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European Journal of Internal Medicine Oct 2022As of August 5, 2022, >26,000 cases of monkeypox have been diagnosed worldwide and the steep increase of cases has spurred renewed concern about the risk for another... (Review)
Review
As of August 5, 2022, >26,000 cases of monkeypox have been diagnosed worldwide and the steep increase of cases has spurred renewed concern about the risk for another viral pandemic. In this narrative review, we address etiology, epidemiology and virology of monkeypox, describing routes of transmission and modes of spread. We also describe the current clinical presentation of monkeypox, focusing on circumstances where the disease should be suspected, and the methods to diagnose it. Finally, we briefly describe available treatments and strategies for active immune prophylaxis.
Topics: Humans; Mpox (monkeypox); Monkeypox virus; Physicians
PubMed: 35999095
DOI: 10.1016/j.ejim.2022.08.022 -
Current Opinion in Virology Dec 2022Poxviruses are a diverse family of double-stranded DNA viruses that cause mild-to-severe disease in selective hosts, including humans. Although most poxviruses are... (Review)
Review
Poxviruses are a diverse family of double-stranded DNA viruses that cause mild-to-severe disease in selective hosts, including humans. Although most poxviruses are restricted to their hosts, some members can leap host species and cause zoonotic diseases and, therefore, are genuine threats to human and animal health. The recent global spread of monkeypox in humans suggests that zoonotic poxviruses can adapt to a new host, spread rapidly in the new host, and evolve to better evade host innate barriers. Unlike many other viruses, poxviruses express an extensive repertoire of self-defense proteins that play a vital role in the evasion of host innate and adaptive immune responses in their newest host species. The function of these viral immune modulators and host-specific cytokine responses can result in different host tropism and poxvirus disease progression. Here, we review the role of different cytokines that control poxvirus host tropism and adaptation.
Topics: Animals; Humans; Viral Tropism; Cytokines; Viral Proteins; Poxviridae; Poxviridae Infections
PubMed: 36427482
DOI: 10.1016/j.coviro.2022.101286 -
Archives of Virology Jun 2023Since May 2022, there has been a global increase in the number of Mpox virus (MPXV) cases in countries that were previously considered non-endemic. In July 2022, the... (Review)
Review
Since May 2022, there has been a global increase in the number of Mpox virus (MPXV) cases in countries that were previously considered non-endemic. In July 2022, the World Health Organization (WHO) declared this outbreak a public health emergency of international concern. The objective of this systematic review is to examine the novel clinical features of Mpox and to assess the available treatment options for managing the disease in patients who are afflicted with it. We conducted a systematic search in several databases, including PubMed, Google Scholar, Cochrane Library, and the grey literature, from May 2022 to February 2023. We identified 21 eligible studies, which included 18,275 Mpox cases, for final qualitative analysis. The majority of cases were reported in men who have sex with men (MSM) and immunocompromised individuals with HIV (36.1%). The median incubation period was 7 days (IQR: 3-21). The novel clinical manifestations include severe skin lesions on the palms, oral and anogenital regions, as well as proctitis, penile edema, tonsillitis, ocular disease, myalgia, lethargy, and sore throat, without any preceding prodromal symptoms or systemic illness. In addition, fully asymptomatic cases were documented, and various complications, including encephalomyelitis and angina, were noted. Clinicians must be familiar with these novel clinical characteristics, as they can aid in testing and tracing such patients, as well as asymptomatic high-risk populations such as heterosexuals and MSM. In addition to supportive care, currently, there are several effective prophylactic and treatment strategies available to combat Mpox, including the vaccines ACAM2000 and MVA-BN7, as well as the immunoglobulin VIGIV and the antivirals tecovirimat, brincidofovir, and cidofovir against severe Mpox infection.
Topics: Male; Humans; Monkeypox virus; Homosexuality, Male; Mpox (monkeypox); Sexual and Gender Minorities
PubMed: 37386209
DOI: 10.1007/s00705-023-05808-4 -
The American Journal of Emergency... Nov 2022Monkeypox is an emerging viral disease that has been declared a global health emergency. While this disease has been present for over 50 years, the recent surge in cases... (Review)
Review
INTRODUCTION
Monkeypox is an emerging viral disease that has been declared a global health emergency. While this disease has been present for over 50 years, the recent surge in cases and expanding knowledge of this has prompted a need for a focused review for practicing clinicians.
OBJECTIVE
This narrative review provides a focused overview of the epidemiology, presentation, evaluation, and management of monkeypox for emergency clinicians.
DISCUSSION
Monkeypox is an orthopoxvirus endemic to central and western Africa. An outbreak in May and June 2022 across Asia, Europe, North America, and South America was declared a global health emergency in July 2022. The disease can be transmitted via contact with an infected animal or human, as well as contact with a contaminated material. The disease presents with a prodromal flu-like illness and lymphadenopathy. A rash spreading in a centrifugal manner involving the oral mucosa, face, palms, and soles is typical. Lesions progress along various stages. Complications such as bacterial skin infection, pneumonitis, ocular conditions, and encephalitis are uncommon. Confirmation typically includes polymerase chain reaction testing. The majority of patients improve with symptomatic therapy, and as of July 2022, there are no United States Food and Drug Administration-approved treatments specifically for monkeypox. However, antiviral treatment should be considered for several patient populations at risk for severe outcomes.
CONCLUSION
An understanding of the presentation, evaluation, and management of monkeypox is essential for emergency clinicians to ensure appropriate diagnosis and treatment of this emerging disease.
