Through June 18, 2003, there were 93 cases of monkeypox in the United States including Wisconsin (44 cases), Indiana (24), Illinois (19), Ohio (4), Kansas (1), Missouri (1), and New Jersey (1). Analysis of the first 53 cases showed all 50 had contact with prairie dogs that were purchased from Phil's Pocket Pets of Villa Park. Electron microscopy and serologic studies were used to confirm that the disease was human monkeypox.
The onset of the illness among the patients in the United States began in early May 2003. Patients typically experienced a prodrome consisting of fever, headaches, myalgias, chills, and drenching sweats. Roughly one-third of patients had nonproductive cough. This prodromal phase was followed 1–10 days later by the development of a papular rash that typically progressed through stages of vesiculation, pustulation, umbilication, and crusting. In some patients, early lesions had become ulcerated. Rash distribution and lesions occurred on head, trunk, and extremities; many of the patients had initial and satellite lesions on palms, soles, and extremities. Rashes were generalized in some patients. After onset of the rash, patients generally manifested rash lesions in different stages. All patients reported direct or close contact with prairie dogs, most of which were sick. Illness in prairie dogs was frequently reported as beginning with a blepharoconjunctivitis, progressing to presence of nodular lesions in some cases. Some prairie dogs died from the illness, while others reportedly recovered.
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