care

Mpox (Monkeypox) Clinical Pathway — Emergency Department, Outpatient Specialty Care and Primary Care

History and Physical

Mpox Transmission

Occurs through direct contact with infected lesions or body fluids, contaminated fomites, exposure to respiratory secretions, prolonged face-to-face encounters, and/or aerosol generating procedures.

Timeline

Mpox timeline

Prodromal Signs

  • May or may not be present
  • Include fevers, chills, headache, malaise, myalgias, and lymphadenopathy

Classical Rash

  • Firm, deep-seated, well-circumscribed, sometimes umbilicated lesions
  • Start on the face and spread to the extremities, including palms and soles
  • Progresses through several synchronized stages
  • Painful or pruritic
  • Last up to 4 weeks

Confirmed Case

Patients currently presenting with rash or exanthem starting in genital/perianal areas as either scattered or diffuse lesions, or localized to a specific body site, with lesions in different stages seen side-by-side.

History

Pertinent Medical History
  • Assess Exposure
    • Close or intimate contact with person or people with similar appearing rash
    • Contact with a person or people with a similar appearing rash or who received a diagnosis of confirmed or probable mpox
    • or
    • Networks experiencing mpox activity such as sexually active adolescents and young adults, especially those with a history of STIs, multiple partners, or anonymous partners
  • Rash
    • May be solely anogenital or also appear on other
    • areas of body including trunk, extremities, palms/soles
    • May appear as pustules, papules, or vesicles and evolves into scabs
    • May be painful or pruritic
  • Rash Visual Diagnosis  
  • Systemic Symptoms Below May or May Not Occur with the Rash
    • Fever
    • Headache
    • Myalgias
    • Lymphadenopathy
    • Chills
    • Malaise
    • Respiratory symptoms
      • Sore throat, nasal congestion, or cough
    • Rectal symptoms
      • Purulent or bloody stools, rectal pain, or rectal bleeding
PMH
  • Assess Risk Factors for Severe Disease
    • Immunocompromise
    • Skin disorders
      • Eczema
Social History

Physical

Physical Exam