What is Mpox: Symptoms, Transmission, Management and Treatment

Is Mpox the Same as Monkeypox?

• Endemic Regions: In Central and West Africa, where the virus is naturally found, human cases are sporadically reported, often linked to contact with wildlife. The Democratic Republic of Congo has historically seen the highest number of cases.
• Non-Endemic Regions: Outside of Africa, mpox cases are uncommon but have been reported, often linked to travel or imported animals. Recent outbreaks in non-endemic regions have raised global awareness, with cases appearing in Europe, North America, and other parts of the world.

• 2022-2023 Outbreaks: In 2022, a significant outbreak of mpox was reported in multiple countries where the virus is not endemic, leading to an increased focus on surveillance and prevention. This outbreak spread primarily through close contact, including sexual contact, and highlighted the potential for the virus to spread beyond its usual geographic boundaries.

• Zoonotic Origin: Mpox is primarily a zoonotic virus, meaning it is transmitted from animals to humans. The natural reservoir of the virus is believed to be certain species of rodents, such as squirrels and rats, though it was first identified in monkeys, which led to the original name "monkeypox."
• Transmission to Humans: Humans can contract the virus through direct contact with the blood, bodily fluids, or skin lesions of infected animals. Human-to-human transmission can also occur through direct contact with infected bodily fluids, respiratory droplets during prolonged face-to-face contact, or through contaminated objects, such as bedding or clothing.
• Virus Structure: The mpox virus is a double-stranded DNA virus, making it relatively stable and less prone to rapid mutations compared to RNA viruses like the influenza virus or coronaviruses.

Mpox symptoms

• Fever: Often the first symptom, typically high.
• Headache: Intense and persistent.
• Muscle Aches (Myalgia): Commonly affecting the back and legs.
• Backache: Severe and persistent.
• Swollen Lymph Nodes (Lymphadenopathy): A distinguishing feature from other similar diseases like smallpox, particularly in the neck, armpits, or groin.
• Chills: Accompanied by fever
• Exhaustion: A general feeling of tiredness and lack of energy.

• Timing: The rash usually begins 1 to 3 days after the onset of fever.
• Progression: The rash evolves through several stages:
• Macules: Flat, red spots that appear on the skin.
• Papules: Raised bumps that develop from the macules.
• Vesicles: Fluid-filled blisters that form from the papules.
• Pustules: Pus-filled blisters that form as the vesicles become more solid.
• Scabs: The pustules eventually crust over and form scabs, which then fall off.
• Distribution: The rash typically begins on the face and then spreads to other parts of the body, including the palms of the hands and soles of the feet. It may also affect the inside of the mouth, genital area, and eyes.

• Sore Throat: Occurs in some cases.
• Cough: Sometimes present, especially if the respiratory tract is affected.
• Nasal Congestion: May occur along with other respiratory symptoms.

• Secondary Infections: Bacterial infections of the skin or other tissues.
• Respiratory Distress: In severe cases, the virus can affect the respiratory system.
• Sepsis: A life-threatening response to infection.
• Eye Involvement: May lead to vision impairment if the eyes are affected.

• Direct Contact: Transmission often occurs through direct contact with the blood, bodily fluids, or skin lesions of infected animals. This is most common in regions where the virus is endemic, and people may come into contact with wildlife.
• Infected Animals: While the exact animal reservoir is not definitively known, rodents (such as squirrels, rats, and mice) are suspected to be the primary carriers. The virus was first discovered in monkeys, which led to the name "monkeypox."
• Consumption of Infected Meat: Handling or eating poorly cooked meat from infected animals (bushmeat) can also be a source of transmission.

• Direct Contact: The virus can spread through direct contact with an infected person's skin lesions, bodily fluids, or mucous membranes.
• Respiratory Droplets: Prolonged face-to-face contact can result in transmission through respiratory droplets. This is similar to how other respiratory viruses, like the flu, spread.
• Contaminated Objects: The virus can survive on surfaces, so touching contaminated objects, such as bedding, clothing, or towels that have been used by an infected person, can lead to infection.
• Close Physical Contact: Intimate contact, including sexual contact, has been identified as a mode of transmission during recent outbreaks, particularly in non-endemic regions.

• During Pregnancy: The virus can be transmitted from a pregnant woman to her fetus through the placenta, which can lead to congenital mpox.
• During Birth or Close Contact: A newborn can also be infected after birth through close contact with an infected mother.

• Incubation Period: The time from exposure to the onset of symptoms typically ranges from 5 to 21 days.
• Infectious Period: An individual is considered contagious from the onset of symptoms, particularly the appearance of the rash, until all lesions have crusted over, fallen off, and new skin has formed.

