The Monkeypox Viral Infection

MONKEYPOX VIRUS
In 1970, a 9-year-old boy from Congo-DR, developed a pox-like infection that turned out to be the first human case of monkeypox viral infection.

Sporadic cases of human-monkeypox infections were reported across West Africa, from Nigeria to Sierra Leone in 1970-71 period

In 2021, 2 cases of human monkey-pox infections were imported into the USA by travelers from Nigeria.

In 2022, several European and other non-endemic countries have reported numerous outbreaks of monkey pox infections.

VIRAL TRANSMISSION.
The monkeypox virus is a DS-DNA-virus from the pox-family of viruses.

The monkeypox viruses reside in monkeys, and rodents (squirrel, rats, porcupines, mice) in Central and Western Africa.

Human acquire infections when they come in contact with infected rodents and other vertebrates, as they catch, sell/buy and eat these animals and their carcass.

Person-to-person transmission is through inhalation of droplet/airborne secretions, and direct skin contacts with infected skin, contaminated secretions, clothing and bedding.

The monkeypox virus is transmissible during the onset of symptoms, and until all the skin lesions have cleared and a fresh layer of skin has formed.

Once inside the body, the virus enters the bloodstream and spread to the other parts of the body.

RISK FACTORS:
Rodent-hunters, pet-keepers, and those who prepare and eat under-cooked bush meat.

Those who live in over-crowded quarters, and those who come into close contacts with infected persons.

CLINICAL FEATURES
Monkey pox-viral infections start with high-Fever, Chills, Sweat within 4-21 days after initial contact with the virus.

The High fever and chills are followed by Backache and other Muscular aches, intense Headache, mouth and throat soreness, Poor Appetite, Cough and Exhaustion

Swollen lymph nodes (specific sign)
Early Monkeypox-viral infections, are often associated with swollen lymph-glands.

The glandular swellings start 2-3 days after the initial onset of fever; the swellings appear in the neck area (chin, angle of the jaw, and the neck-base) and the groin.

Skin Rash:
The pox-rash starts from the face (within 1-3 days of the fever) and spread centrifugally to the scalp, extremities, including the palms and soles and the rest of the body. The oral/genital/anal mucosae, as well as the Eyes (cornea, conjunctiva) may develop the rash.

The skin-bumps vary from 3mm-1.5cm in diameter. The bumps start as papules (<10mm) and evolve into vesicles (fluid-filled bumps), pustules (pus-filled bumps) and crusts within 2-4 weeks.

The crusts become dry, slough off, and may leave scars.

COMPLICATIONS
In majority of cases, monkey pox viral infection is mild, and resolves on their own within 2-4 weeks.

The sores and crusted lesions provide conduits for bacterial to enter the body, and gain access to the blood stream.

Some of the complications associated with monkeypox infections include PNEUMONIA, RESPIRATORY DISTRESS, BLOODSTREAM infections.

The virus may reach the brain to cause viral ENCEPHALITIS (headache, behavioral abnormalities).

Cornea rash may lead to corneal ulcers, and eventual blindness

Most of the complications are seen in persons with poor health.

DIAGNOSTICS
Clinically, the enlarged lymph nodes at the onset of monkey pox infections, help to separate monkey pox from chickenpox and smallpox infections

Diagnostic samples from skin lesions may be sent to the laboratory for polymerase chain reaction (PCR) and specific diagnosis.

Blood samples may be obtained for serology. Paired serum samples tested for IgM (during first week) and IgG-antibodies (during the 2nd week).

VACCINATIONS:
The small-pox vaccine offers protection against monkeypox too. Those with previous smallpox-vaccinations (a scar at the shoulder area is a sign) develop only mild monkeypox symptoms.

JYNNEOS (the new vaccine that is administered in 2 doses of 0.5ml 4 weeks apart) is available for adults (>18-year-olds) who are at risk for complicated small pox and monkeypox infections.

PREVENTION OF MONKEYPOX INFECTIONS.
Contact precaution:
Avoid touching/getting into contact with rodents, monkeys and bush meats.

Avoid getting near persons with rash and other symptoms of monkeypox.

If you develop a new/unexplained rash, see your doctor. Until then, avoid close contacts with all persons.

If a sexual partner develops rash and other symptoms of monkeypox, avoid sex/intimacy until all the rashes have cleared

Health care workers should observe standard contact precautions; wear face-masks when attending to patients in enclosed areas.

Smallpox vaccine may be given within 4 days-2 weeks after exposure to the monkeypox virus (as a post-exposure prophylaxis)

TREATMENT OF MONKEYPOX INFECTIONS.
For the average healthy persons, monkeypox virus infections are self-limiting and do not require specific treatments.

Treatment is indicated in complicated monkeypox infections: sepsis, encephalitis, severe bleeding.

Treatment may also be considered for the immunocompromised, pregnant/lactating mothers, and kids younger than 8 years.

There are no specific antiviral medications for monkeypox infection.

Physicians may use the following antiviral for life-threatening conditions and in hospitalized patients:

TECOVIRIMAT (an antiviral for smallpox infections)
BRINCIDOVIR (an antiviral for smallpox infections)
CIDOFOVIR (specifically used for CMV-retinitis in persons with impaired immunity

.ALEX SARKODIE, MD.