symptoms for monkeypox Symptoms, Causes , Diagnosis and Unknown Facts

Monkeypox is a viral zoonotic disease (it can spread from animals to humans) with symptoms very similar to those seen previously in smallpox patients, although the illness is less severe.

Monkeypox has appeared as the most important orthopoxvirus infection for public health, after the eradication of smallpox in 1980 and the subsequent cessation of smallpox vaccination.

The disease is called monkeypox because it was first identified in colonies of monkeys kept for research in a Danish laboratory in 1958.

Outbreaks of human monkeypox

Monkeypox was first identified in humans in 1970 in a child in the Democratic Republic of the Congo. Since then, monkeypox has been reported in humans in other central and western African countries- Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Cote d’Ivoire, Liberia, Nigeria, the Republic of the Congo, Sierra Leone and South Sudan.

In 2003, the first monkeypox outbreak outside of Africa was reported in the United States of America and was linked to contact with infected pet prairie dogs.

Monkeypox has also been reported in travellers from Nigeria to Israel in September 2018, to the United Kingdom in September 2018, December 2019, May 2021 and May 2022, to Singapore in May 2019, and to the United States of America in July and November 2021.

In May 2022, multiple cases of monkeypox were identified in several non-endemic countries. Investigations are currently going on to understand the epidemiology, sources of infection, and transmission patterns.

The Union Ministry of Health and Family Welfare has issued ‘Guidelines on Management of Monkeypox Disease

The clinical presentation of monkeypox resembles that of smallpox which was declared eradicated worldwide in 1980. Monkeypox is less contagious than smallpox and causes less severe illness. The incubation period (interval from infection to onset of symptoms) of monkeypox is usually from 5 to 21 days.

The infection can be divided into two periods.

• The febrile stage of illness usually lasts 1 to 3 days with symptoms including fever, intense headache, lymphadenopathy (swelling of the lymph nodes), back pain, myalgia (muscle ache), and an intense asthenia (lack of energy).
• The febrile stage is followed by the skin eruption stage, which lasts for 2 to 4 weeks. Lesions start from macules (lesions with a flat base) to papules (raised firm painful lesions) to vesicles (filled with clear fluid) to pustules (filled with pus), followed by scabs or crusts which dry up and fall off. The rash affects more on the face, palms of the hands and soles of the feet. They can also be found on the mouth, genitals and eyes.

Monkeypox is usually a self-limited disease with symptoms lasting from 2 to 4 weeks.

Monkeypox disease is caused by the monkeypox virus. Monkeypox virus belongs to the Orthopoxvirus genus in the family Poxviridae. The Orthopoxvirus genus also includes variola virus (which causes smallpox), vaccinia virus (used in the smallpox vaccine), and cowpox virus)

Monkeypox virus is an enveloped double-stranded DNA virus. There are two distinct genetic clades of the monkeypox virus: the central African (Congo Basin) clade and the West African clade.

The natural host of the monkeypox virus:

Various animal species are susceptible to the monkeypox virus. Animal hosts include rodents and primates such as rope squirrels, tree squirrels, Gambian pouched rats, dormice, non-human primates and other species.

Transmission:

Monkeypox virus can spread from animal to human from direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of infected animals. Human cases are often found close to tropical rainforests where there are animals that carry the virus.

Human-to-human transmission can occur from close contact with respiratory secretions, skin lesions and saliva of an infected person or recently contaminated objects- clothing, bedding, towels or objects like eating utensils/dishes.

People with monkeypox are infectious while they have symptoms (two to four weeks). Health workers, household members and sexual partners are at greater risk of getting the infection.

The virus can also spread from mother to fetus through the placenta (congenital monkeypox) or from an infected parent to child during or after birth through close contact.

It is currently not known whether monkeypox can be spread through sexual transmission routes (e.g., through semen or vaginal fluids), but direct skin-to-skin contact with lesions during sexual activities can spread the virus.

Monkeypox must be clinically differentiated from other rash illnesses, such as chickenpox, measles, bacterial skin infections, scabies, syphilis, herpes simplex virus, molluscum contagiosum virus, enterovirus, parapoxviruses (causing orf and related conditions), chancroid and medication associated allergies.

Lymphadenopathy (swollen lymph nodes) during the prodromal stage of monkeypox can distinguish it from chickenpox or smallpox.

Any individual that meets the suspected case definition for monkeypox should be tested. The recommended specimen type is skin lesion material, including swabs of lesion exudate, roofs from more than one lesion, or lesion crusts. Detection of viral DNA by polymerase chain reaction (PCR) is the preferred laboratory test for monkeypox.

Antigen and antibody detection methods do not confirm monkeypox as orthopoxviruses are serologically cross-reactive. A recent or remote vaccination with a vaccinia-based vaccine (e.g. anyone vaccinated before smallpox eradication, or more recently vaccinated due to higher risk such as orthopoxvirus laboratory personnel) may show false-positive results.

In India, All the clinical specimens are tested by the Apex Laboratory of ICMR-NIV (Pune) routed through the Integrated Disease Surveillance Programme (IDSP) network of the respective district/state.

symptoms for monkeypox Complications

Complications from severe cases of monkeypox include skin infections, bronchopneumonia, sepsis, encephalitis and eye infections which can lead to loss of vision.

In recent times around 3–6% of reported cases have led to death in endemic countries. Newborns, children, pregnant women and people with underlying immune deficiencies may be at risk of serious disease and death from monkeypox.

symptoms for monkeypox Complications

• Reduce your risk by limiting contact with people who have suspected or confirmed monkeypox.
• Encourage the infected person to self-isolate and cover any skin lesion if they can (by wearing clothing over the rash).
• Both patient and caregiver should wear a medical mask, especially if patients are coughing or have lesions in their mouth.
• Regularly clean your hands with soap and water or an alcohol-based hand rub, especially after contact with the person who is infected, their clothes, bed sheets, towels and other items or surfaces they have touched or that might have come into contact with their rash or respiratory secretions (e.g., utensils, dishes).
• Gloves and other personal protective clothing and equipment should be worn while taking care of the sick, whether in a health facility or the home.
• Wash the person’s clothes, towels and bedsheets and eating utensils with warm water and detergent.
• Clean and disinfect any contaminated surfaces and dispose of contaminated waste (e.g., dressings) appropriately.
• There are several vaccines available for the prevention of smallpox that also provide some protection against monkeypox. A newer vaccine that was developed for smallpox was approved in 2019 for use in preventing monkeypox but is not yet widely available.

In the current context, as soon as a suspected case is identified, contact identification and contact tracing should be initiated. Contacts should be monitored at least daily for the onset of any signs/symptoms for 21 days from the last contact with a patient or their contaminated materials during the infectious period.