How a Delhi doctor diagnosed first local transmission of monkeypox in India

Unusual lesions that did not completely fit the criteria for any one disease led the West Delhi skin specialist to suspect monkeypox even without an international travel history in Delhi’s first case. A 34-year-old from Paschim Vihar was diagnosed with monkeypox on Sunday, confirming the country’s first local transmission of the infection. The patient has since remained in isolation at Lok Nayak hospital.

The patient first went to see Dr Richa Chaudhary with complaints of fever and rashes, thinking he had contracted chickenpox. “But he had lesions on his palms and soles of the feet, which does not happen in chickenpox. The chickenpox rashes are also itchy, but the patient said the lesions were painful. Since he did not have a history of international travel (and the virus is not prevalent in India), I thought he had erythema multiforme,” said Dr Chaudhary. Erythema multiforme is a skin reaction that can be triggered by an infection or medicines. Dr Chaudhary treated him accordingly and asked him to come back in a week.

When the patient returned to her OPD last Thursday, the lesions had not healed. “If it were erythema multiforme, healing should have started. In fact, even if it were chickenpox, it should have started. Chickenpox lesions start healing in a week or so.”

In fact, when the doctor looked at the lesions across the body, the pattern fit that of two or three diseases. “That’s when I suspected he might have monkeypox. So, I pulled out medical journals and compared his lesions to what is seen in monkeypox cases. And, it matched completely. Barring his history of international travel, everything matched,” said Dr Chaudhary. She informed the patient of her suspicions and called the district surveillance officer. A test from the National Institute of Virology within days confirmed her suspicions.

The doctor is among the thirteen contacts who have been asked to remain in quarantine in their home. She has not developed any symptoms.

Speaking about how monkeypox lesions are different from the commonly seen chickenpox, Dr Chaudhary said, “Chickenpox lesions are smaller, these were much bigger in comparison. There is no clustering of these lesions in the genital area in chickenpox cases. Lesions are not formed on the palms and soles of the feet. And, varicella zoster (chickenpox) starts healing in seven days.”

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