Monkeypox- Dermatology, General Medicine/ Check Up

What is Monkeypox?

Monkeypox is a rare viral infection that can affect humans. The monkeypox virus is an orthopoxvirus commonly found in the rainforests of Central and Western Africa; but cases in urban areas have also been rising. It produces an illness similar to smallpox, but is much less severe. Those infected usually present with skin lesions, fever, swollen lymph nodes, respiratory manifestations, and in some instances, death.

How Is Monkeypox transmitted?

Zoonotic (animal-to-human) transmission occurs when there is direct contact with blood, mucosal lesions, skin lesions, or bodily fluids of infected animals. Bites or scratches from infected animals can also cause transmission of the virus. The main disease host of monkeypox is still unknown; but some animals such as squirrels, rats, and monkeys, especially those from the rainforests in Africa, were found to be susceptible to the virus.

Human-to-human transmission occurs when someone comes in contact with the virus either through direct contact, respiratory transmission, or though contact with objects or materials contaminated with the virus. Congenital monkeypox is also possible when the virus is transmitted via the placenta from the mother to the fetus. Transmission through sexual contact is uncertain and requires more investigation.

The virus can enter the body through broken skin, mucous membranes (eyes, mouth, nose), or through the respiratory tract. Transmission through the respiratory tract usually requires prolonged face-to-face contact.

What are the symptoms of Monkeypox?

The time from the infection up until the appearance of symptoms (incubation period) of monkeypox can range from 5 to 21 days (average of 6 to 13 days). Common symptoms include:

• Fever
• Skin rashes within 1-3 days of having fever
• Swollen lymph nodes – significant feature that can distinguish monkeypox from smallpox
• Headache
• Muscle aches
• Back pain
• Lack of energy or lethargy

Other symptoms include:

• Sore throat, cough
• Nausea, vomiting
• Chills
• Nasal congestion
• Conjunctivitis
• Gastrointestinal symptoms

The skin lesions start to appear 1-3 days after having fever. The face, palms, soles, and extremities are the most commonly affected areas. Oral mucous membranes, conjunctivae, and the genitalia can also be affected. Skin lesions will evolve from being red and flat to raised lesions, some with clear or yellowish fluid inside. Lesions are expected to dry and form crusts, which will spontaneously fall off.

Diagnostic tests for Monkeypox

The preferred laboratory test for Monkeypox is the polymerase chain reaction (PCR) test. Samples from infected skin lesions should be obtained for this test. Biopsy is also an option.

What is the treatment for Monkeypox?

Monkeypox is a viral infection; therefore, treatment and management mainly consists of supportive and symptomatic care. Patients should have adequate food and fluid intake to maintain nutrition. Secondary bacterial infections should be treated with topical or oral antibiotics, when indicated. The viral infection lasts for about 2-4 weeks.

Prevention

General advice for prevention includes the following:

• Avoid contact with animals that could carry the virus, including their meat, blood, and other body parts and organs.
• Avoid contact with an infected person.
• Avoid contact with any object that has been in contact with a sick animal or an infected person.
• Isolate sick animals from healthy animals.
• Wear personal protective equipment when caring for the infected.
• Practice proper hand hygiene by washing hands with soap and water or an alcohol-based hand sanitizer.
• Proper surveillance and rapid identification of cases is important.

Monkeypox is a self-limiting disease and can last for 2-4 weeks. Children are prone to have more severe cases, as well as those who are immunocompromised. In Africa, it can cause death in 1 in 10 persons who develop the disease.

Vaccination against smallpox provides approximately 85% protection against monkeypox and results in milder disease. However, vaccinations for smallpox were discontinued in the 1970s when the disease was eradicated. Only some health workers or researchers have received a more recent smallpox vaccine for protection in case of exposure in the workplace. Some new vaccines for smallpox were recently developed, but are still limited in availability.

Current Situation

Currently, cases of monkeypox have been reported in Europe. Some were said to have been infected via sexual contact, some through direct contact with an infected person. However, more studies need to be done. According to the Centers for Disease Control and Prevention (CDC), the risk to the general public is low. They advised practicing enhanced precautions such as those preventive measures listed above. We must always be prepared for the possibility of an outbreak.

References:

• About Monkeypox | Monkeypox | Poxvirus | CDC. (n.d.). Centers for Disease Control and Prevention. Retrieved May 23, 2022, from https://www.cdc.gov/poxvirus/monkeypox/about.html
• Diven, D. G. (2001). An overview of poxviruses. Journal of the American Academy of Dermatology, 1, 1–16. https://doi.org/10.1067/mjd.2001.109302
• Lupi, O., & Tyring, S. (2003). Tropical dermatology: Viral tropical diseases. Journal of the American Academy of Dermatology, 6, 1001–1002. https://doi.org/10.1016/s0190-9622(03)02728-2
• Monkeypox. (n.d.). WHO | World Health Organization. Retrieved May 23, 2022, from https://www.who.int/news-room/fact-sheets/detail/monkeypox
• Monkeypox in Multiple Countries - Alert -  Level 2, Practice Enhanced Precautions - Travel Health Notices | Travelers’ Health | CDC. (n.d.). Centers for Disease Control and Prevention. Retrieved May 23, 2022, from https://wwwnc.cdc.gov/travel/notices/alert/monkeypox#:~:text=Monkeypox%20is%20a%20rare%20disease,often%20near%20tropical%20rain%20forests.
• Sale, T. A., Melski, J. W., & Stratman, E. J. (2006). Monkeypox: An epidemiologic and clinical comparison of African and US disease. Journal of the American Academy of Dermatology, 3, 478–481. https://doi.org/10.1016/j.jaad.2006.05.061
• Smallpox Questions and Answers: The Disease and the Vaccine. (n.d.). New York State Department of Health. Retrieved May 23, 2022, from https://www.health.ny.gov/publications/7004/

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