Are you scared of Monkeypox - Know it's Signs, Risk Management

Description and Origin of Monkeypox

Monkeypox is a zoonotic viral infection (transmitted from animals to humans) caused by a virus belonging to the Orthopox family. It is similar to smallpox but less severe in intensity and transmissibility. The disease is more common in the forest regions of Western and Central Africa, and cases have been seen in parts of Europe, the UK, Australia, the USA, Canada, and the UAE.

Is this condition a medical emergency?

Monkeypox is not a medical emergency, but as it is an infectious disease, quarantining of the infected person is advised, along with monitoring.

Causes and Transmission 

Monkeypox is caused by a virus belonging to the orthopox family of viruses that also cause other diseases such as smallpox, cowpox, and vaccinia. The primary transmission mode is through direct contact with an infected animal or via ingestion of improperly cooked meat of an infected animal. It is also possible to catch the infection if infected secretions from the animal enter the body through broken skin secondary to bites, scratches, or other injuries. Animals considered natural reservoirs of the virus include pigs, rats, striped mice, porcupines, elephant shrews, and squirrels, and transmission has also been seen from infected prairie dogs.

Human to human transmission is also possible through close contact with an infected person and occurs through respiratory droplets, mucocutaneous (skin) lesions and secretions, and fomites via the nose, respiratory tract, mouth, and broken skin.

Risk Factors

There are no significant risk factors other than close contact and exposure to infected animals and individuals. There is a slight increase in risk and incidence in individuals who live near forests and wild animals. The risk of infection is seen to be greater in children and in the age group of 15-30 years. Other risk factors include travel to regions where the disease is endemic.

Triggering Factors 

A monkeypox infection is triggered when there is an exposure to or contact with an infected animal or its secretions or an infected individual via respiratory droplets or skin lesions. 

Symptoms & Signs

The main symptoms of monkeypox can be seen to develop 2 to 20 days after exposure to an infected person or an animal. The main signs and symptoms include

• Fever and chills
• Headaches
• Sore throat
• Backache
• Shortness of breath
• Enlarged glands and lymph nodes – most common locations are below the lower jaw and in front of the neck, glands in the neck, and the inguinal or groin region. This feature differentiates it from smallpox, in which no lymph nodes or gland enlargements exist.
• Skin and mouth lesions – nonspecific inflammatory lesions on the skin, inside the mouth, eyes, and genitalia may be seen before the eruption of skin rash and fever. Skin eruptions then begin to appear in crops and continue for a period of 14-21 days. They change from macules to papules and pustules and then become fluid-filled vesicles. An indentation then develops in the lesions, giving them an umbilicus-like appearance. This is followed by crusting and scab formation, which then falls off. Skin lesions are usually in a size range of 3-15mm. The lesions can appear anywhere on the body, i.e., both covered and uncovered regions, on the face, trunk, extremities, palms, and soles. In children, the lesions may be much smaller and appear as inflammatory reactions and eruptions seen after insect bites, and indentation may be seen.
• Itching can be seen after the skin eruptions begin and can be mild to moderate.
• Pain is usually absent, but its presence can indicate a secondary bacterial infection.
• Extreme fatigue, tiredness, and feeling of being unwell

Investigations

The following investigations may be advised to establish a diagnosis of monkeypox.

• Laboratory Tests
  • Viral Culture – of specimen obtained from a throat or nasal swab
  • PCR test of tissue samples
  • Tzanck Smear or other Immunohistochemical Studies
  • Serum testing for specific IgM or IgG antibodies

Diagnosis 

A diagnosis of monkeypox is established based on signs, symptoms, clinical examination, and results of the investigations done. It is confirmed if the monkeypox virus is isolated from a sample obtained from the patient, is identified in the PCR reaction, or is confirmed by other immunological or histochemical tests. A case of monkeypox can be suspected or is probable if there are signs of fever and typical skin eruptions within 21 days after exposure to any of the previously mentioned animals or infected individuals.

Course & Stages

The symptoms of the disease usually develop 2-20 days after exposure, and in most cases, the disease is self-limiting and resolves within 2-4 weeks after the development of symptoms.

Treatment Options

Monkeypox is usually a self-limiting disease, and treatment is generally not required. In addition to isolation, medical management in supportive care and medications is all required, even in moderate to severe cases.

Medical Management

Medical management is usually limited to supportive care and isolation. During the phase of fever and the beginning of skin rash, the individual feels extremely weak and tired, and the following may be required.

• Isolation – until the last crust or scab is shed.
• Bed rest
• Supportive Care
• Antibiotics – oral or IV for the management or prevention of secondary bacterial infections to prevent complications such as septicemia

Non Medical - Role of Diet/Exercise/Lifestyle Changes/ Prevention

If monkeypox has been confirmed, it is important to do the following.

• Isolate
• Get plenty of rest
• Stay hydrated
• Eat healthy
• Take prescribed medications on time

To prevent monkeypox infection, the following measures need to be taken

• It is important to isolate imported exotic animals, especially those with respiratory or skin rash symptoms.
• It is also important to avoid contact with their secretions, avoid bites, scratches, or wounds due to them
• It is important to avoid all forms of contact with an infected person and wear a protective covering in the form of face masks, gloves, etc., if contact is unavoidable.
• Take all necessary precautions when handling fomites such as clothes, utensils, furnishings, etc.

Vaccination

It is recommended to get a smallpox vaccination, ideally within 4 days or a maximum of 2 weeks after exposure to a confirmed case of monkeypox, especially for healthcare workers and household contacts. The following vaccines are available and are known to be effective against monkeypox

• Vaccinia Vaccine – Live Vaccinia Virus
• Small Pox Vaccine – Live Vaccinia Virus
• Small Pox and Monkey Pox Vaccine – Live Non-Replicating Virus Vaccine. It is administered in 2 doses 4 weeks apart

Complications

The main complication of monkeypox is the development of secondary bacterial infection of the skin lesions. In some people, after the skin lesions resolve, there may be scarring left behind. In severe cases, the following complications can be seen

• Severe scarring – pitted scars, deforming scars
• Severe secondary bacterial infection
• Bronchopneumonia
• Severe Respiratory Distress
• Eye and Vision Problems – Keratitis, Corneal Ulceration, and blindness
• Septicemia
• Encephalitis

Prognosis

The prognosis for monkeypox is generally very good, as it is a self-limiting disease that usually resolves in 2-4 weeks without any intervention. It has been observed that vaccination received for smallpox results in a milder form of the disease. However, in some people, the disease can become very severe and result in death, mostly due to secondary bacterial infection, septicemia, severe bronchopneumonia, and encephalitis. The mortality rate can vary between 1-10% in case of severe infections.

When to Contact the Doctor or Hospital/How to Identify the Emergency or Complications

Suppose there has been recent exposure and close contact with a known case of monkeypox. In that case, it is important to seek immediate medical assistance and get isolated to prevent the possibility of complications and the spread of the disease.

Indications for Hospitalization If Required

Isolation is required for all cases of monkeypox, and hospitalization, preferably in a negative pressure room, is required for cases with severe symptoms.

Suggested Clinical Specialists/Departments to Consult for this Condition

General Physician, Infectious Diseases Specialists