Definition

Monkeypox is a zoonotic infection. It is a disease transmitted from animals to humans, caused by the monkeypox virus. This virus belongs to the same group as the variola virus (which causes smallpox) and the chickenpox virus. According to a 2022 report by the World Health Organization (WHO), cases of monkeypox were found in 12 non-endemic countries, including European, American, and Western Pacific nations. WHO has classified this virus as a global health emergency.

The first recorded outbreak of monkeypox occurred in 1958 when a smallpox-like illness affected a group of research monkeys, which led to the name "monkeypox." Research into prevention and management strategies for the disease continues in countries experiencing outbreaks as of 2022.

Causes

The monkeypox virus is the direct cause of the disease, and it spreads between humans through various forms of contact. Transmission routes include:

• Physical contact with rashes or lesions of an infected person
• Engaging in sexual activity with someone infected with monkeypox
• Contact with the mucous membranes of an infected person, such as the mouth or genital area
• Exposure to bodily fluids from a person infected with monkeypox
• Touching contaminated objects or surfaces that have not been disinfected
• Exposure to respiratory droplets from an infected individual

Pregnant women who contract monkeypox may pass the virus to the fetus through the placenta. Additionally, transmission can occur from infected animals, including monkeys, rabbits, dogs, and rodents such as rats and squirrels. Animal-to-human transmission happens through:

• Bites or scratches from infected animals
• Consuming meat or products derived from infected animals

People infected with monkeypox can spread the virus to others from the onset of symptoms until the skin lesions have healed. Typically, the illness lasts between 2 and 4 weeks.

Risk Factor

Several factors can increase the risk of contracting monkeypox, primarily through direct exposure to infected animals or individuals. These risk factors include:

• Physical contact with infected animals
• Open wounds caused by scratches or bites from infected animals
• Consuming meat from animals infected with the monkeypox virus

Human-to-human transmission is also a risk factor, and it can occur through:

• Sharing personal items with an infected individual
• Contact with bodily fluids of an infected person
• Living with someone confirmed to have monkeypox

Symptoms

The incubation period for monkeypox, which is the time between initial exposure and the appearance of symptoms, typically ranges from 1 to 3 weeks. The symptoms resemble those of chickenpox and may include:

• Fever, though this may not always be present
• Headache, back pain, or muscle aches
• Sore throat
• Dry cough
• Chills
• Fatigue
• Swollen lymph nodes
• A painful rash, usually beginning in the genital or anal area
• Blister-like lesions filled with pus
• Open sores
• Difficulty breathing

In some cases, digestive symptoms have been reported, such as the need to defecate despite an empty stomach, anal bleeding, or severe anal pain caused by inflammation.

The progression of the rash follows several stages:

• The rash appears within 1 to 3 days after the onset of fever, typically beginning on the face and spreading across the body.
• The rash often affects the hands, feet, and arms, initially appearing as flat, round lesions (macules) before developing into raised areas (papules) and eventually fluid-filled blisters (vesicles).
• In most cases, patients develop 10 to 150 lesions that evolve into pustules filled with a yellowish fluid.
• Finally, the lesions form scabs or crusts, which dry out and fall off as the skin heals.

Diagnosis

As with other illnesses, doctors employ various methods to establish a diagnosis. These methods typically include medical interviews, physical examinations, and diagnostic tests.

Medical Interview

During the interview, the doctor will likely inquire about:

• The main symptoms you are experiencing and any additional symptoms.
• The time when your symptoms first appeared.
• Any known history of contact with individuals infected with monkeypox, including humans or animals.
• Recent travel history.
• Previous treatments you have received.
• Your medical history as well as your family’s medical history.

Physical Examination

In a physical examination, the doctor will assess the patient’s overall condition by checking blood pressure, body temperature, breathing rate, and pulse. The doctor will also examine the body for lymph node enlargement, inspect the throat, and listen to lung sounds using a stethoscope. Additionally, the skin will be closely observed for any rashes, and if the patient complains of rectal pain or rash, a rectal examination may be conducted.

Diagnostic Tests

Following the physical exam, the doctor may perform additional tests such as blood work and polymerase chain reaction (PCR) tests to confirm a monkeypox diagnosis. Blood tests serve to detect signs of infection, while PCR testing aims to identify the presence of monkeypox virus components. PCR tests typically use samples taken from skin lesions or rash fluid.

Management

Currently, there is no specific treatment that cures monkeypox. The treatment provided is aimed at alleviating symptoms. For instance, if the patient has a fever, the doctor may prescribe fever reducers. Painkillers and anti-itch medications might be administered to address discomfort caused by the rash. In severe cases, antivirals can be prescribed by a physician. If the patient has other underlying medical conditions, the doctor will treat those concurrently.

Supportive therapies include:

• Ensuring adequate rest
• Staying hydrated by meeting daily fluid requirements
• Consuming a balanced and nutritious diet to boost the immune system
• Self-isolation to avoid transmitting the virus to others

Complications

Monkeypox can lead to severe complications, especially in children or those with compromised immune systems. Some of the complications include:

• Encephalitis, or inflammation of the brain.
• Sepsis, or a serious condition in which infection spreads throughout the body
• Bronchopneumonia, an infection of the lung tissues.
• Corneal infections that may result in vision loss.

Prevention

To reduce the risk of contracting monkeypox, preventive measures include:

• Receiving the smallpox vaccine
• Avoiding direct contact with animals that may harbor the monkeypox virus
• Steering clear of individuals at risk of having monkeypox
• Not sharing personal items with others
• Isolating yourself from infected animals or people
• Using personal protective equipment like masks and glasses
• Frequently washing hands with soap and running water

When to See a Doctor?

It is advisable to seek medical attention if you exhibit symptoms that resemble monkeypox. While it is important to remain calm, if symptoms do not improve despite taking fever-reducing and pain-relieving medications—or if symptoms worsen—it is recommended to visit the nearest hospital.

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