What are the other Names for this Condition (Also known as/Synonyms)

• Human Monkeypox
• Monkeypox Infection

What is Monkeypox? (Definition/Background Information)

• Monkeypox is a viral infection which affects humans and other animals. The disease spreads within humans both from animal sources and by other infected humans
• The Monkeypox virus, with two naturally occurring variants, is in the Orthopox virus genus. The endemic natural animal source is in western Africa and the Congo Basin
• The infection begins with fever, muscle aches, swollen lymph nodes, followed by the presence of skin lesions that may appear all over the body
• The skin lesions begin flat, become elevated, then fill with yellow fluid (termed vesicopustules), which rupture. Lesions then crust over with the dried scab eventually falling off
• Scarring at lesion sites is typical, as are pigmentary changes. Classic distribution is densest on the face, palms and soles. Involvement of the eye, mouth, and genitalia may also be observed
• Presently, there is no specific treatment available for Monkeypox. The disease duration is between two to four weeks, and the outcomes are generally good. It is reported that vaccination against smallpox carries protection against Monkeypox

Who gets Monkeypox? (Age and Sex Distribution)

• Individuals of any age exposed to Monkeypox can become infected
• There is no disparity in potential susceptibility to Monkeypox by gender (i.e., both males and females are equally at risk)
• Cases have been reported across the world, in Africa, North and South America, Europe, Australia, and Asia

2022 Monkeypox outbreak: Thus far (up to August 2022), a great majority of cases have been reported in adult males.

What are the Risk Factors for Monkeypox? (Predisposing Factors)

The predisposing factors for Monkeypox may include:

• Exposure to animals or humans infected with Monkeypox virus carries a high risk for the infection
• Infected animal bites, cuts, contact with animal fluids to the eyes and mouth and respiratory system are considered at risk for spreading Monkeypox
• Most cases in the 2022 Monkeypox outbreak have been traced to human-to-human sexual contact
• Prior outbreaks (US 2003 outbreak) have been traced to exposure to wild animals, particularly rodents, including rodents kept as pets

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Monkeypox? (Etiology)

Monkeypox is caused by the Monkeypox virus, a member of the Orthopox virus genus, which includes smallpox and cowpox.

• The virus was first isolated and characterized in 1958 - detected in laboratory monkeys in Denmark (hence the term Monkeypox)
• Human transmission is common, with family members and medical workers being at risk
  • Direct contact with (infected) body fluids can result in Monkeypox transmission
  • Airborne spread is possible
  • Contact with skin crusts, infected surfaces, and bedding are possible transmission routes
  • Monkeypox virus is present and transmissible in seminal fluids, making sexual transmission likely
  • Monkeypox can spread from pregnant women to their fetus
• Predominant human-to-human transmission was reported in an outbreak in 1996 and is currently the mode of transmission in 2022
• Previous reported outbreaks were predominantly caused by exposure to rodents or other wild animals
• Consuming infected animals has been a common source of human infections in most reported outbreaks

Please visit the following link for additional information on Monkeypox transmission, based on the CDC website (July 2022 update): https://www.dovemed.com/ask-a-doctor/question/30671

What are the Signs and Symptoms of Monkeypox?

Monkeypox incubation period, the time from exposure (when the infection has begun), until the signs and symptoms appear, varies from 5-21 days.

• Initial symptoms include fever, exhaustion, headaches, and muscle aches. These are typical non-specific symptoms of many viruses
• Rashes and swollen lymph nodes appear within days, with the rash starting flat and red at first
• The skin lesions then become slightly elevated, fill with yellow pus, then rupture
• The lesions then crust over, dry out, and the crust falls off. The time course of skin lesions is up to four weeks
• Classic outbreaks show most rash on the face, palms and soles

The 2022 outbreak also shows involvement of the genital, perianal, eye, and intraoral regions. Mouth lesions can cause difficulty in swallowing.

How is Monkeypox Diagnosed?

