Monkeypox has recently seen a resurgence and has affected countries worldwide. However, its current appearance differs from the first recorded human case in Africa in 1970. This owes to the changes in the inclusion criteria among the populations that required the adoption of different nominations while respecting diversity. Monkeypox virus, which was first discovered in transported laboratory monkeys from Singapore to Denmark, has been called “Mpox”.1
Mpox has a relatively bigger size than other viruses, described as a brick-like shape. In addition, its structures seem to be well organised, having a lipoprotein capsule and double DNA. Therefore, it has an integrated multiplication system that partly uses the host cells. It can cause smallpox-like disease symptoms, so there is a similarity between both viruses.
Although mpox is a zoonotic virus, its spread to humans was first recorded in the Republic Of Congo and became endemic to rural parts of Africa. This is due to the under-reporting of cases in addition to less vaccination coverage. However, globalisation has made endemic microorganisms easier to spread worldwide with a resulting outbreak. This was evident on the first discovery of a case of mpox in the UK with the following record of 92 cases all over the world through May 2022.2
Ways to prevent monkeypox
Mpox has two family forms that have been identified and isolated in both central and west Africa. Moreover, its transmission has been recently reported in relation to skin and sexual contact, and sharing towels and nasal droplets. Sanitary measurements including the avoidance of sharing personal tools, clothing, and bedding help to control the virus. In addition, the reporting of any abnormal skin lesions after travelling or being exposed to one of the above risk factors should be a must.3 The proven infected persons should remain in isolation until they become non-infectious while adopting some precautionary measurements such as wearing surgical masks and covering skin lesions.
Symptoms, causes, and treatment
Symptoms of monkeypox
The early symptoms of mpox start with prodromal coryza-like symptoms which include:5
- Muscle aches
- Enlarged lymph glands are found initially, distinguishing mpox from smallpox.
This prodromal stage can appear a couple of days before the appearance of mucosal lesions as following:6
- Lesions affect the face, mouth, genitals, anus, and skin, mainly on the central part of the body
- The lesions may spread to the periphery down to the soles and palms
- Lesions could last over a relatively long period
- Lesions show up in different forms and shapes of either elevated pimples, pustules, papules, or flattened plaques
Later on, skin lesions become larger and flattened and form scaly crusts within a week. The stage of crusty pustules may continue until they fall during the following one to two weeks. Pain and bleeding from the anus may appear among the late symptoms.
Causes of monkeypox
The causative agent of mpox is a virus that belongs to the orthopox family of viruses, including cowpox and vaccinia viruses. These viruses infect by binding their membrane to receptors of the host cells that help to melt the viral-host cell membranes. This would help in creating a bridge of transport of viral DNA into the host cells to encourage gene fusion and multiplication as well as debilitating the defence of host cells.7
Although mpox is meant to mainly infect animals such as monkeys and rats, its transmission to humans is not impossible.8 This could happen through
- Direct contact with an infected animal through a scratch or bite
- An indirect consumption of infected animals
The infection has a wider dispersion by transmission among human beings through
- Physical contact with body secretions as nasal droplets by coughing or sneezing
- Physical contact with infected secretions on clothing or bedding
- Sexual contact with infected persons in the infective period
- Skin exposure to infected lesions
Treatment for monkeypox
As in any viral disease, symptoms of mpox are treated with medications such as rehydrating saline, analgesics and antipyretics. However, there is no specific treatment for mpox. Clinical trials investigated the potential efficacy of antiviral medications that either inhibit viral DNA replication, such as tecovirimat, or inhibit viral growth by targeting its capsule, such as cidofivir. Vaccina virus immunoglobulin, a similar pox virus to mpox, has not yet shown its efficacy in mpox. It is worth noting that saline and cidofivir are currently approved for treatment in USA.6
How long does monkeypox last?
The process of monkeypox infection may last for up to thirteen weeks, depending on how long the skin lesions took to appear, which should be two days after the prodromal symptoms. The prodromal symptoms themselves follow an incubation period of two to three weeks, with mild or no symptoms. The skin lesions develop over a period of two to four weeks, ended by crust formation. The crust takes one to two weeks to fall off, when the person is no longer infectious. The condition resolves three to four weeks after the symptoms disappear.9
How common is monkeypox?
Since the discovery of the first human infection of mpox in the Democratic Republic of Congo in 1970, cases of mpox have shown a gradual rise of 400 reported cases between 1970 and 1990 within the African continent. The first outbreak was in the USA in 2003, where 47 cases were recorded. The outbreak was repeated in 2022, with a record that approximates 58,000 individuals across hundreds of countries worldwide, according to the CDC.10
When should I see a doctor?
It is worth noting that monkeypox has a wide range of differential diagnosis, not only for the pox virus family, but also for viruses such as measles and herpes simplex, bacteria such as syphilis and parasites such as scabies.
Due to the high pressure on healthcare systems after the COVID-19 pandemic, NHS has indicated cases of mandatory seeking of medical advice as the following;
- The appearance of a vesicular skin rash or bleeding from the bottom
- Having a history of one or multiple recent sexual partners, while experiencing some symptoms
- Having close contact with a person who tested positive or suspected to have mpox
- Having the symptoms following an overseas trip to one of the endemic areas
Mpox is one of the threatening zoonotic diseases that have interfered with the safety of the world's human population. Consequently, we should keep an eye on protection rather than its treatment, especially while we are still recovering from the COVID-19 pandemic. We should develop this concept of prophylaxis and immediate management of any potential threat.
- Moore MJ, Rathish B, Zahra F. Monkeypox. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Dec 10]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK574519/
- Hraib M, Jouni S, Albitar MM, Alaidi S, Alshehabi Z. The outbreak of monkeypox 2022: An overview. Ann Med Surg (Lond). 2022 Jul;79:104069.
- Rizk JG, Lippi G, Henry BM, Forthal DN, Rizk Y. Prevention and treatment of monkeypox. Drugs [Internet]. 2022 [cited 2022 Dec 10];82(9):957–63. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9244487/
- Hammarlund E, Lewis MW, Carter SV, Amanna I, Hansen SG, Strelow LI, et al. Multiple diagnostic techniques identify previously vaccinated individuals with protective immunity against monkeypox. Nat Med. 2005 Sep;11(9):1005–11.
- McCollum AM, Damon IK. Human monkeypox. Clin Infect Dis. 2014 Jan;58(2):260–7.
- Weaver JR, Isaacs SN. Monkeypox virus and insights into its immunomodulatory proteins. Immunol Rev. 2008 Oct;225:96–113.
- Alkhalil A, Hammamieh R, Hardick J, Ichou MA, Jett M, Ibrahim S. Gene expression profiling of monkeypox virus-infected cells reveals novel interfaces for host-virus interactions. Virol J. 2010 Jul 28;7:173.
- Brown K, Leggat PA. Human monkeypox: current state of knowledge and implications for the future. Trop Med Infect Dis [Internet]. 2016 Dec 20 [cited 2022 Dec 10];1(1):8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082047/
- Hutson CL, Carroll DS, Gallardo-Romero N, Drew C, Zaki SR, Nagy T, et al. Comparison of monkeypox virus clade kinetics and pathology within the prairie dog animal model using a serial sacrifice study design. Biomed Res Int. 2015;2015:965710.
- Huang Y, Mu L, Wang W. Monkeypox: epidemiology, pathogenesis, treatment and prevention. Sig Transduct Target Ther [Internet]. 2022 Nov 2 [cited 2022 Dec 10];7(1):1–22. Available from: https://www.nature.com/articles/s41392-022-01215-4
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