Table 3.
Characteristics of eligible studies. Clinical manifestations, localization, the evolution of lesions, and treatment of monkeypox cases.
| Authors | Number of Cases (N) | Symptoms and Findings in Physical Examination | Days from Systemic Symptoms to Appearance of Lesion | Localization of Skin Lesions | Evolution of Lesions | Treatment |
|---|---|---|---|---|---|---|
| Antinori, A. et al. [8] | 1 | No | NR | Genital, thorax and calf area. | Asynchronous | Ciprofloxacin, acyclovir, and benzylpenicillin |
| 2 | Fever | 3 | Anal, back, legs and foot sole. | Asynchronous | NR | |
| 3 | Fever | 3 | Anal, head, thorax, legs, arms, hand, and genital area. | Asynchronous | anti-inflammatories and antihistamines | |
| 4 | Myalgia | 2 | Genital and pubic area. | Asynchronous | NR | |
| Heskin, J. et al. [31] | 1 | Lymphadenopathy, fever, headache, and diarrhea. Perioral white patches and painful lesions with perianal blisters. |
1 | Perioral and perianal. | Asynchronous | Intravenous ceftriaxone |
| 2 | Lymphadenopathy, fever, headache, and diarrhea. Perioral papules, papules on the mons pubis and penile shaft that evolved into painful ulcers. |
2 | Genital, pubic and tongue, oral and buccal mucous membranes. | Asynchronous | Intravenous ceftriaxone, antibiotic therapy. | |
| Hammerschlag, Y. et al. [32] | 1 | Fever and general malaise | 3 | Penis, trunk, face, extremities, hand, calf, nasal throat. | Asynchronous | Intramuscular ceftriaxone, oral doxycycline, oral cephalexin, intravenous cephalorin and oral analgesia. |
| Minhaj, F.S. et al. [22] | 17 | Rash (n = 17), Fatigue or malaise (n = 13), Chills (n = 12), Lymphadenopathy (n = 9), Headache (n = 8), Fever (n = 7), Body aches (n = 6), Sore throat or cough (n = 5), Sweat (n = 4). | NR | Arm (n = 9), Trunk (n = 9), Leg (n = 8), Face (n = 7), Hand (n = 6), Perianal (n = 6), Oral (n = 5), Neck (n = 5), Genital (penis or vagina) (n = 4), Feet (n = 4). | Asynchronous | NR |
| Vivancos, R. et al. [33] | 86 | NR | NR | NR | NR | NR |
| Perez Duque, M. et al. [34] | 27 | Exanthema (n = 14), inguinal lymphadenopathy (n = 14), fever (n = 13), genital ulcers (n = 6) | NR | Anus (n = 14) and genitalia (n = 12) | Asynchronous | NR |
| Vallée, A. et al. [35] | 1 | Fever, severe fatigue, chills, myalgia, sore throat, severe anal pain, and lymphadenopathy. | 5 | None | Asynchronous | No specific treatment. |
| Oprea, C. et al. [36] | 1 | High fever (up to 39 degrees Celsius), chills, rectal pain, vesiculopustular rash, dysphagia, severe pain in the anorectal region, marked hyperemia of the pharynx, with pseudomembranous appearance, and palatal petechiae, aphthous ulcers, lymphadenopathy. | 4 | Anogenital, buttocks, neck, trunk, upper and lower limbs, and sole of one foot. | Asynchronous | Symptomatic, fluid, and topical treatment for aphthous ulcers and pharyngeal hyperemia. |
| Bížová, B. et al. [28] | 1 | High fever, chills, lymphadenopathy, rash, painless perianal erosions, and perianal umbilicated papules. | 3 | The perianal and left side of the body | Asynchronous | Antibiotic therapy |
| Patrocinio-Jesus, R. et al. [29] | 1 | Painless genital rash, fever, sore throat, macular rash, lymphadenopathy. | 2 | Genitals and hands | Asynchronous | No specific intervention |
| Basgoz, N. et al. [30] | 1 | Rectal pain, vesiculopustular rash, rectal bleeding, foul-smelling and mucopurulent discharge, fever, chills, lymphadenopathy, and swelling in the groin. | 3 | Perianal, penis, arms, and legs. | Asynchronous | Penicillin G benzathine, ceftriaxone, valacyclovir, doxycycline, and intravenous acyclovir. |
