BENGALURU: The appearance of the infection has two stages of clinical features with a prodromal phase or early stage of symptoms characterised by fever, malaise, sweats, lymphadenopathy and headache followed by skin eruptions 2-4 days later
Monkeypox is a viral zoonotic disease with symptoms similar to smallpox but with lesser clinical severity. Monkeypox, which was first discovered in 1958 among the colonies of monkeys kept for research, is caused by the orthopox virus, and humans rarely contract the disease.
The first case of monkeypox in humans was reported from the Democratic Republic of the Congo (DRC) in 1970. The disease has been at a low-level of endemicity in west and central Africa for decades, but now the pathogen has spread across the globe with over 16,000 cases across 75 countries.
The World Health Organisation (WHO) has declared monkeypox as a public health emergency of international concern (PHEIS), an indication that the challenges might be similar to that of Covid-19 pandemic. The warning will prepare governments to equip themselves for prevention, surveillance, treatment and risk communication.
Transmission
Although the exact reservoir of the virus is still unknown, rodents are suspected to play a role in transmission. Several species of animals are susceptible to the infection. Animal to human transmission through handling and ingestion of wild game animals have been identified as the primary route of infection after studying the African outbreaks followed by human-to-human transmission through close contact with infected individuals.
Spread of respiratory droplets and direct contact with skin lesions and scabs have been described as the cardinal routes of transmission among humans. It can also take place through objects and materials which are likely to carry the infection such as clothes, utensils and furniture. At present, the incubation period is about 12 days, but it could range between five and 24 days.
Symptoms
The appearance of monkeypox infection has biphasic or two stages of clinical features with a prodromal phase or early stage of symptoms characterised by fever, malaise, sweats, lymphadenopathy and headache followed by skin eruptions two to four days later.
Skin lesions follow a typical pattern of evolution. It starts as macules, and progresses into papules, vesicles and pustules, which subsequently crusts and come off in scales or flakes. Lesions predominantly affect the face (95 per cent), palms and soles (75 per cent), mucous membranes (70 per cent), but less commonly genitals. Most infections are self-limiting, and relatively mild with symptoms lasting two to four weeks.
Severe manifestations of infections include encephalitis, secondary skin infection, pneumonia, and ocular disease leading to a loss of vision. Those in the higher risk population include neonates, children and people with immunodeficiency.
Monkeypox variations
At present, a majority of cases has been transmitted among gay, bisexual and other men who have sex with men (MSM). Urgent research is needed for a deeper understanding about the modes of transmission of monkeypox with regard to secual contact, and also the possibility of asymptomatic transmission.
Rectal pain and penile edema are the most common symptoms which require admission to a hospital in case of the prevailing monkeypox infection as against cases which were detected earlier.
Treatment
Treatment of monkeypox is mainly supportive. The illness is usually mild, and those infected will recover within a few weeks without treatment. Vaccination against smallpox can be used for both pre-and post-exposure which is up to 85 per cent effective in preventing monkeypox. Those vaccinated against smallpox in childhood may experience a milder form of the disease. Smallpox vaccine, Cidofovir, Tecovirimat, antiviral drug for smallpox can be used, and should be domestically produced and stocked.
The writer is head
and senior consultant, department of intensive care & critical care, Kauvery Hospital, Electronics City
DIAGNOSIS
Clinical diagnosis of monkeypox can be difficult as it is often confused with other infections such as chickenpox. A definite diagnosis of monkeypox requires assessment by a health professional and specific testing in a specialist laboratory (PCR testing).