Monkeypox vs Chickenpox: Difference in way symptoms of both diseases manifest in patients, say docs

New Delhi: Skin rashes and fever, the common symptoms in both monkeypox and chickenpox have caused confusion among people although doctors have stressed that there is a difference in the way the symptoms of both the viral diseases manifest in patients.

They have also advised to consult a doctor to dispel any doubts.

Monkeypox is a viral zoonosis (a virus transmitted to humans from animals) with symptoms similar to those seen in the past in smallpox patients, although it is clinically less severe.

In the rainy season, people are more prone to viral infections, and chickenpox cases are largely seen during this time along with other infections that also show symptoms like rashes and nausea, said Dr Ramanjit Singh, visiting consultant, dermatology, Medanta Hospital.

"Due to this situation, some patients are getting confused and misinterpret chickenpox with monkeypox. The patient may determine whether they have monkeypox or not by understanding the sequence and the onset of symptoms," Singh said.

Explaining further, he said monkeypox usually starts with fever, malaise, headache, sometimes sore throat and cough, and lymphadenopathy (swollen lymph nodes) and all these symptoms appear four days prior to skin lesions, rashes and other problems which primarily start from hand and eyes and spread to the whole body.

Other experts agree and say that apart from skin involvement, there are other symptoms too in the case of monkeypox, but it is always better to consult a doctor to dispel any doubts.

In a couple of instances reported recently, two suspected cases of monkeypox turned out to be chickenpox.

A suspect case of monkeypox admitted to the LNJP Hospital in Delhi last week with fever and lesions, tested negative for the infection but was diagnosed with chickenpox. Similarly, an Ethiopian citizen, who had gone to Bengaluru was tested for monekypox after he showed symptoms but his report confirmed that he had chickenpox.

India has so far reported four cases of monkeypox - three from Kerala and one from Delhi.

Dr Satish Koul, Director, Internal Medicine, Fortis Memorial Research Institute said, "In monkeypox, the lesions are bigger than chickenpox. In monkeypox, the lesions are seen on palms and soles. In chickenpox, lesions are self limiting after seven to eight days but not so in monkeypox. The lesions are vesicular and itchy in chicken pox. In monkeypox the lesions are broad vesicular and non-itchy." Koul also said the duration of fever is longer in monkeypox and such a patient has enlarged lymph nodes.

Elaborating on the virus that causes chickenpox, Dr. S.C.L. Gupta, medical director of Batra Hospital, said chickenpox is a RNA virus which is not as severe but it too leads to rashes on the skin.

"This is the season of chickenpox. Usually, during monsoon, there is this dampness, rise in temperature, water logging, formation of moisture and wet clothes, all these leads to growth of the virus.

"Also, there is a religious aspect associated with the disease. People treat it like a 'goddess' and so such patients are not treated with any sort of medicines. They are kept in isolation and are given time to heal," he said.

Talking about monkeypox, Gupta explained that such virus requires an animal host but is self limiting with soar throat, fever and normal virus signs.

"The main sign of this virus is the rashes on the body which have liquids inside. This leads to viral infection which weakens the body resistance. But problems arise due to its complication. In case, any bacterial infection and gets pusses and leads to blisters leading further complication into the body.

"Right now, monkeypox is at its juvenile stage. We do not have a proper treatment. We are just following the method of isolation and treating the suspected patient according to their symptoms. If there is a throat infection, we use the generic medicines that we usually take. So, here it is a case of symptomatic treatment," he said.

Doctors have also received queries that whether previous chickenpox infection makes a patient immune to monekypox, to which the answer is an emphatic no.

Dr. Rajinder Kumar Singal, Senior Director & HOD, Internal Medicine, BLK Max Hospital, New Delhi, said both are caused by different viruses, the mode of transmission is different, and previous infection does not ensure any protection against the new one.

But, those who have received the smallpox vaccination have lesser chances of contracting monkeypox, he asserted.

"The small pox vaccine was discontinued after teh World Health Organisation said the disease had been completely eradicated around 1979-80. People born before 1980 who have taken smallpox vaccine have lesser chances of contracting monkeypox. Both smallpox and monkeypox are caused by viruses of the same family," Singhal added.

Due to this similarity between small pox and monkeypox, many countries have allowed the 'small pox' vaccines to be given but in India, it is still not allowed.

"The virus is at its juvenile stage and doctors are still figuring it out," Gupta added.