Monkeypox is caused by a virus called the monkeypox virus. It is a disease that is transmitted from wild animals to humans. It can spread from person to person. The first human case of monkeypox was noted in 1970 in the Democratic Republic of Congo during a period when efforts were being taken to eradicate smallpox. Since then, human cases of the monkeypox virus have started to be reported. To know more about the monkeypox virus, its symptoms, treatment, and prevention, read the article.
What Is Monkeypox?
Monkeypox is a zoonotic viral disease, which means it is transmitted from wild animals such as rodents and primates to humans. It is caused by the monkeypox virus, which belongs to the Orthopoxvirus genus in the Poxviridae family. It is primarily seen in the tropical rainforest areas of Central and West Africa, and it occasionally can be exported to other regions of the world. It has the potential to spread from one person to another through contact with the lesions, respiratory droplets, body fluids, or contaminated materials such as bedding. Its symptoms were similar to those symptoms of smallpox, but it was clinically less severe.
How Is Monkeypox Virus Transmitted?
Monkeypox virus is transmitted from wild animals like rodents, rope squirrels, tree squirrels, Gambian pouched rats, dormice, and different species of monkeys and others. Even though the main carrier of the monkeypox virus is not known, rodents are considered to be more likely a causative factor of this monkeypox virus. The infection spreads through the direct contact of the cutaneous or mucosal lesions of the infected animals or through contact with the blood or bodily fluids of the infected animals.
For humans, it is spread through bite or scratch by the infected animal or through eating meat or other animal products of the infected animal that is inadequately cooked. Even though human-to-human transmission is limited, it can transmit from one person to another through close contact with the respiratory droplets, cutaneous lesions, or through contact with the contaminated objects. The transmission through the respiratory droplets can only take place after prolonged face-to-face contact. These respiratory droplets generally cannot travel more than a few feet. It is considered that the person-to-person transmission can also occur through the placenta from the mother to her fetus. This kind of transmission that occurs through the placenta from the mother to the fetus is called congenital monkeypox. According to current researches and reports mens who have sex with other mens are more prone to transmission of monkeypox virus infection and are at increased risk.
What Are the Signs and Symptoms of Monkeypox?
The symptoms of monkeypox are similar to that of the symptoms of smallpox. But it is known to be clinically less severe. The incubation period is the time period between the infection to the onset of the symptoms, which is generally around 6 to 13 days. Still, it can also range between 5 to 21 days.
In the initial days of the infection, around 0 to 5 days, monkeypox is characterized by the following symptoms:
Fluid -filled lesions of varying size and shapes.
Black or red coloured patches on the skin.
Chills and malaise.
Swelling of the penis (penile edema).
Nasal congestion or blockage.
Discharge from the nose.
Lesions affecting genital and perianal areas.
Swelling of the lymph nodes is one important symptom that is used to differentiate monkeypox from smallpox or any other infectious disease with similar conditions.
Later along with fever, skin eruptions start to appear. It is most commonly seen in the regions of the face and the extremities. It can also be seen on the oral mucous membranes, genitalia, conjunctiva, and cornea. The number of skin eruptions can be from a few to some thousands. Usually, these skin eruptions progress through the following way before sloughing off.
These symptoms typically last for about 2 to 4 weeks. In Africa, around 1 in 10 people who contracted the disease die from monkeypox. According to recent studies swelling of the penis (penile lesions) and pain in the rectum has also been observed in some patients in the current outbreak (2022) in London.
How Is Monkeypox Diagnosed?
Typically monkeypox is diagnosed by the symptoms. Lymphadenopathy is one of the most distinctive features to differentiate monkeypox from other illnesses. To confirm the diagnosis, the specimen samples are collected and shipped to the laboratory according to the WHO guidelines. Polymerase chain reaction (PCR) is the most preferred laboratory diagnostic test done to diagnose monkeypox because of its accuracy and sensitivity.
A biopsy is also another method to diagnose monkeypox.
If the patient is in the late phase of having rash or fluid filled skin eruptions the fluid is collected in the intradermal syringe and is sent to the laboratory for investigation.
Swab Test: Throat swab or nasopharyngeal swabs test are done by running the sterile cotton tipped swab in the throat and near both the tonsils without touching the sides of the mouth, tongue, gums or teeth and sent for microscopic examination.
How Is Monkeypox Treated?
