Monkeypox: Difference between revisions

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==Background==
==Background==
*A zoonotic disease  
*A zoonotic disease  
*Caused by an orthopoxvirus, 
*Caused by an orthopoxvirus  
*Initially diagnosed in 1970 in the Democratic Republic of the Congo (DRC), it has spread to other regions of Africa (primarily West and Central), and cases outside Africa have emerged in recent years.   
*Initially diagnosed in 1970 in the Democratic Republic of the Congo (DRC), it has spread to other regions of Africa (primarily West and Central), and cases outside Africa have emerged in recent years.  <ref>Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, et al. (2022) The changing epidemiology of human monkeypox—A potential threat? A systematic review. PLoS Negl Trop Dis 16(2): e0010141. https://doi.org/10.1371/journal.pntd.0010141</ref>
*Overall case fatality rate of 8.7%<ref>Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, et al. (2022) The changing epidemiology of human monkeypox—A potential threat? A systematic review. PLoS Negl Trop Dis 16(2): e0010141. https://doi.org/10.1371/journal.pntd.0010141</ref>
*Overall case fatality rate of 8.7%<ref>Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, et al. (2022) The changing epidemiology of human monkeypox—A potential threat? A systematic review. PLoS Negl Trop Dis 16(2): e0010141. https://doi.org/10.1371/journal.pntd.0010141</ref>
*Interactions with infected animals or individuals are risk behaviors associated with acquiring monkeypox.  
*Interactions with infected animals or individuals are risk behaviors associated with acquiring monkeypox.  


===Transmission===
*Mostly transmitted to people from wild animals such as rodents and primates, but human-to-human transmission also occurs
*Transmitted from one person to another by contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding


==Clinical Features==
==Clinical Features==
[[File:2BE0JCC..jpg|thumb|Monkeypox]]
[[File:MonkeyPox-key-characteristics.png|thumb]]
*Results in a smallpox-like disease in humans.
*Results in a smallpox-like disease in humans.
*The incubation period (interval from infection to onset of symptoms) of monkeypox can range from 5 to 21 days.<ref>World Health Organization. (n.d.). Monkeypox. World Health Organization. Retrieved May 19, 2022, from https://www.who.int/news-room/fact-sheets/detail/monkeypox </ref>
*Typically presents clinically with fever, rash and swollen lymph nodes.<ref>World Health Organization. (n.d.). Monkeypox. World Health Organization. Retrieved May 19, 2022, from https://www.who.int/news-room/fact-sheets/detail/monkeypox </ref>
*Typically presents clinically with fever, rash and swollen lymph nodes.<ref>World Health Organization. (n.d.). Monkeypox. World Health Organization. Retrieved May 19, 2022, from https://www.who.int/news-room/fact-sheets/detail/monkeypox </ref>
*Mostly transmitted to people from wild animals such as rodents and primates, but human-to-human transmission also occurs
*Characterized by fever, intense headache, lymphadenopathy myalgia and lethargy. <ref>World Health Organization. (n.d.). Monkeypox. World Health Organization. Retrieved May 19, 2022, from https://www.who.int/news-room/fact-sheets/detail/monkeypox </ref>
*Transmitted from one person to another by contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding
**Lymphadenopathy is a distinctive feature of monkeypox compared to other diseases that may initially appear similar (e.g. [[chickenpox]], [[measles]], [[smallpox]]).
*The infection can be divided into two periods:
*Skin eruption usually begins within 1-3 days of appearance of fever.  
**The invasion period (lasts between 0-5 days)
**The rash tends to be more concentrated on the face and extremities rather than on the trunk.  
**characterized by fever, intense headache, lymphadenopathy myalgia and lethargy.  
**It affects the face (in 95% of cases), and palms of the hands and soles of the feet (in 75% of cases).  
**Lymphadenopathy is a distinctive feature of monkeypox compared to other diseases that may initially appear similar (chickenpox, measles, smallpox).
**Also affected are oral mucous membranes (in 70% of cases), genitalia (30%), and conjunctivae (20%), as well as the cornea.  
**Skin eruption usually begins within 1-3 days of appearance of fever.  
**The rash evolves sequentially from macules to papules, vesicles, pustules, and finally, crusting, which dry up and fall off.  
***The rash tends to be more concentrated on the face and extremities rather than on the trunk.  
**The number of the lesions varies from a few to several thousand.  
***It affects the face (in 95% of cases), and palms of the hands and soles of the feet (in 75% of cases).  
***In severe cases, lesions can coalesce until large sections of skin slough off.
***Also affected are oral mucous membranes (in 70% of cases), genitalia (30%), and conjunctivae (20%), as well as the cornea.  
***The rash evolves sequentially from macules to papules, vesicles, pustules, and crusts which dry up and fall off.  
***The number of the lesions varies from a few to several thousand.  
****In severe cases, lesions can coalesce until large sections of skin slough off.
Monkeypox is usually a self-limited disease with the symptoms lasting from 2 to 4 weeks. Severe cases occur more commonly among children and are related to the extent of virus exposure, patient health status and nature of complications. Complications of monkeypox can include secondary infections, bronchopneumonia, sepsis, encephalitis, and infection of the cornea with ensuing loss of vision.


