Mpox (Monkeypox): Causes, Symptoms, Treatment and Variants

Mpox (Monkeypox): Causes, Symptoms, Treatment & Variants

Mpox, previously known as monkeypox, is a rare zoonotic viral infection that was first identified in laboratory monkeys in 1958. It is caused by the monkeypox virus, which belongs to the Orthopoxvirus genus, the same family of viruses that includes smallpox. Though the disease is relatively uncommon, its recent outbreaks have brought it to global attention. Understanding the causes, symptoms, treatment options, and variants of mpox is crucial for effective management and prevention.

Causes

Mpox is primarily a zoonotic disease, meaning it is transmitted from animals to humans. The primary reservoirs of the monkeypox virus are believed to be rodents, such as squirrels and rats, and certain primates, including monkeys. The virus is endemic in parts of Central and West Africa, where it is transmitted from wildlife to humans through direct contact with infected animals or their bodily fluids. This can occur during hunting, handling, or consuming bushmeat. Human-to-human transmission is also possible, though less common. It can occur through respiratory droplets, direct contact with the lesions or bodily fluids of an infected person, or by touching contaminated materials like bedding or clothing.

Symptoms

The incubation period for mpox typically ranges from 7 to 14 days, although it can be as short as 5 days or as long as 21 days. The symptoms of mpox can be divided into two phases: the prodromal phase and the rash phase.

Prodromal Phase: This initial phase is characterized by symptoms similar to those of many other viral infections. These symptoms can include fever, chills, headache, muscle aches, backache, swollen lymph nodes, and exhaustion. Some individuals may also experience sore throat, cough, and nasal congestion.

Rash Phase: After the prodromal symptoms, a rash typically develops. This rash evolves through several stages, beginning as flat, red spots (macules) that develop into raised bumps (papules). These papules then turn into fluid-filled blisters (vesicles), which eventually become pustules. The pustules crust over and eventually fall off, leaving a temporary mark. The rash usually starts on the face and can spread to other parts of the body, including the arms, legs, and trunk. It is worth noting that the rash may be less extensive in some cases.

The course of the disease can last from 2 to 4 weeks. In severe cases, especially among individuals with weakened immune systems or young children, the disease can lead to complications such as secondary bacterial infections, pneumonia, or severe dehydration.

Treatment

Currently, there is no specific antiviral treatment for mpox. Management of the disease is primarily supportive, aimed at alleviating symptoms and preventing complications. Treatment strategies include:

1. Symptom Management: Patients are typically treated with antipyretics to manage fever, analgesics for pain, and antihistamines for itching. Proper hydration and nutritional support are also essential.
2. Infection Control: To prevent the spread of the virus, infected individuals should be isolated from others. Caregivers should use appropriate personal protective equipment (PPE) and adhere to good hygiene practices. Contaminated bedding and clothing should be cleaned and disinfected thoroughly.
3. Vaccination: There is some evidence that smallpox vaccination can provide cross-protection against monkeypox. The smallpox vaccine is no longer routinely administered, but it is available for individuals at high risk of exposure, particularly during outbreaks.
4. Antiviral Agents: While not specifically approved for mpox, antiviral drugs such as tecovirimat (TPOXX), which is used for smallpox, may be considered in severe cases. These treatments are still under investigation for their efficacy against monkeypox.
5. Supportive Care: For severe cases, especially those involving secondary infections or complications, more intensive medical care may be required, including hospitalization.

Variants

The monkeypox virus has two distinct clades: the Central African (Congo Basin) clade and the West African clade. These clades differ in their geographical distribution and clinical severity.

1. Central African Clade: This variant is associated with more severe disease and higher mortality rates. It is predominantly found in the Congo Basin region of Central Africa. The central African clade is known for causing more extensive rashes and more severe systemic symptoms.
2. West African Clade: This variant is generally associated with milder symptoms and has a lower mortality rate compared to the Central African clade. It is primarily found in West Africa. Recent outbreaks outside Africa, including those in the Americas and Europe, have been associated with this clade.

Genetic studies have shown that there are subtle differences between strains within these clades, which may affect their virulence and transmissibility. Ongoing research aims to better understand these differences and their implications for public health.

FAQs

What is mpox and how is it different from smallpox?

