Monkeypox



What?

Monkeypox virus belongs to the family Poxviridae, subfamily Chordopoxvirinae, and genus orthopoxvirus

Viral zoonotic disease that is caused by monkeypox virus



When to Suspect?

Characteristic Rash + risk factors for infection



How?

• Sexual activity

• Via cutaneous inoculation

• Fomites

• Live in a home with someone with Mpox

• Respiratory secretions



Monkeypox affects both children and adults

Typically has three phases:

• Incubation: Mean incubation period is 13 days

• Prodrome: High temperature, headache, fatigue, and often, lymphadenopathy - cervical and maxillary regions

• Eruptive stage:

    - 14 to 28 days

    - Skin lesions appear in a centrifugal distribution and progress through several stages: macules, papules, vesicles, and finally, pustules

    - Umbilification

    - Rash: 1 to 2 days before and 3 to 4 days after the onset of the systemic symptoms

    - Continues for two to three weeks



Clinical Presentation:

• 6 to 36% of patients have reported rectal pain, rectal bleeding, or other symptoms of proctitis

• 10 to 21% of patients have had pharyngitis, epiglottitis, or ulcerative tonsillitis

• Painful lymphadenopathy, particularly in the cervical or inguinal region

• Mpox-related encephalitis, encephalomyelitis, myocarditis, and pneumonia

• 23% of patients with confirmed mpox had ocular manifestations

• Pruritus and myalgia

• Conjunctivitis

• Blepharitis

• Severe keratitis

• Photophobia

• Decreased visual acuity

Skin: The lesions develop crusts that desquamate → hypopigmentation → hyperpigmentation

    • Occurs on palms and soles

    • Oral ulcers and conjunctival damage

    • Skin lesions: asynchronous

    • Genital, anal, and perianal areas can be involved



DDX: Varicella, Herpes simplex virus, Other sexually transmitted infections, Impetigo, Molluscum contagiosum, Smallpox, Vaccinia virus, Other pox viruses



Viral Testing:

• Polymerase chain reaction (PCR) testing for orthopoxvirus DNA

• Serologic testing for monkeypox virus antiorthopoxvirus IgM antibody



Complications:

• Cutaneous bacterial infections

• Bronchopneumonia

• Respiratory distress



Treatment:

• Tecovirimat

• Brincidofovir



#Monkeypox #MPOX #Diagnosis #Management #Dermatology