==Differential Diagnosis==
==Differential Diagnosis==
*Smallpox
*Chickenpox
*Measles
*Measles
*Multiple Endocrine Neoplasia (MEN)
*Multiple Endocrine Neoplasia (MEN)
{{Bullous rashes DDX}}


==Management==
==Management==
*Vaccinia vaccine used during the smallpox eradication program was also protective against monkeypox. A new third generation vaccinia vaccine has now been approved for prevention of smallpox and monkeypox. Antiviral agents are also being developed
*Clinicians should first consult their state health department (State Contacts) or CDC through the CDC Emergency Operations Center (770-488-7100) as soon as monkeypox is suspected.<ref>Shahid, S. (n.d.). The American College of Emergency Physicians Guide to Monkeypox Disease. The American College of Emergency Physicians. Retrieved August 13, 2022, from https://www.acep.org/monkeypox-field-guide/cover-page/ </ref>
*The incubation period (interval from infection to onset of symptoms) of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days.
*Currently, there is no proven, safe treatment for monkeypox virus infection. For purposes of controlling a monkeypox outbreak in the United States, smallpox vaccine, antivirals, and vaccinia immune globulin (VIG) can be used. <ref>Centers for Disease Control and Prevention. (2021, July 16). Treatment. Centers for Disease Control and Prevention. Retrieved May 19, 2022, from https://www.cdc.gov/poxvirus/monkeypox/treatment.html </ref>
 
*Monkeypox is usually a self-limited disease with the symptoms lasting from 2 to 4 weeks.
 
*Severe cases occur more commonly among children and are related to the extent of virus exposure, patient health status and nature of complications.
*Treatment is mostly supportive but treat potential complications of monkeypox such as secondary infections, bronchopneumonia, sepsis, encephalitis, and infection of the cornea with ensuing loss of vision.


==Disposition==
==Disposition==
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*Diagnosis is uncertain
*Diagnosis is uncertain
*Patient is treatment non-adherent
*Patient is treatment non-adherent
==See Also==
*[[Smallpox]]
==External Links==


==References==
==References==

Latest revision as of 16:54, 7 September 2022

Background

  • A zoonotic disease
  • Caused by an orthopoxvirus
  • Initially diagnosed in 1970 in the Democratic Republic of the Congo (DRC), it has spread to other regions of Africa (primarily West and Central), and cases outside Africa have emerged in recent years. [1]
  • Overall case fatality rate of 8.7%[2]
  • Interactions with infected animals or individuals are risk behaviors associated with acquiring monkeypox.

