Mpox (Monkeypox) is an infectious disease caused by an orthopoxvirus and appears similar to smallpox, but not as serious. It is a respiratory virus spread is via close contact with an infected person. The case fatality rate in Africa is about 1 in 10. The incubation period following exposure is usually 7-14 days but can range from 5−21 days.
Mpox was first identified in 1958 in monkeys at a lab in Denmark and then in humans in 1970 in the Democratic Republic of the Congo. It is endemic primarily in tropical rainforest areas of West and Central Africa with occasional outbreaks in other regions. Widespread community transmission outside of Africa began in 2022 with initial cases spreading from Nigeria to the United Kingdom in May 2022 and then in Europe, North America and Australia. By July 2022, the outbreak was declared a public health emergency of international concern by the World Health Organization. That declaration of the emergency ended in May 2023 with a new emergency declared in August 2024.
In August 2022, the WHO put out an urgent call to rename the disease as ‘monkeypox’ was considered ”discriminatory and stigmatising”. They considered that the name change would reduce “negative impacts on nations, geographic regions, economies and people and that considers the evolution and spread of the virus.” In November, 2022, they recommended the name of the disease be changed to ‘mpox’.
Clinical Features:
Initially, it begins with fever, chills, headache, muscle pains, easy fatigue or exhaustion and swollen glands.
After a few days of the onset of fever, lesions usually occur on the face and then spread to other parts of the body – the lesions begin as smaller flat spots, then bumps filled with clear fluid and then pus. These lesions burst and scabs develop. This sequence is: Macules > Papules > Vesicles > Pustules > Scabs.
The course of the disease is usually self-limiting and lasts from two to four weeks.
Typical monkeypox rash on the forearm
It has been reported that in the UK 2022 outbreak appeared to have a lower prevalence of tiredness and fever and a higher prevalence of lesions in the genital region compared to previous outbreaks.
Involvement of the Foot:
A case was reported by Cuomo et al (2023) of the monkeypox only affecting the foot in a HIV positive male and resulting in what was a necrotising fasciitis.
A further case was reported by Mahtani et al (2023) of a severe soft tissue infection of the foot in a HIV positive individual. They subsequently developed worsening lesions over the entire body.
A review of 69 cases of mpox by Sánchez-Cárdenas et al (2024) found a significant higher proportion of splinter hemorrhages, papulo-nodular lesions, anonychia, onychomadesis, acute paronychia, and nail bed ulcer-atrophy.
Treatment:
Tecovirimat as first-line antiviral drug.
Isolation (some countries now mandate a 21 day isolation period).
Antibiotics for any secondary bacterial infection.
Supportive care: antipyretics; maintain fluid balance; oxygenation; rest.
Prevention:
Vaccination with Jynneos (attenuated live virus vaccine) has been approved.
The vaccine used against smallpox also protects against monkeypox, but mass vaccination used in some countries against smallpox ceased in the 70’s and that disease is now considered eradicated.
Commentary:
- Soon after the May 2022 outbreak, the conspiracy theorists were soon promoting their conspiracies and bad science. It was embarrassing. This included, for example, that Bill Gates will profit from it (he won’t); that its really shingles (its caused by a different virus); its caused by the COVID-19 vaccines (its not as it was around before COVID-19); it started in Wuhan from the same lab that they allege caused COVID-19 (it didn’t); etc
External Links:
Monkeypox affecting the foot (Podiatry Arena)
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