Review of clinical features, diagnosis, and management of Mpox

Clinical features, diagnostic tools, and management of monkeypox infection. It provides important insights into how the virus spreads, its impact on high-risk populations, and the effectiveness of current treatments and vaccines.

​​​​​​​study: Mpox clinical manifestations, diagnostic approaches, and treatment strategies. Image credit: karacacennet/Shutterstock.com

recent reviews Japan Automobile Manufacturers Association Describe the clinical manifestations and management options of monkeypox.

background

Monkeypox virus (MPXV) is a double-stranded DNA virus that is classified into two clades: clade I, which is endemic to Central African countries, and clade II, which is endemic to West African countries.

The clade IIb MPXV outbreak rapidly spread to 118 countries, leading to a population health emergency requiring global concern from July 2022 to May 2023. The outbreak affected approximately 99,000 people worldwide, caused more than 33,000 cases of illness, and killed 60 people in the United States.

Recent research in eastern DRC uncovers a new emerging strain known as clade Ib, highlighting the need for increased surveillance and global vaccination equity to address ongoing public health issues has been.

About reviews

This review focuses on the clinical features, diagnostic techniques, and treatment protocols of monkeypox infections.

Using the PubMed database, researchers focused on high-quality randomized clinical trials (RCTs) and longitudinal observational studies of monkeypox from January 1, 1975 to September 13, 2024. Records were examined.

We also checked government websites for the latest instructions. The study received 111 citations, including 1 RCT, 59 longitudinal studies, 23 reviews, 13 government websites, basic science papers, 4 case reports, and 1 news release. I used it.

Clinical symptoms of monkeypox

Humans are most commonly infected by direct contact with monkeypox virus. The virus is spread through infected lesions, body fluids, bites, scratches, contaminated fomites, and respiratory droplets.

Clade IIb infections occur frequently among homosexuals, bisexuals, and men who have sex with men. Clade Ia MPXV infections are caused by zoonotic exposure and household distribution, with a significant number of infections occurring in children.

MPXV attacks immune cells and nearby lymph nodes. It multiplies rapidly and spreads throughout the lymphatic system and circulation, infecting many organs and harming the host. Median incubation time ranges from 7 to 10 days.

After an asymptomatic incubation period, prodromal symptoms such as fever, lymphadenopathy, headache, myalgia, and fatigue appear before or after the onset of the rash.

Painful skin lesions range from macules and papules to vesicular and pustular lesions. In the final stage, it scabs and desquamates. These lesions may occur simultaneously. mpox patients remain infectious until all lesions are re-epithelialized. Re-epithelialization may take up to 4 weeks.

Mpox rash commonly occurs on the face, torso, and extremities and can cause genital, anogenital, oral, and perioral lesions during sexual intercourse. A small number of lesions (median, <10) may appear and develop heterogeneously.

Effects of Mpox include proctitis, pharyngitis, urethritis, and eye disease. It can also cause necrotic skin lesions with bacterial superinfections, pneumonia, and encephalitis, especially in immunocompromised people.

Diagnosis and treatment of monkeypox

Clinicians should suspect Mpox in individuals with skin lesions and possible exposure to MPXV. Polymerase chain reaction (PCR) confirms Mpox.

The differential diagnosis includes secondary syphilis, herpes simplex virus, impetigo, and cellulitis. Secondary syphilitic lesions are not painful. Herpes simplex, impetigo, and cellulitis present with painful pustular or bullous lesions that resemble monkeypox.

First-line treatment for mpox is pain control with analgesics and supportive care with wound care. Supportive treatments for skin and genital lesions include lidocaine gel and nonsteroidal anti-inflammatory drugs. The lesion must be clean and dry. If infected, debridement of the lesion with wet-to-dry dressing is required and antibiotics should be administered.

The U.S. Food and Drug Administration (FDA) has not approved antiviral treatments for Mpox patients. However, some treatments, such as vaccinia immunoglobulin intravenous (VIGIV), brincidofovir, and tecobilimat, are available through clinical trials and expanded accessibility programs. VIGIV administration includes a single dose of 6,000 to 9,000 units/kg.

Brincidofovir, given orally at 200 mg weekly for 2 weeks, may increase liver enzymes. Tecobilimat is administered orally (600 mg) and intravenously (200 mg) and is contraindicated in patients with a creatinine clearance of less than 30 mL per minute.

The modified Vaccinia Ankara-Bavarian Nordic (MVA-BN) vaccine has an efficacy of 66% to 86% in adults with high morbidity. The Advisory Committee on Immunization Practices (AICP) recommends that individuals who are gay, bisexual, transgender, non-binary, newly diagnosed, have multiple sexual partners, or engage in sexual activity in commercial establishments or establishments. The MVA-BN vaccine is recommended as pre-exposure prophylaxis for adults at non-occupational risk, including: Public events in areas with high MPXV transmission.

The Centers for Disease Control and Prevention (CDC) recommends MVA-BN vaccination as post-exposure preventive care for people with known or probable exposure. Ideally it is given within 4 days after MPXV exposure, but can be given up to 14 days after exposure.

conclusion

Based on research findings, monkeypox refers to a viral disease that is transmitted through direct skin contact. Although it causes a disease that is self-limited, it can cause severe morbidity and mortality in immunocompromised individuals.

Supportive care is the first-line treatment, but health care professionals may consider advanced treatments in severe cases.

Monkeypox vaccination is effective and people at high risk should be vaccinated. Clinicians must timely recognize the characteristic signs and symptoms of monkeypox diagnosis and appropriate management.