This transcript has been edited for clarity.
Hello. I’m Paul Auwaerter with Medscape Infectious Diseases, speaking from Johns Hopkins University School of Medicine.
Monkeypox joins the legion of occasional emerging infectious diseases that, as an infectious disease consultant, we should at least become familiar with, even though we have never seen it in person, and consider it when the opportunity arises.
Monkeypox is a member of the orthopoxvirus family, which is the same as smallpox. In general, it is a milder infection that causes very similar diseases, which I have never seen clinically, with the exception of one case of generalized vaccine acquired in the lab from a lab worker many years ago that we diagnosed by electron microscopy.
The current situation of the smallpox in the monkey has certainly been news after an outbreak that, at the end of May, has at least 260 cases in 19 countries, including many European countries, Argentina and Australia, and also here in the United States, with at least 6 states that report infections, including California, New York, Massachusetts, and Florida.
Monkeypox is something we’ve seen before in the United States. In 2003, there was an outbreak of 71 suspected or confirmed cases that went back to the importation of giant rats, squirrels or shrimps from the Gambia that had spread to dogs in the meadows that were later sold as pets. . A total of 18 people were hospitalized, but there were no deaths, which suggests a milder disease and higher mortality from smallpox.
We don’t know much about smallpox. Although it may reside in monkeys and be transmitted by this route, it is thought to probably have a reservoir that is most often seen in rodents. Acquisition in humans could be from the handling of infected animals or transmission through the skin or mucous membranes, but it is mainly believed to be related to large drops, because it is a DNA virus. large and probably not prone to aerosol.
The current outbreak here, in 2022, is not exactly clear, but there have been descriptions in Europe that certain social networks, such as men who have sex with men, may be contributing to the spread. Therefore, it should also be considered in the spectrum of, perhaps, a sexually transmitted disease (STD) when evaluating patients.
From the acquisition to the acquisition of the symptoms can vary between 5 and 21 days, with an average of 1 to 2 weeks. The initial infection is, in fact, just a viral-type prodrome: sometimes a sore throat or injury, with a rash usually starting 1-3 days later, initially a non-specific viral-type rash. Flat or macular to papular lesions subsequently become nodular, umbilical, or pustulovesicular before forming a crust. They typically appear on the face and then spread to other parts of the body, involving the palms and soles, which certainly makes it different from other things that might be on your differential, such as chickenpox. . You may also have some lymphadenitis.
The differential diagnosis, of course, involves a primary chickenpox infection, but other smallpox infections (smallpox or smallpox if there is a bioterror event) may need to be considered if you are thinking about measles or measles infections. sexual transmission (STIs), such as syphilis, herpes simplex virus (HSV) or chancroid.
How to diagnose it, unfortunately, is not easy. Neither a commercial lab nor your health care lab will be able to diagnose you, so you need to contact your local or state health department. Below this video are links to the CDC’s monkeypox site, where there is information on collecting specimens for direct skin damage material for PCR analysis that can help confirm this.
In general, the skin is where most of this infection is seen. Occasionally, if severe, in patients with high fever or more than 100 injuries, especially in children, it can be quite awful and include pneumonitis. You may also need to consider proctitis if there is sexual transmission.
As for treatment, there are no approved treatments and most have been lifted from smallpox. There are now two FDA-approved oral drugs that appear to have extensive in vitro poxvirus activity, including tecovirimate, which is FDA-approved for smallpox in adults and children, and brincidofovir, a variant of cidofovir, which it can also be used on young people. as the neonatal age range.
Other modalities could include immunoglobulin vaccinia, in the hope of cross-reactivity. In terms of prevention, there is a smallpox vaccine available with a limited supply, as well as a modified vaccine that has fewer side effects than the typical vaccine virus known by the trade name Jynneos. It is available in a very limited supply, but if you have a case with potential contacts, it could be considered or can be considered as adjuvant therapy for someone infected.
Nothing is well known or described. There are a handful of case reports and a good UK study summarizing the experience with monkeypox and some of these newer treatments, but it is not known if they had an impact on the results or a resolution. faster than the disease, given the limited number of data points.
These are all things that I think will continue to evolve. Undoubtedly, this seems to be the biggest smallpox outbreak so far and needs to be monitored. Many have said that they do not believe that this will be important from a public health point of view, but that infectious disease consultants should certainly be monitored and taken into account when evaluating certain types of patients.
Thank you so much for listening. I hope this is helpful. Please see the background information if you need more. Thanks.
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