| Mileto, D. et al. [7] | 1 | Asthenia, fever, general malaise, anorexia, papular lesions on both elbows, ulcerated perianal lesion, pharyngodynia, bilateral inguinal lymphadenopathy. | 3 | Perianal, face, both elbows, trunk, buttock, and right foot. | Asynchronous | Dolutegravir, rilpivirine, isolated in a negative pressure room. |
| Girometti, N. et al. [37] | 54 | Fatigue (n = 36), fever (n = 31), myalgia (n = 16), sore throat (n = 11), lymphadenopathy (n = 30) and skin lesions (n = 54). | 3 | Skin (n = 54), genitalia (n = 33), perianal (n = 24), upper and lower extremities (n = 27), facial (n = 11), oropharyngeal (n = 4) and torso (n = 14). | Asynchronous | No specific treatment was recorded and all individuals improved clinically. |
| Noe, S. et al. [38] | 1 | General malaise, fever, arthralgia, myalgia and back pain, headache, dysphagia, and presence of white spots on his tonsils. | 2 | Tonsils, trunk, limbs, and head. | Asynchronous | No specific treatment was recorded. |
| 2 | Fever, fatigue, cough, inguinal lymphadenopathy, and anal pain. | 2 | Trunk | Asynchronous | No specific treatment was recorded. | |
| Jang, Y.R. et al. [39] | 1 | Headache, fever, rash, lymphadenopathy, and chills. | 3 | Penis, oropharynx, nasopharynx, face, abdomen, and trunk. | Asynchronous | No specific treatment was recorded. |
| Maronese, C.A. et al. [40] | 1 | Fever, headache, malaise, and lymphadenopathy. | 5 | Penis, scrotum, and extremities. | Asynchronous | No specific treatment was recorded. |
| Peiró-Mestres, A. et al. [41] | 1 | Myalgia, fatigue | NR | Arm, perianal area and trunk | Asynchronous | No specific treatment was recorded. |
| 2 | Odynophagia, general malaise | Genital area | Asynchronous | No specific treatment was recorded. | ||
| 3 | Myalgia, fever, Proctitis | Anal area | Asynchronous | No specific treatment was recorded. | ||
| 4 | Proctalgia, odynophagia, general malaise | Perianal, chest and trunk | Asynchronous | No specific treatment was recorded. | ||
| 5 | Fever, myalgia, general malaise | Chest and legs | Asynchronous | No specific treatment was recorded. | ||
| 6 | Fever, proctitis | Wrist, pectoral, fingers, hand and perianal area | Asynchronous | No specific treatment was recorded. | ||
| 7 | Headache, general malaise | Ulcerated ventral tongue | Asynchronous | No specific treatment was recorded. | ||
| 8 | General malaise, fever | Trunk and genital area | Asynchronous | No specific treatment was recorded. | ||
| 9 | Myalgia, general malaise | Genital lesions | Asynchronous | No specific treatment was recorded. | ||
| 10 | General malaise, myalgia, proctitis | Perianal area | Asynchronous | No specific treatment was recorded. | ||
| 11 | NR | Genital area | Asynchronous | No specific treatment was recorded. | ||
| 12 | Myalgia, general malaise | Genital and anal area | Asynchronous | No specific treatment was recorded. | ||
| Iñigo Martínez, J. et al. [42] | 508 | Exanthema (n = 498), fever (n = 324), lymphadenopathy (n = 311), asthenia (n = 238), myalgia (n = 185), headache (n = 162), odynophagia (n = 143), and proctitis (n = 81) | NR | Anogenital and/or perineal area (n = 359), legs and/or arms (n = 222), face (n = 177), chest and/or abdomen (n = 159), back (n = 132), palms and/or plants (n = 124). | Asynchronous | No specific treatment was recorded. |
| Selb, R. et al. [43] | 521 | NR | NR | NR | NR | NR |