Transmission

  • Mostly transmitted to people from wild animals such as rodents and primates, but human-to-human transmission also occurs
  • Transmitted from one person to another by contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding

Clinical Features

Monkeypox
MonkeyPox-key-characteristics.png
  • Results in a smallpox-like disease in humans.
  • The incubation period (interval from infection to onset of symptoms) of monkeypox can range from 5 to 21 days.[3]
  • Typically presents clinically with fever, rash and swollen lymph nodes.[4]
  • Characterized by fever, intense headache, lymphadenopathy myalgia and lethargy. [5]
    • Lymphadenopathy is a distinctive feature of monkeypox compared to other diseases that may initially appear similar (e.g. chickenpox, measles, smallpox).
  • Skin eruption usually begins within 1-3 days of appearance of fever.
    • The rash tends to be more concentrated on the face and extremities rather than on the trunk.
    • It affects the face (in 95% of cases), and palms of the hands and soles of the feet (in 75% of cases).
    • Also affected are oral mucous membranes (in 70% of cases), genitalia (30%), and conjunctivae (20%), as well as the cornea.
    • The rash evolves sequentially from macules to papules, vesicles, pustules, and finally, crusting, which dry up and fall off.
    • The number of the lesions varies from a few to several thousand.
      • In severe cases, lesions can coalesce until large sections of skin slough off.

Differential Diagnosis

  • Measles
  • Multiple Endocrine Neoplasia (MEN)

Vesiculobullous rashes

Febrile

Afebrile

Management

  • Clinicians should first consult their state health department (State Contacts) or CDC through the CDC Emergency Operations Center (770-488-7100) as soon as monkeypox is suspected.[6]
  • Currently, there is no proven, safe treatment for monkeypox virus infection. For purposes of controlling a monkeypox outbreak in the United States, smallpox vaccine, antivirals, and vaccinia immune globulin (VIG) can be used. [7]
  • Monkeypox is usually a self-limited disease with the symptoms lasting from 2 to 4 weeks.
  • Severe cases occur more commonly among children and are related to the extent of virus exposure, patient health status and nature of complications.
  • Treatment is mostly supportive but treat potential complications of monkeypox such as secondary infections, bronchopneumonia, sepsis, encephalitis, and infection of the cornea with ensuing loss of vision.

Disposition

Discharge

  • Otherwise healthy
    • Contact public health services before discharge
      • Instructions for home isolation and follow up at appropriate clinic to receive meds

Admit

  • Ill-appearing
  • Diagnosis is uncertain
  • Patient is treatment non-adherent

See Also

External Links

References

  1. ↑ Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, et al. (2022) The changing epidemiology of human monkeypox—A potential threat? A systematic review. PLoS Negl Trop Dis 16(2): e0010141. https://doi.org/10.1371/journal.pntd.0010141
  2. ↑ Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, et al. (2022) The changing epidemiology of human monkeypox—A potential threat? A systematic review. PLoS Negl Trop Dis 16(2): e0010141. https://doi.org/10.1371/journal.pntd.0010141
  3. ↑ World Health Organization. (n.d.). Monkeypox. World Health Organization. Retrieved May 19, 2022, from https://www.who.int/news-room/fact-sheets/detail/monkeypox
  4. ↑ World Health Organization. (n.d.). Monkeypox. World Health Organization. Retrieved May 19, 2022, from https://www.who.int/news-room/fact-sheets/detail/monkeypox
  5. ↑ World Health Organization. (n.d.). Monkeypox. World Health Organization. Retrieved May 19, 2022, from https://www.who.int/news-room/fact-sheets/detail/monkeypox
  6. ↑ Shahid, S. (n.d.). The American College of Emergency Physicians Guide to Monkeypox Disease. The American College of Emergency Physicians. Retrieved August 13, 2022, from https://www.acep.org/monkeypox-field-guide/cover-page/
  7. ↑ Centers for Disease Control and Prevention. (2021, July 16). Treatment. Centers for Disease Control and Prevention. Retrieved May 19, 2022, from https://www.cdc.gov/poxvirus/monkeypox/treatment.html
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