The following procedures may be used to diagnose Monkeypox Infection:

• Complete evaluation of the individual’s medical history and a thorough physical examination including vital signs, entire skin surface, eyes, oral, lymph nodes, etc.
• During history taking the physician may want to know the following: 
  • When the symptoms began and whether they are getting worse or better
  • List of prescription and over-the-counter medications currently taken
  • A personal history of recent travel, occupation, skin diseases, allergies, etc.
  • A history of sexual contact
• Differential diagnosis: Before a diagnosis of Monkeypox Infection is made, other vesicular (blistering) and vesicopustular skin diseases, such as the following, may be considered
  • Chickenpox
  • Herpes zoster (shingles)
  • Tularemia
• Monkeypox (Orthopoxvirus) DNA, PCR test: Polymerase chain reaction (PCR) testing is available for detecting Monkeypox virus
• Viral culture for Monkeypox: The results are generally available much later than PCR testing
• Skin biopsy of the lesion: In this procedure, the physician removes a sample of the skin tissue and sends it to the laboratory for histopathologic   examination. The pathologist examines the specimen under a microscope and arrives at a definitive diagnosis after a thorough evaluation of the clinical and microscopic finds, as well as by correlating the results of the special stains on tissues (if required)

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis

What are the possible Complications of Monkeypox?

The complications of Monkeypox may include:

• Scarring of skin and increased or decreased pigment at the sites of lesions can be permanent 
• Secondary bacterial and yeast infections of the skin lesions are possible
• Scar formation and pigment changes can be emotionally distressing
• Eye involvement can lead to blindness in one or both eyes 
• Pneumonia and encephalitis have been reported

In patients with a compromised immune system, recovery can be prolonged. In some cases, the disease can even be fatal.

How is Monkeypox Treated?

In general, Monkeypox is considered to be a self-limited disease that may last between 2 to 4 weeks. Presently, there are no specific FDA-approved medications available for Monkeypox.

However, treatment options to those infected with the Monkeypox virus include:

• Control of fever with antipyretics such as acetaminophen (paracetamol)
• Fluids by mouth or intravenously, as needed, to keep safe fluid and electrolyte levels
• Topical cleansing and care for skin lesions to prevent secondary bacterial or yeast infection
• Antiviral medications active against and approved for smallpox and cytomegalovirus, similar to Monkeypox, are recommended for patients likely to experience severe infections

How can Monkeypox be Prevented?

Avoiding contact with known or highly likely sources of Monkeypox virus is the key to prevention of Monkeypox Infection.

• Prior smallpox vaccination is protective for Monkeypox, although
  • The routine USA general population smallpox vaccination program ended in 1972
  • The USA military routine smallpox vaccination ended in 1990
• The US-based Centers for Disease Control and Prevention (CDC) recommends smallpox vaccination in the following cases:
  • Individuals caring for those infected with Monkeypox
  • Those who have had known close or intimate contact with a Monkeypox infected person or animal
• Healthcare providers caring for those with Monkeypox should wear full personal protective equipment that includes (but is not limited to):
  • Gown
  • Mask
  • Goggles
  • Disposable filtering respirator (N95)
• Hospitalized Monkeypox patients should be placed isolated, preferably in a negative pressure room to prevent airborne spread 
• Avoidance of close or intimate (sexual) contact with persons with known Monkeypox
• Avoidance of contact with rodents in areas where Monkeypox virus is endemic   

Please visit the following links for additional information on Monkeypox prevention, based on the CDC website (July 2022 update):

https://www.dovemed.com/ask-a-doctor/question/30672

https://www.dovemed.com/ask-a-doctor/question/30673

https://www.dovemed.com/ask-a-doctor/question/30674

What is the Prognosis of Monkeypox? (Outcomes/Resolutions)

The prognosis is generally good in Monkeypox, as it is a self-limiting infection. In most cases, the chance of recovery is very high.

• Those who receive early treatment and have better overall health have a better prognosis
• The duration of the disease is usually between 2-4 weeks
• Immunocompromised patients, such as those with HIV infection or undergoing cancer chemotherapy, are prone to severe infections and worse outcomes

In African outbreaks, fatality rates of between 3.6-10.6% were reported. Most fatalities were in children and untreated HIV infections.

Additional and Relevant Useful Information for Monkeypox:

In June 2022, the World Health Organization (WHO) announced a search for a different name for Monkeypox in context of their initiative to remove stigmatizing place and species names for viruses. When selected the new name will replace Monkeypox.