| Tarín-Vicente, E.J. et al. [44] | 181 | Influenza-like illness (n = 147), Fever (n = 131), Headache (n = 96), Sore throat (n = 66) and lymphadenopathy (n = 153) | NR | Genital (n = 100), Perianal (n = 66), Oral ulcer (n = 45), Perioral (n = 51), Hands and feet (n = 108), Trunk and extremities (n = 104) | Asynchronous | No specific treatment was recorded. |
| Ogoina, D. et al. [45] | 16 | Fever (n = 9), Genital rash (n = 4), facial rash (n = 3) | NR | Genital (n = 13) | Asynchronous | No specific treatment was recorded. |
| Orviz, E. et al. [46] | 48 | Fever (n = 25), Asthenia (n = 32), Myalgia (n = 25), Inguinal lymphadenopathies (n = 30), Other location of lymphadenopathies (n = 9), Headache (n = 25), Proctitis (n = 13), Urethritis (n = 7), Rash (n = 4), Nasal congestion (n = 4), and Cough (n = 8) | NR | Vesicular-umbilicated skin lesions location (n = 45), Genitals (n = 26), Upper extremities (n = 20), Perianal (n = 17), Trunk (n = 16), Facial (n = 12), Periorally (n = 9), Lower extremities (n = 10), and Palms and soles (n = 2) | Asynchronous | No specific treatment was recorded. |
| Patel, A. et al. [47] | 197 | Mucocutaneous manifestations (n = 197), Fever (n = 122), Headache (n = 49), Fatigue/lethargy (n = 46), Myalgia (n = 62), Arthralgia (n = 21), Back pain (n = 21), Rectal pain or pain on defecation (n = 71), and Lymphadenopathy (n = 114) | NR | Face (n = 71), Trunk (n = 70), Arms/legs (n = 74), Hands/feet (n = 56), Genitals (n = 111), Anus or perianal area (n = 82), and Oropharyngeal (n = 27) | Asynchronous | No specific treatment was recorded. |
| Pfäfflin, F. et al. [48] | 1 | Fever, Perianal pain, Anal abscess, and Lymphadenopathy | NR | Limbs | Asynchronous | Ibuprofen |
| 2 | Fever, malaise, anal pain, and anal fissure | NR | Left arm | Asynchronous | Metamizole, tramadol, lidocaine | |
| 3 | Anal pain, Rectal ulcer, and proctitis | NR | Limbs | Asynchronous | Ibuprofen, metamizole, lidocaine | |
| 4 | Fatigue, Anal pain, and Anal ulcer | NR | Arms, trunk, genital | Asynchronous | Metamizole, lidocaine, Penicillin G benzathine, ceftriaxone | |
| 5 | Fever, malaise, myalgia, sweats, Anal pain, Inflammation of sigmoid, rectum and anal canal | NR | Head, neck, trunk, limbs | Asynchronous | Metamizole, lidocaine, Ceftriaxone, azithromycin | |
| 6 | Myalgia, fever, malaise, Anal pain, Anal ulcer, proctitis | NR | Legs | Asynchronous | Metamizole, lidocaine, Ceftriaxone, azithromycin | |
| Philpott, D. et al. [49] | 1195 | Rash (n = 1004), Fever (n = 596), Chills (n = 550), Lymphadenopathy (n = 545), Malaise (n = 531), Myalgia (n = 507), Headache (n = 469), Rectal pain (n = 201), Pus or blood in stools (n = 184), Abdominal pain (n = 96), Rectal bleeding (n = 90), Tenesmus (n = 90), and vomiting or nausea (n = 83) | NR | Genitals (n = 333), Arms (n = 284), Face (n = 276), Legs (n = 265), Perianal (n = 225), Mouth, lips, or oral mucosa (n = 179), Palms of hands (n = 157), Trunk (n = 156), Neck (n = 130), Head (n = 97), and Soles of feet (n = 77) | Asynchronous | No specific treatment was recorded. |
| Raccagni, A.R. et al. [50] | 36 | NR | NR | Genital (n = 13), Rectal (n = 18), cutaneous (n = 20) | Asynchronous | No specific treatment was recorded. |
| Rodríguez, B.S. et al. [51] | 1256 | Report of some cases (n = 530): Fever (n = 302), lymphadenopathy (n = 216), Asthenia (n = 224), Muscle pain (n = 167), Throat pain (n = 136), and Headache (n = 140) | NR | Report of some cases (n = 530): Anogenital (n = 355), other than anogenital or oro/peribuccal (n = 293) | Asynchronous | No specific treatment was recorded. |
| Vusirikala, A. et al. [52] | 45 | NR | NR | NR | Asynchronous | No specific treatment was recorded. |
NR: No report.