Topics: Humans; United States; Animals; Mpox (monkeypox); Monkeypox virus; Exanthema; Antiviral Agents; Emergency Medicine
PubMed: 36030595
DOI: 10.1016/j.ajem.2022.08.026 -
NEJM Evidence Mar 2024The multinational outbreak of mpox (formerly known as monkeypox) that began in 2022 resulted in more than 90,000 reported cases, over 150 deaths, and - importantly - a...
The multinational outbreak of mpox (formerly known as monkeypox) that began in 2022 resulted in more than 90,000 reported cases, over 150 deaths, and - importantly - a coordinated international response to a rapidly spreading infectious disease. Because of decades of global preparedness efforts, vaccines and therapeutics for a related orthopox virus (smallpox) were available in many global stockpiles. Few of these medical countermeasures were specifically designed, evaluated, or approved for use against mpox disease, requiring the global scientific community to identify how best to quickly translate what was known into what was needed.
Topics: Humans; Mpox (monkeypox); Disease Outbreaks; Medical Countermeasures; Orthopoxvirus; Smallpox
PubMed: 38411451
DOI: 10.1056/EVIDe2300357 -
Microbial Pathogenesis Dec 2022The detection of >400 Monkeypox virus cases in the month of May 2022 and increase to 57,527. confirmed cases by September 9th 2022, across the world, emphasizes the need... (Review)
Review
The detection of >400 Monkeypox virus cases in the month of May 2022 and increase to 57,527. confirmed cases by September 9th 2022, across the world, emphasizes the need of new therapeutics for this emerging viral epidemic in humans. Largely the cases seen in Europe, Australia and America are among men who have sex with men making transmission through intimate contact with infectious skin lesions the likely mode of transmission. This implies that this high human-to-human transmission observed in the young Caucasian clusters, and the probable community transmission without any history of travelling to endemic areas would suggest that the epidemic is likely to be sustained human-to-human transmission and unlikely one that would be a short-lasting epidemic. This might necessitate the need for new therapeutic approaches and agents for prophylaxis and treatment of acute infections which is the focus of this review article.
Topics: Male; Humans; Mpox (monkeypox); Antiviral Agents; Homosexuality, Male; Sexual and Gender Minorities; Vaccines
PubMed: 36182078
DOI: 10.1016/j.micpath.2022.105799 -
International Immunopharmacology Dec 2022Monkeypox is a zoonotic illness caused by the monkeypox virus (MPXV) that has a similar etiology to smallpox. The first case of monkeypox was reported in Western and... (Review)
Review
Monkeypox is a zoonotic illness caused by the monkeypox virus (MPXV) that has a similar etiology to smallpox. The first case of monkeypox was reported in Western and Central Africa in 1971, and in 2003, there was an outbreak of monkeypox viruses outside Africa. According to the World Health Organization (WHO) and Center for Disease Control and Prevention (CDC), monkeypox is transmitted through direct contact with infected animals or persons exposed to infectious sores, scabs, or body fluids. Also, intimate contact between people during sex, kissing, cuddling, or touching parts of the body can result in the spreading of this disease. The use of the smallpox vaccine against monkeypox has several challenges and hence anti-virals such as cidofovir, brincidofovir, and tecovirimat have been used for the symptomatic relief of patients and reversing the lesion formation on the skin. Despite the recent outbreak of monkeypox most especially in hitherto non-endemic countries, there is still a lack of definitive treatment for monkeypox. In the present review, emphasis was focused on etiopathology, transmission, currently available therapeutic agents, and future targets that could be explored to halt the progression of monkeypox. From our review we can postulate that owing to the lack of a definitive cure to this reemerging disorder, there is a need for general awareness about the transmission as well as to develop appropriate diagnostic procedures, immunizations, and antiviral medication.
Topics: Animals; Mpox (monkeypox); Monkeypox virus; Smallpox Vaccine; Cidofovir; Antiviral Agents
PubMed: 36330915
DOI: 10.1016/j.intimp.2022.109382 -
The New England Journal of Medicine Oct 2022
Topics: Humans; Infant, Newborn; Mpox (monkeypox); Monkeypox virus
PubMed: 36223535
DOI: 10.1056/NEJMc2210828 -
JAMA Oct 2022
Topics: Disease Outbreaks; False Positive Reactions; Humans; Mpox (monkeypox)
PubMed: 36219400
DOI: 10.1001/jama.2022.16814 -
Cleveland Clinic Journal of Medicine Mar 2023The monkeypox (mpox) epidemic was declared a global health emergency in July 2022. The mpox virus belongs to the same virus family as the smallpox, or variola virus, but... (Review)
Review
The monkeypox (mpox) epidemic was declared a global health emergency in July 2022. The mpox virus belongs to the same virus family as the smallpox, or variola virus, but the infection is a less lethal threat than smallpox. Nevertheless, its relationship to smallpox is a worldwide concern, as is the discontinuation of universal smallpox vaccinations since the 1980s. Newer therapies and vaccines are available for both infections, including 2 antiviral drugs that can be used under certain conditions. Two vaccines have been developed for mpox prevention, but clarity is needed on when and how to use them. Preventive public health measures and prioritization of resources for managing infectious disease are concerns.
Topics: Humans; Smallpox; Variola virus; Mpox (monkeypox); Antiviral Agents; Epidemics
PubMed: 36858615
DOI: 10.3949/ccjm.90a.22067