Monkeypox

Introduction

Monkeypox is a viral zoonotic infection that results in a rash similar to smallpox. However, the person-to-person spread and the mortality from a monkeypox infection are significantly lower than for smallpox. Clinically, these 2 viral infections are difficult to distinguish.

  • The virus belongs to the genus Orthopoxvirus in the family Poxviridae (other family member includes variola - causative agent of smallpox).
  • It was first isolated in 1958 from a colony of sick monkeys.

NOTE: Any case represents a public health emergency and suspicion of smallpox warrants immediate contact of local health departments.



Transmission

The virus is typically acquired through contact with an infected animal's bodily fluids or through a bite.

  • Monkeys and humans are incidental hosts; the reservoir remains unknown but is likely to be rodents.

Also, human-to-human transmission is possible through

  • Large respiratory droplets
  • Close contact with infectious skin lesions
  • Contact with lesion material

The incubation period of monkeypox virus infection is usually from 6 to 13 days, but can range from 5 to 21 days.



Symptoms

Prodromal phase (2-4 days) characterized by abrupt onset of systemic symptoms such as fever, muscle aches and headache.

Skin lesions (exanthem) begin on face and appear on all parts of body within 24-48 hours.

  • Crusting of lesions completed in 2-3 weeks

Monkeypox



Management

Monkeypox is usually a self-limited disease with the symptoms lasting from 2 to 4 weeks.
  • Most patients have mild disease and recover without medical intervention.
  • Others who have risk factors for dehydration (e.g., nausea, vomiting, dysphagia) may require a short hospital stay for intravenous hydration.
  • For the seriously ill patient, supportive care is necessary until the patient recovers from the infection.

The antiviral agents, tecovirimat and brincidofovir, which have been approved for treatment of smallpox in the United States, also have activity against monkeypox in animal models and are likely to be efficacious against this infection in humans as well.



Prevention

Avoid contact with infected animals and material that has been in contact with a sick animal.

Isolate infected patients from others.

Practice good hand hygiene after contact with infected animals or humans (e.g. washing hands with soap and water or using an alcohol-based hand sanitizer).

Data suggest that prior immunization with smallpox vaccine prevents infection and ameliorates symptoms.



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