As of now, there is no treatment available specifically for monkeypox. However, during the monkeypox outbreak, the affected individuals were treated with smallpox vaccines (since it is closely related to the monkeypox virus), Cidofovir, Vaccinia immune globulin, and ST-246 - Tecovirimat (used to treat individuals affected by orthopoxvirus).
Imvanex, a smallpox vaccine, is found to be 85 % effective against the monkeypox virus. ACAM200, another smallpox vaccine containing a live vaccinia virus, is suggested to be used in people affected by monkeypox. But the smallpox vaccine is not currently available to the public, but the Imvanex vaccine has been made available for monkeypox-affected individuals in the United States since 2019.
Cidofovir is recommended for use in life-threatening monkeypox cases.
Few studies have concluded that Tecovirimat (ST-246), when administered for 14 days in individuals affected by monkeypox, can increase the survival rates. But this drug is reserved for emergency use. It can be made available under an IND (investigational drugs are available to patients affected by a severe and life-threatening disease when no other treatments are effective). Survival rates are higher when treatment is started at the earliest stage of infection.
Vaccinia Immune Globulin:
Vaccinia immune globulin is used as IND and has no proven benefits against monkeypox but can be considered to be used under serious circumstances. Vaccinia immune globulin can also be used as a prophylactic in cases where the smallpox vaccine is contraindicated in monkeypox-affected individuals.
Brincidofovir (CMX001 or Tembexa):
Brincidofovir is an antiviral drug approved by food and drug administration (FDA) has been proven to be effective against orthopoxvirus in animal studies. Trials are going on to see the efficacy of Brincidofovir in the treatment of monkeypox.
According to centers of disease control Jynneos smallpox vaccine has been proven to be effective in patients infected with monkeypox virus.
What Are The Guidelines For The Management Of Monkeypox Virus?
The principles of management include:
1) Isolation of the Infected Individual:
- Affected individuals should be isolated in a separate room.
2) Protection of the Affected Skin and Mucous Membranes:
- With all the precautionary measures clean the skin with a mild antiseptic solution.
- Do not touch or scratch the lesion.
- Cover the affected area with loose dressing (Fucidin ointment is used for dressing).
- For oral infections warm saline gargles and topic antibiotic gels are advised.
3) Rehydration or Fluid Administration to the Patient:
- Advice to increase oral fluids.
- In case of severe dehydration start with intravenous fluids.
4) Nutritional Support:
- Encourage nutritional diet.
5) Symptomatic Management (Management of the Presenting Symptoms):
- For fever start with Paracetamol medication.
- For skin itching and eruptions, advice application of topical Antihistamines and calamine lotion.
- Antiemetics drugs are prescribed to control nausea and vomiting.
6) Monitoring and Treating Complications:
- Look for any pain or burning sensation in the eyes.
- Check for any symptoms of blurring vision.
- Check for any symptoms like shortness of breath, chest pain.
- Monitor the symptoms like decrease oral intake or decrease urine output.
What Are the Complications of Monkeypox Virus?
Some of the complications of monkeypox include:
Infection of the cornea resulting in the loss of vision.
Dehydration due to loss of fluids by loose motions and vomiting.
Permanent scarring of the skin.
How To Prevent Monkeypox?
1) Creating awareness about the risk factors and educating the people about the measures to reduce exposure to the monkeypox virus is the most important strategy that has to be followed in preventing monkeypox.
2) In the case of animal-to-human transmission, close contact with the infected animals is the main causative factor for the spread of the monkeypox virus. So unprotected contact with animals that are ill or dead should be avoided.
3) Foods containing meat or any other animal parts should be adequately cooked before consumption.
4) When handling monkeypox infected patients, healthcare professionals should take adequate and safety protocols and infection control precautions. It is better if a person previously vaccinated against smallpox handles the monkeypox infected patients.
5) When the patient's specimens need to be transported, it has to be safely prepared for transport with proper packaging according to the WHO guidelines and then has to be transported.
What Is The Current Research Ongoing For Monkeypox Virus Eradication?
Researchers have started with the sequencing of the virus sample to rule out the mechanism of spread and to understand the mutational changes in the virus making it transmissible.
Monkeypox is typically a self-limited disease. The symptoms usually last for about 2 to 4 weeks. Surveillance and rapid diagnosis of the cases infected with the monkeypox virus can be easy to contain the transmission. Raising awareness about the risk factors and educating the public about the measures to prevent and control the monkeypox virus is an essential strategy to deal with this virus.
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