Mpox is a rare viral infection caused by the monkeypox virus, which belongs to the Orthopoxvirus genus. Smallpox, on the other hand, is caused by the variola virus, which is also part of the Orthopoxvirus family. While both diseases share some similarities, such as the presence of a rash and fever, they differ in several key aspects. Smallpox was eradicated globally by 1980 through a successful vaccination campaign, while mpox remains endemic in certain regions. Smallpox typically caused more severe illness with a higher mortality rate compared to mpox, and it had a more uniform rash pattern. Mpox generally has a lower fatality rate and can present with a more varied rash.

How does mpox spread from animals to humans?

Mpox primarily spreads from animals to humans through direct contact with infected animals or their bodily fluids. This can occur during activities such as hunting, handling, or consuming bushmeat from infected animals like rodents and primates. The virus can enter through broken skin or mucous membranes. Human-to-human transmission is less common but can occur through respiratory droplets or direct contact with the lesions or bodily fluids of an infected person. Indirect transmission through contaminated materials like bedding is also possible.

What are the key symptoms of mpox?

The key symptoms of mpox include a combination of fever, headache, muscle aches, backache, swollen lymph nodes, and exhaustion. These are followed by a rash that progresses through several stages: macules (flat red spots), papules (raised bumps), vesicles (fluid-filled blisters), pustules (pus-filled lesions), and finally crusting over. The rash often starts on the face and can spread to other parts of the body. In addition to the rash, some individuals may experience sore throat, cough, and nasal congestion.

How long does the incubation period for mpox last?

The incubation period for mpox, which is the time between exposure to the virus and the onset of symptoms, typically ranges from 7 to 14 days. However, it can be as short as 5 days or as long as 21 days. During this period, individuals may not show any symptoms but can still be infectious to others.

Is there a vaccine available for mpox?

Currently, there is no specific vaccine for mpox. However, research has shown that the smallpox vaccine, which is no longer routinely administered, can offer cross-protection against monkeypox. During outbreaks, individuals at high risk of exposure may receive the smallpox vaccine as a preventive measure. Efforts are ongoing to develop and test vaccines specifically targeting mpox.

What treatments are available for mpox?

There is no specific antiviral treatment for mpox. Management is mainly supportive, focusing on relieving symptoms and preventing complications. Treatments include antipyretics for fever, analgesics for pain, and antihistamines for itching. Patients should be isolated to prevent the spread of the virus, and good hygiene practices should be followed. In severe cases, antiviral drugs such as tecovirimat, used for smallpox, may be considered. Supportive care in a hospital setting may be necessary for severe complications.

How can mpox be prevented?

Prevention of mpox involves reducing the risk of contact with potentially infected animals. This includes avoiding handling or consuming bushmeat from wildlife and practicing good hygiene when in contact with animals. In regions where mpox is endemic, wearing protective clothing and using personal protective equipment (PPE) can help. During outbreaks, isolation of infected individuals, good hygiene practices, and vaccination with the smallpox vaccine for those at high risk can help prevent further spread.

Are there any long-term effects of mpox?

Most individuals with mpox recover fully within a few weeks without long-term effects. However, in severe cases or among those with weakened immune systems, complications such as secondary bacterial infections, pneumonia, or severe dehydration can occur. There may also be scarring or pigmentation changes in areas where the rash was present. Long-term effects are generally rare but can be more significant in those who experienced severe illness.

How is mpox diagnosed?

Mpox is diagnosed based on clinical presentation and supported by laboratory testing. The diagnosis is typically confirmed through molecular techniques such as polymerase chain reaction (PCR) testing, which detects the presence of the monkeypox virus’s DNA in lesions or other samples. Serological tests that identify antibodies against the virus can also be used, especially if lesions are not present. Differential diagnosis is important as the symptoms of mpox can resemble those of other diseases, such as chickenpox or syphilis.

What are the challenges in managing mpox outbreaks?

Managing mpox outbreaks poses several challenges. One challenge is the need for effective surveillance and early detection, especially in remote or underserved areas where the disease is more common. There is also the challenge of ensuring adequate healthcare resources and training for managing cases. The limited availability of specific antiviral treatments and vaccines for mpox complicates control efforts.