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Monkeypox

Disease Details

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Description: Monkeypox is a viral zoonotic disease characterized by fever, rash, and swollen lymph nodes, and can sometimes lead to serious complications.
Type: Monkeypox is a viral disease caused by the monkeypox virus, which is a DNA virus belonging to the Orthopoxvirus genus. The virus is transmitted genetically through its double-stranded DNA (dsDNA).
Signs And Symptoms: Initial symptoms of mpox infection are fever, muscle pains, and sore throat, followed by an itchy or painful rash, headache, swollen lymph nodes, and fatigue. Not everyone will exhibit the complete range of symptoms.Most mpox patients become symptomatic 4–11 days after infection. However, the incubation period can be as short as 1 day. The 2022–2023 outbreak revealed that incubation periods of up to 4 weeks are possible, with 5% of cases having incubation periods longer than the previously assumed 21 days.The rash comprises many small lesions which may appear on the palms and soles, face, mouth and throat, genitals or anus. They begin as small flat spots, before becoming small bumps which then fill with fluid and subsequently burst and scab over, persisting for around ten days.Some patients may manifest only a single sore from the disease while others may have hundreds. It is possible for a person to be infected with monkeypox virus without showing any symptoms. Symptoms typically last for two to four weeks, but may last longer if the patient has a weakened immune system.
Prognosis: Prognosis for monkeypox can vary based on several factors, such as the patient's overall health, the strain of the virus, and access to medical care. In general, monkeypox is a self-limiting disease with symptoms lasting 2 to 4 weeks. The case fatality rate has historically ranged from 1% to 10%, depending on the strain. Severe cases are more likely in children or individuals with weakened immune systems. Access to supportive medical care can improve outcomes.
Onset: Monkeypox has an incubation period of about 5 to 21 days, with symptoms typically beginning to appear within 1 to 2 weeks following exposure. The onset of the disease is marked by flu-like symptoms such as fever, headache, muscle aches, backache, swollen lymph nodes, chills, and exhaustion. This is often followed a few days later by a rash that progresses from macules to papules to vesicles and pustules, and eventually scabs. The rash often starts on the face and then spreads to other parts of the body.
Prevalence: Prevalence represents the number of cases of a disease that are present in a population at a given time. For monkeypox, the prevalence can vary significantly based on geography and outbreaks. As of recent updates, monkeypox primarily occurs in Central and West African countries, with periodic outbreaks reported in other regions due to international travel or importation of animals. Specific prevalence rates can fluctuate, so it is essential to refer to the latest data from health organizations such as the World Health Organization (WHO) or the Centers for Disease Control and Prevention (CDC) for the most current statistics.
Epidemiology: For monkeypox:

**Epidemiology**: Monkeypox is a viral zoonotic disease primarily occurring in central and west African countries. It is caused by the monkeypox virus, a member of the Orthopoxvirus genus. Human cases are often linked to contact with wild animals or through close contact with infected individuals. The disease can spread from person to person through respiratory droplets, bodily fluids, and skin lesions. Cases have been reported outside of Africa, often linked to international travel or imported animals.

**Nan**: No applicable information available.
Intractability: Monkeypox is not considered intractable. It can be managed and treated with supportive care, antiviral medication, and prevention measures such as vaccination and isolation of infected individuals. While it can cause serious illness, particularly in individuals with weakened immune systems, it is generally not beyond the capability of modern medical interventions to control and treat the disease.
Disease Severity: Monkeypox is generally considered to have mild to moderate disease severity, though it can lead to severe outcomes in certain populations, such as immunocompromised individuals, children, and pregnant women.
Healthcare Professionals: Disease Ontology ID - DOID:3292
Pathophysiology: Monkeypox is a viral zoonosis caused by the monkeypox virus, a member of the Orthopoxvirus genus. The pathophysiology involves the virus entering the body through broken skin, the respiratory tract, or mucous membranes. Once inside the body, the virus replicates at the site of entry and then spreads to local lymph nodes, leading to viremia (presence of the virus in the blood). This systemic spread can trigger an immune response, resulting in symptoms such as fever, lymphadenopathy, and a characteristic vesiculopustular rash. The virus can infect various cell types, including epithelial cells, leading to skin lesions.
Carrier Status: Monkeypox primarily affects humans and certain animals, with rodents and primates being common carriers. Human-to-human transmission can occur through direct contact with infectious sores, scabs, or body fluids, respiratory droplets, or contaminated materials.
Mechanism: Monkeypox is caused by the monkeypox virus, a member of the Orthopoxvirus genus. The primary mechanism involves the virus entering the body, typically through broken skin, respiratory tract, or mucous membranes.

Molecularly, the virus attaches to host cells via specific surface receptors and is then internalized. Upon entry, the viral DNA is released into the cytoplasm where it uses the host's machinery and its own enzymes to replicate. The virus has an envelope that fuses with the host cell membrane, facilitating the release of viral particles. The viral genome is double-stranded DNA, and its replication occurs in the cytoplasm, unlike many other DNA viruses that replicate in the nucleus. Viral proteins are synthesized, assembled into new virions, and released to infect additional cells. The immune response includes the activation of antiviral cytokines and T-cells to control and eliminate the virus.

