The South African health care system should be on high alert as people infected with mpox may not present with lesions.
Dr Richard Lessells, an infectious diseases specialist at the KwaZulu-Natal Research Innovation and Sequencing Platform in the School of Laboratory Medicine and Medical Sciences, said most of the cases in the country were towards the severe end of the spectrum while more recent cases were milder.
He was speaking on Wednesday during a webinar hosted by the University of KwaZulu-Natal (UKZN) together with Professor Yunus Moosa, head of the department of infectious diseases at UKZN, and the head of Virology in the School of Laboratory Medicine and Medical Sciences at UKZN, Dr Nokukhanya Msomi.
South Africa has 20 confirmed mpox cases in KZN, Gauteng and the Western Cape with three deaths reported. All are males between the ages of 17 and 43.
Lessells said most cases so far were in people who self-identify as men who have sex with men, and many are people living with HIV.
“Linked to the severity of the cases is the fact that many of the more severe initial cases were in people with advanced HIV disease.”
He said mpox is essentially an infectious disease characterised by skin lesions or a skin rash, with or without systemic symptoms.
Lessells noted that because of the mode of transmission, there can be cases without skin lesions, and with only mucosal lesions.
“This is important for us as health care workers and for the health system, because essentially we have to be on high alert because people may present with atypical presentations.
“For example, rectal pain, anal rectal pain, oral ulceration and oral pain – so a wide range of specialities need to have awareness of impacts and how it might present,” he said.
Lessells said what has been seen so far has been towards the more severe end of the spectrum, suggesting that milder cases are happening, “but we are not yet detecting them in big numbers”.
He said one of the critical things for South Africa, and KZN in particular, is the fact that with advanced HIV disease, “mpox is really a very different and very concerning disease”.
Lessells said in some of the early cases in association with advanced HIV disease, patients had large ulcerating necrotic lesions and took several months to get better.
Moosa said while Mpox was predominantly in males, there is risk to females and children when there is close skin-to-skin contact.
Moosa said it is the lesion that is infectious: “Lesions have to rub skin to skin between individuals.”
Lessells added that not only must there be contact with the infectious skin lesion, but there has to be an entry point on the recipient’s skin, like a cut or burn, for transmission.
Msomi said the mpox virus which causes the disease is part of the same family as the virus that causes smallpox.
The Mercury