• Symptom Assessment: Healthcare providers start by evaluating the patient’s symptoms, including the characteristic rash that progresses from macules to papules, vesicles, pustules, and eventually scabs. Other symptoms like fever, headache, swollen lymph nodes, and muscle aches are also considered.
• History and Risk Factors: The patient's medical history, including recent travel to endemic areas, contact with animals, or exposure to a known case of mpox, is reviewed to assess the likelihood of infection.

• Specimen Collection: Samples are collected from skin lesions, such as fluid from vesicles or pustules, or crusts from scabs. Other samples, such as throat swabs or blood, may also be taken.
• Polymerase Chain Reaction (PCR): This is the most reliable and commonly used test for diagnosing mpox. PCR testing can detect viral DNA in the collected samples, confirming the presence of the mpox virus. PCR is highly specific and can differentiate mpox from other orthopoxviruses, like smallpox.
• Serological Tests: Blood tests may be conducted to detect antibodies against the mpox virus. These tests can help identify a past infection but are not typically used for diagnosing an active infection.
• Electron Microscopy: In some cases, electron microscopy may be used to visualize the virus particles, although this method is less commonly employed in routine diagnostics due to the availability of PCR.
• Virus Isolation: The virus can be cultured in a laboratory setting, but this process is complex, time-consuming, and requires specialized facilities, so it is not routinely used for diagnosis.

• Ruling Out Other Conditions: Given that mpox can resemble other illnesses with similar symptoms, such as chickenpox, measles, or even smallpox, it’s important to differentiate mpox from these conditions. The presence of swollen lymph nodes is one key feature that can help distinguish mpox from similar diseases.

• Reporting: Mpox is a notifiable disease in many countries, meaning that confirmed cases must be reported to public health authorities for monitoring and controlling outbreaks.
• Contact Tracing: Identifying and monitoring individuals who have been in contact with a confirmed case can help prevent further spread.

• Symptom Management: The primary approach to treating mpox involves alleviating symptoms. This includes:
• Fever and Pain: Over-the-counter medications like acetaminophen (paracetamol) or ibuprofen can be used to reduce fever and relieve pain.
• Hydration: Patients are encouraged to stay well-hydrated, especially if they have fever or are losing fluids due to vomiting or diarrhea.
• Skin Care: Keeping the skin clean and dry is important. Topical treatments may be applied to help soothe and protect skin lesions.
• Itch Relief: Antihistamines or calamine lotion can be used to reduce itching.

• Isolation: Infected individuals should be isolated to prevent the spread of the virus, particularly until all lesions have crusted over, fallen off, and new skin has formed.
• Infection Control: Proper hygiene, including handwashing, and the use of personal protective equipment (PPE) by caregivers are essential to prevent transmission. Contaminated clothing and bedding should be handled with care and disinfected.

• Tecovirimat (Tpoxx): Tecovirimat is an antiviral medication approved for the treatment of smallpox, and it has been used off-label for mpox, particularly in severe cases or for those at higher risk of complications. It works by inhibiting the virus from spreading within the body.
• Cidofovir and Brincidofovir: These are other antiviral drugs that have shown some efficacy against orthopoxviruses in laboratory studies. They may be considered in certain cases, especially when tecovirimat is not available.

• Post-Exposure Prophylaxis (PEP): The smallpox vaccine, particularly the newer generation vaccines like Jynneos (Imvamune or Imvanex), can be used for post-exposure prophylaxis. When administered within 4 days of exposure, it can prevent the onset of symptoms; if given up to 14 days after exposure, it can reduce the severity of symptoms.
• Pre-Exposure Prophylaxis (PrEP): Vaccination can also be provided to individuals at high risk of exposure, such as healthcare workers, laboratory personnel, and those in close contact with confirmed cases.

• Secondary Bacterial Infections: Skin lesions may become infected with bacteria, requiring antibiotic treatment.
• Respiratory Distress: In cases where the respiratory tract is involved, supportive measures such as oxygen therapy may be necessary.
• Eye Involvement: If the eyes are affected, specific treatments may be required to prevent vision loss.

• Monitoring: Patients should be monitored for the development of complications, and follow-up care may be needed to address any long-term effects of the infection.
• Scarring: Skin lesions may leave scars, and treatments such as moisturizing creams or ointments can help improve the healing process.
• Public Health Response: Contact Tracing: Identifying and monitoring individuals who have been in contact with an infected person helps control the spread of the virus.
• Education: Public health authorities may provide education on prevention measures and early recognition of symptoms to reduce transmission during outbreaks.