By Dr. Vivek Sinha
In today’s internet age, unlimited information is at our fingertips. We can essentially look up any subject matter, anywhere in the world, and become well-versed about any topic. But one drawback to this is sometimes the information we have access to may not be completely accurate.
Never has this been more relevant than during a worldwide pandemic. Over the past three years, COVID-19 has dominated news headlines.
This is slowly evolving. Over the past few months, we are seeing more and more articles and news reports about monkeypox. While there is a tremendous amount of information available online about monkeypox, how can we be sure that the information we are reading about is accurate? Let’s talk about some basics of monkeypox and discuss what we do know and what we don’t know yet.
What is monkeypox?
Monkeypox is a viral infection that causes a rash that is very similar to smallpox. It is classified as a zoonotic infection — an infectious disease that is spread from animal to humans. One of the reasons why we are so concerned about monkeypox is that the virus has evolved to human-to-human spread. While the rash that monkeypox causes can look similar to chickenpox, these viruses are unrelated.
How is monkeypox transmitted?
There are two main types of transmission that can occur: animal-to-human and human-to-human. Animal- to-human transmission usually occurs through contact with an infected animal’s bodily fluid, or through a bite. Less commonly, it can also occur through eating raw or minimally processed meat that comes from wild animals in certain regions of the world.
Human-to-human transmission can occur in several ways. Direct contact with infected sores, scabs or bodily fluids are the main cause of spread. The virus is also thought to be spread through respiratory secretions when prolonged face-to-face contactoccurs. In addition, spread can also occur through contact with secondary objects, such as clothes or linens that have come into contact with infected sores. Spread from the mother to the fetus can also occur in pregnant females.
If a non-infected person is exposed to the monkeypox virus, it can take five to 13 days for the person to develop symptoms. However, some estimates state that the incubation period – time of exposure to time of disease presentation – can last from four to 21 days. People infected with the monkeypox virus through an animal bite may have a shorter incubation period.
If a person is diagnosed with monkeypox, they are considered infectious from the moment they have symptoms until all of their skin lesions have scabbed over and new skin has grown over.
What are the symptoms?
Since monkeypox is a virus, the timeline of symptoms presents typically like other viruses. There is a period of symptoms that last for approximately five days prior to the onset of the rash. This period is called the prodromal period. During these five days the patient may experience fever, severe headache, body aches, fatigue and severe swelling of the lymph nodes. Towards the end of the prodromal period, typically one to four days after the fever develops, a rash appears. The rash itself tends to concentrate around the face, but it also can develop on the palms, soles and areas of mucus membrane such as the area around the eyes, anus and genitalia. Once they erupt, the rash lesions usually progress through various stages:
They start as small, flattened discolored rashes usually two to five millimeters in diameter called macules. The lesions then evolve to one centimeter area of raised skin called a papule, then to a clear and small blister filled with fluid called a vesicle. Finally, they progress into a pustule, a patch of skin that’s filled with yellowish fluid/secretions. Often, the lesions form a central depression on top of the lesion. Eventually after one to two weeks, the lesions crust over and they then drop off. The rashes have been described by patients as painful and itchy.
Several complications can occur, including respiratory infections, sepsis and loss of life.
How do you diagnose monkeypox?
Like many disease processes, proper diagnosis involves clinical and laboratory findings. The diagnosis should be considered when patients present with the typical rash. Typically they would have some other risk factor for infection, such as recent travel to areas of outbreaks or close or intimate in-person contact with someone suspected or confirmed of having monkeypox or people part of a social network experiencing monkeypox. In addition, clinicians should suspect monkeypox in people who may not fall into the risk factors above but do present with lesions in their genital regions or are experiencing proctitis, a painful inflammation of the lining of the rectum. Testing is most commonly accomplished via obtaining a swab of the dry lesions and processing it via PCR in a lab.
There are several other infections that should be ruled out prior to diagnosing monkeypox: varicella (chickenpox), herpes simplex virus and other sexually transmitted infections. Less likely but given concerns of bioterrorism, it is important to consider smallpox as well.
Can monkeypox be treated?
Monkeypox usually causes mild to moderate infection and typically is self-limiting. Most people recover without medical intervention. However, it is important to closely monitor people because very serious complications can occur. There are certain people who have a higher risk of severe disease: people younger than 8 years of age, people with immuno-compromising conditions and pregnant or breastfeeding women. These people should undergo treatment with antivirals. In addition, treatment can also be considered for people with very severe symptoms or people with lesions in the mouth, eyes or genital areas.
One of the more common treatments is an oral antiviral medication that is taken several times a day for two weeks. People who are seeking treatment must coordinate with their physician, who will coordinate with the local health department. There is also a vaccine available for certain people who are immuno-compromised or who have been exposed to suspected infection.
Recently, the World Health Organization has declared monkeypox a global public health emergency. Like most things in medicine, education is the most important first step.
If you are concerned that you or someone you know may have been exposed to the virus, or if you have a fever that is associated with a rash, seek help. Speak to your physician and determine if testing is indicated.
Stay educated. Stay informed and stay safe.
The writer is chief medical officer of Belleview Medical Partners, an office and house call practice based in Old Town.