{"id":5443,"date":"2024-12-31T06:42:25","date_gmt":"2024-12-31T01:42:25","guid":{"rendered":"https:\/\/pni.net.pk\/us\/?p=5443"},"modified":"2024-12-31T07:44:10","modified_gmt":"2024-12-31T02:44:10","slug":"monkeypoxthe-basics-16","status":"publish","type":"post","link":"https:\/\/pni.net.pk\/us\/monkeypoxthe-basics-16\/","title":{"rendered":"Monkeypox\u2026The Basics"},"content":{"rendered":"
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Background: Monkeypox is a poxviridae virus closely related to smallpox (variola). It was first described in humans in 1970 and has since become endemic in parts of Africa. In recent weeks, clusters of cases have been described in several countries prompting us to revisit this topic as it is not one we typically deal with in the ED.<\/p>\n

The Virus:
\nFamily: Poxviridae
\nSubfamily: Chordopoxvirinae
\nGenus: Orthopoxvirus
\nSpecies: Monkeypox virus<\/p>\n

Brick-shaped virus , surrounded by a lipoprotein envelope with linear double-stranded DNA genome
\nGenetically distinct from other viruses of the Poxviridae family (i.e. variola, vaccinia, ectromelia, camelpox, and cowpox)
\nThere are two distinct clades of monkeypox virus [3]
\nWest African: More favorable prognosis with case fatality rate <1% Central Basin: more lethal, with a case fatality rate of up to 11% in unvaccinated children\u00a0\"\"<\/p>\n

Epidemiology\/Transmissibility:
\n1st identified in monkeys in 1958
\n1st human case reported in 1970
\nEndemic in areas of Africa<\/p>\n

Typically, only see sporadic cases outside of Africa in people who have traveled to certain regions or have been in close contact with those travelers
\nFrom the 1970s up until 2003, sporadic cases were identified in central and western Africa
\nBefore 1980, case-fatality rate was 17% and secondary transmission was the cause in 9% of cases
\nFrom 1981 to 1986, the case-fatality rate was 10% and secondary transmission was the cause in 28%
\nFrom 1996 to 1997, the largest outbreak of human monkeypox occurred, which had a case-fatality rate of 1.5% and secondary transmission was the cause in 78%
\nThe 2003 outbreak, was the first documented cases in the western hemisphere with a case-fatality rate of 0% and secondary transmission was the cause in 0%<\/p>\n

Cases of Monkeypox in 2022 from May 6th \u2013 20th [2]:
\nUK: 20 (Confirmed)
\nSpain: 23 (Unconfirmed)
\nPortugal 5 (Confirmed) + 15 (Unconfirmed)
\nUS 1 (Confirmed)<\/p>\n

Precise prevalence and incidence are limited (But both have increased since the discontinuation of routine smallpox vaccination)
\nWide range of hosts which has allowed a reservoir in wild animals and some sporadic cases in humans
\nIn contrast to smallpox, monkeypox associated with low transmissibility between human beings
\nMode of transmission remains poorly characterized:
\nLarge respiratory droplets most likely mode of transmission
\nDirect contact through bodily fluids also possible<\/p>\n

The likelihood of transmission between individuals without prolonged close contact is considered to be low
\nHosts\/Reservoirs:
\nPrimary reservoir is thought to be squirrels, non-human primates, prairie dogs, rabbits, and rats
\nPrimary reservoir for human infection remains unknown
\nWho to Suspect:
\nTravelers to known endemic areas
\nAnyone in contact with a traveler to a known area<\/p>\n

Clinical Features:
\nClinically monkeypox is almost indistinguishable from smallpox, chickenpox, and other causes of vesiculopustular rashes
\nTypical incubation period 10 \u2013 14 days (up to 21 days)
\nInfectious period occurs during the 1st week of the rash
\n2-day prodrome manifested by fever, malaise, and lymphadenopathy typically occurs before development of rash
\nLymphadenopathy is key distinguishing characteristic of human monkeypox compared to smallpox
\n90% of patients infected with monkeypox develop lymphadenopathy (Typically in submandibular, cervical, postauricular, axillary, or inguinal areas)
\nRash begins as maculopapular lesions of 2 to 5mm in diameter<\/p>\n

Typically, centrifugal pattern (from the torso outwards)
\nCan be monomorphic (like smallpox) or pleiomorphic (like chickenpox)
\nSkin lesions typically progress from popular, to vesicular, to pustular, and crust phases over a 14-to-21-day period
\nIn patients with smallpox vaccination the rash will be milder and only \u224850% will have lymphadenopathy
\nMost patients will not become seriously ill<\/p>\n

In the 2003, US outbreak (81 confirmed cases) there were zero deaths [1]
\nMortality seems to be higher in children, young adults, and immunocompromised individuals
\nGenerally, cases are mild, and people tend to recover within weeks<\/p>\n

\"\"<\/p>\n

\"\"<\/p>\n

\"\"<\/p>\n

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Complications:
\nBacterial superinfection of skin
\nSkin scarring
\nCorneal scarring\/vision loss
\nPneumonia
\nDehydration (secondary to painful oral lesions and insensible fluid loss)
\nEncephalitis
\nDeath (Very rare)<\/p>\n

Diagnosis:Skin biopsy tissue and\/or blood
\nAt a minimum, 2 scabs or material from vesicles should be collected in separate sterile containers
\nDNA-based tests, such as PCR with sequencing, is the most precise method available for orthopoxvirus identification and species assignment
\nSerological testing for monkeypox antigens is difficult because of close antigenic relation between surface antigens among orthopoxviruses<\/p>\n

Treatment\/Management:
\nThere is no proven treatment for monkeypox
\nFor contacts of a case, recommend twice daily fever\/symptom monitoring for 21 days + Isolation recommended
\nCurrently, CDC recommending airborne and contact precautions (i.e. negative pressure room, N95, gloves, and eye shield)
\nPre-exposure smallpox vaccination has been shown to confer 85% protection against monkeypox [1]<\/p>\n

Role of post-exposure smallpox vaccination is less clear
\nAccording to the CDC, vaccination within 4 days of exposure may prevent disease onset and vaccination within 14 days may reduce disease severity [3]
\nVaccinia immune globulin has no available data on effectiveness in the treatment of monkeypox<\/p>\n

For severe cases, antiviral agents with known activity against orthopoxviruses in animal studies (No published data on its effectiveness for treatment on human monkeypox)
\nCidofovir a broad-spectrum antiviral agent with in-vitro activity against virtually all DNA virsuses
\nBrincidofovir an oral DNA polymerase inhibitor
\nTecovirmat an oral intracellular viral release inhibitor<\/p>\n<\/div>\n<\/article>\n

\n
\"\"<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Background: Monkeypox is a poxviridae virus closely related to smallpox (variola). It was first described in humans in 1970 and has since become endemic in parts of Africa. In recent weeks, clusters of cases have been described in several countries prompting us to revisit this topic as it is not one we typically deal with […]<\/p>\n","protected":false},"author":1,"featured_media":5445,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[12],"tags":[],"class_list":["post-5443","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-memorial"],"yoast_head":"\nMonkeypox\u2026The Basics<\/title>\n<meta name=\"description\" content=\"Background: Monkeypox is a poxviridae virus closely related to smallpox (variola). 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