Monkeypox pathogenesis involves the invasion of the virus into the lymphatic system, leading to viremia and subsequent spreading to various organs and tissues. This viral spread results in characteristic symptoms such as fever, rash, and lymphadenopathy.
Treatment: Most cases of mpox present with mild symptoms and there is complete recovery within 2 to 4 weeks. There is no specific treatment for the disease, although antivirals such as tecovirimat have been approved for the treatment of severe mpox. A 2023 Cochrane review found no completed randomised controlled trials studying therapeutics for the treatment of Mpox. The review identified non-randomised controlled trials which evaluated the safety of therapeutics for Mpox, finding no significant risks from tecovirimat and low certainty evidence that suggests brincidofovir may cause mild liver injury. Pain is common and may be severe; supportive care such as pain or fever control may be administered. Patients with mild disease should isolate at home, stay hydrated, eat well, and take steps to maintain their mental health.Patients who are at high risk from the disease include children, pregnant women, the elderly and those who are immunocompromised. For these patients, or those who have severe disease, hospital admission and careful monitoring of symptoms is recommended, Symptomatic treatment is recommended for complications such as proctitis, and pruritis.
Compassionate Use Treatment: For monkeypox, compassionate use treatments and off-label or experimental treatments may include antiviral medications that are not specifically approved for monkeypox but could potentially be effective based on their mechanism of action or efficacy against related viruses. Some of these treatments include:

1. **Tecovirimat (TPOXX)**: An antiviral medication initially approved for smallpox, it has shown some efficacy against monkeypox in animal studies and is available under expanded access or compassionate use protocols in some countries.

2. **Cidofovir**: Another antiviral initially approved for cytomegalovirus (CMV) retinitis in AIDS patients, it has demonstrated activity against poxviruses in laboratory and animal studies.

3. **Brincidofovir (CMX001)**: An oral prodrug of cidofovir that has been investigated for smallpox and may have potential use against monkeypox. It could be available under emergency or compassionate use settings.

4. **Vaccinia Immune Globulin Intravenous (VIGIV)**: This is used primarily for complications from the smallpox vaccine but might be considered for severe cases of monkeypox under compassionate use.

These treatments are not specifically approved for monkeypox, so their use would typically be guided by emerging evidence, clinical judgment, and regulatory guidelines for compassionate or off-label use.
Lifestyle Recommendations: For monkeypox, here are some lifestyle recommendations:

1. **Practice Good Hygiene:**
- Wash hands frequently with soap and water or use an alcohol-based hand sanitizer.
- Avoid touching your face, especially eyes, nose, and mouth.

2. **Avoid Close Contact:**
- Stay away from individuals who are infected or show symptoms of monkeypox.
- Avoid close physical contact, including intimate activities, with those who may be infected.

3. **Safe Food Practices:**
- Handle animal products, particularly those from wild animals, with care.
- Ensure all meat is cooked thoroughly.

4. **Use Protective Equipment:**
- When caring for infected individuals, wear protective gloves, masks, and clothing.
- Disinfect surfaces and laundry that could be contaminated.

5. **Stay Informed:**
- Keep up-to-date with the latest health advisories and guidelines issued by health authorities.

6. **Travel Precautions:**
- Be cautious when traveling to areas where monkeypox is endemic.
- Follow recommended vaccinations and preventive measures.

7. **Prompt Medical Attention:**
- Seek medical advice if you notice symptoms such as fever, rash, or swollen lymph nodes, especially if you've been in contact with a potentially infected individual.

These recommendations help reduce the risk of infection and transmission of monkeypox.
Medication: For monkeypox, no specific antiviral medications are approved specifically for treating the virus. Supportive treatments are provided to relieve symptoms, and antiviral drugs like Tecovirimat (TPOXX) have been used under investigational protocols.
Repurposable Drugs: In the context of treating monkeypox, certain antiviral drugs initially developed for other diseases might be repurposed. These include:

1. **Tecovirimat (TPOXX)**: Originally developed for smallpox, it has shown efficacy against orthopoxviruses, including monkeypox.
2. **Cidofovir (Vistide)**: Primarily used for cytomegalovirus retinitis in AIDS patients, it may have activity against monkeypox virus.
3. **Brincidofovir (CMX001)**: An antiviral initially created for smallpox, it has potential application in monkeypox treatment due to its broad-spectrum activity.

Research is ongoing to determine the full efficacy and safety of these drugs for monkeypox.
Metabolites: In the case of monkeypox, specific metabolites related to the disease have not been comprehensively studied or identified in the literature. Metabolomics research in viral infections is a developing field, and more research is needed to characterize the metabolic changes associated with monkeypox virus infection. The study of metabolites could potentially offer insights into disease mechanisms, diagnosis, and therapeutic targets in the future.
Nutraceuticals: There is no scientifically validated evidence suggesting that nutraceuticals can treat or prevent monkeypox. The disease is caused by the monkeypox virus and is usually addressed with supportive care and specific antiviral treatments. Preventative measures, such as vaccination with the smallpox vaccine, can also offer protection. For effective management and prevention, it is essential to follow guidelines from health authorities and consult healthcare professionals for accurate information.
Peptides: Peptides are short chains of amino acids that can play various roles in the immune response to infectious diseases, including monkeypox. Researchers are exploring peptide-based vaccines and therapies to combat monkeypox by eliciting targeted immune responses.

Nanotechnology (nan) in the context of monkeypox could involve the use of nanoparticles for vaccine delivery, diagnostics, or treatment. Nanoparticles can enhance the stability and efficacy of vaccines, improve targeted delivery of therapeutic agents, and facilitate sensitive detection of the virus.

Research in both peptides and nanotechnology aims to improve the prevention, diagnosis, and treatment of monkeypox.