Monkeypox
What?
Monkeypox virus belongs to the family Poxviridae, subfamily Chordopoxvirinae, and genus orthopoxvirus
Viral zoonotic disease that is caused by monkeypox virus
When to Suspect?
Characteristic Rash + risk factors for infection
How?
• Sexual activity
• Via cutaneous inoculation
• Fomites
• Live in a home with someone with Mpox
• Respiratory secretions
Monkeypox affects both children and adults
Typically has three phases:
• Incubation: Mean incubation period is 13 days
• Prodrome: High temperature, headache, fatigue, and often, lymphadenopathy - cervical and maxillary regions
• Eruptive stage:
- 14 to 28 days
- Skin lesions appear in a centrifugal distribution and progress through several stages: macules, papules, vesicles, and finally, pustules
- Umbilification
- Rash: 1 to 2 days before and 3 to 4 days after the onset of the systemic symptoms
- Continues for two to three weeks
Clinical Presentation:
• 6 to 36% of patients have reported rectal pain, rectal bleeding, or other symptoms of proctitis
• 10 to 21% of patients have had pharyngitis, epiglottitis, or ulcerative tonsillitis
• Painful lymphadenopathy, particularly in the cervical or inguinal region
• Mpox-related encephalitis, encephalomyelitis, myocarditis, and pneumonia
• 23% of patients with confirmed mpox had ocular manifestations
• Pruritus and myalgia
• Conjunctivitis
• Blepharitis
• Severe keratitis
• Photophobia
• Decreased visual acuity
Skin: The lesions develop crusts that desquamate → hypopigmentation → hyperpigmentation
• Occurs on palms and soles
• Oral ulcers and conjunctival damage
• Skin lesions: asynchronous
• Genital, anal, and perianal areas can be involved
DDX: Varicella, Herpes simplex virus, Other sexually transmitted infections, Impetigo, Molluscum contagiosum, Smallpox, Vaccinia virus, Other pox viruses
Viral Testing:
• Polymerase chain reaction (PCR) testing for orthopoxvirus DNA
• Serologic testing for monkeypox virus antiorthopoxvirus IgM antibody
Complications:
• Cutaneous bacterial infections
• Bronchopneumonia
• Respiratory distress
Treatment:
• Tecovirimat
• Brincidofovir
#Monkeypox #MPOX #Diagnosis #Management #Dermatology
Summary of Monkeypox: Current Knowledge as of May 2022
• What is Monkeypox?
• Origins of Monkeypox
• Epidemiology
• Transmission
• Incubation period (time from infection to symptom onset): 5–21 days
• Clinical Manifestations
- Prodrome: Fever (>90%), chills. malaise, headache, myalgias, lymphadenopathy (~70%, different from smallpox)
- Rash after days (100%, evolves in the same stage): macules → papules → vesicles → pustules → scabs; often starts on face spreads to body; can last up to 4 weeks.
- Syphilis and chickenpox can appear similar; monkeypox rash often painful but important to keep a high index of suspicion.
- Case-fatality rate: Historically 1-10% depending upon specific clade (but potentially lower with early supportive care)
• Diagnosis: PCR of material from skin lesions (ideally sample) at specialized public health laboratories
• Treatment:
- No specific proven treatment exists for monkeypox; most individuals recover with supportive care.
- Potential options include post-exposure prophylaxis (PEP) with smallpox vaccine depending upon exposure risk
• Infection control and Personal Protective Equipment (PPE)
By Prathit Kulkarni, MD @PrathitKulkarni, Dr. Saman Nematollahi @TxID_Edu and Dr. Boghuma Titanji @Boghuma
#Monkeypox #diagnosis #management #virus #infectiousdiseases #microbiology
Criteria for Patients Under Investigation for 2019 Novel Coronavirus (2019-nCoV) / COVID-19
Fever or signs/symptoms of lower respiratory illness (eg, cough or shortness of breath) AND Any person, including health care workers, who has had close contact with a laboratory-confirmed 2019-nCoV patient within 14 days of symptom onset
Fever and signs/symptoms of lower respiratory illness (eg, cough or shortness of breath) AND A history of travel from Hubei Province, China, within 14 days of symptom onset
Fever and signs/symptoms of lower respiratory illness (eg, cough or shortness of breath) requiring hospitalization AND A history of travel from mainland China within 14 days of symptom onset
#PUI #Patient #Under #Investigation #Novel #Coronavirus #nCoV2019 #COVID19 #Criteria #Diagnosis #Wuhan #Screening
MONKEYPOX
Poxviruses that infect humans range from life-threatening smallpox virus to the very contagious but benign molluscum contagiosum virus. Beginning in May 2022, hundreds of cases related to another poxvirus, monkeypox, have been reported from more than 30 countries around the world, including the US.
Monkeypox virus was first isolated in 1958 from monkeys at the Statens Serum Institut in Copenhagen, Denmark—thus its name; however, the natural host of monkeypox virus also includes rope squirrels, tree squirrels, Gambian pouched rats, and dormice. As with many zoonoses, this poxvirus is transmitted incidentally to humans when they encounter infected animals. The first known human case of monkeypox was recorded in 1970 in the Democratic Republic of the Congo.
Satyendra Dhar MD, @DharSaty
#monkeypox #Poxviruses
Monkeypox Skin Rash
30 yr F and her 6 yr daughter purchased 2 prairie dogs 10 days ago (pers got sick & died w/in few days). Now pt & daughter w/ sore throat, malaise & vesiculopustular rash. Diagnosis?
Monkeypox associated with prairie dogs (imported from west Africa) resulting in US outbreak.
Monkeypox was first discovered in 1958 when 2 outbreaks of a pox-like dz in colonies of monkeys kept for research, hence named ‘monkeypox.’ 1st human case in 1970 in Democratic Republic of Congo during a period of intensified effort to eliminate smallpox.
Monkeypox viral zoonosis in tropical rainforest areas of Central & West Africa & occasionally exported to other regions. F, rash, lymphadenopathy. Transmission to people from rodents &primates, but human-to-human w/ lesions, body fluids, resp droplets, contaminated bedding.
Vaccinia vaccine used for smallpox eradication also protective against monkeypox. A new third generation vaccinia vaccine now approved for prevention of smallpox & monkeypox (85% effective in preventing monkeypox).
Incubation period 5-21d. Invasion period: 0-5d: F, HA, LN, back pain, myalgia & intense asthenia→Rash:1-3d post fever (concentrated on face (95%) & extremities >trunk. Palms/soles (75%). macules→papules→vesicles→pustules→crusts→fall off
- Indiana University Infectious Diseases Fellowship @IUIDfellowship
#Monkeypox #SkinRash #clinical #photo #dermatology
