SUMMARY:

Monkeypox is a zoonosis (a disease that is transmitted from animals to humans). However, human-to-human cases have been reported and occur through contact with bodily fluids, lesions on the skin or on internal mucosal surfaces, such as in the mouth or throat, respiratory droplets and contaminated objects. Below are some key informational resources

Signs and Symptoms 

• Incubation period: 7 to 14 days
• Prodromal period (initial symptoms)
  • Fever
  • Headache
  • Muscle aches
  • Backache
  • Swollen lymph nodes
  • Chills
  • Exhaustion
• Within 1 to 3 days (sometimes longer) following fever
  • Rash beginning on the face then spreading to other parts of the body
• Lesions progression prior to falling off
  • Macules
  • Papules
  • Vesicles
  • Pustules
  • Scabs followed by resolution
• Illness duration
  • 2 to 4 weeks
• Mortality
  • In Africa, monkeypox has been shown to cause death in as many as 1 in 10 persons who contract the disease
  • However, severity is dependent on health of the individual, the route of exposure, and the strain of the infecting virus

KEY POINTS:

• Features to help with diagnosis include (CDC)
  • Lesions are well circumscribed, deep seated, and often develop umbilication (resembles a dot on the top of the lesion)
  • Lesions are relatively the same size and same stage of development on a single site of the body (ex: pustules on face or vesicles on legs)
  • Fever before rash
  • Lymphadenopathy common
  • Disseminated rash is centrifugal (more lesions on extremities, face)
  • Lesions on palms, soles
  • Lesions are often described as painful until the healing phase when they become itchy (crusts)
• Monkeypox is considered a rare disease that is caused by infection with monkeypox virus
  • Monkeypox virus belongs to the Orthopoxvirus genus in the family Poxviridae
  • This is the same genus that includes variola virus (which causes smallpox), vaccinia virus (used in the smallpox vaccine), and cowpox virus
  • Symptoms are similar but less severe vs smallpox
• Why ‘monkey’pox?
  • Monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research
  • Natural reservoir of monkeypox: Unknown (although CDC suggests that African rodents and non-human primates like monkeys may harbor the virus and infect people)
• History
  • First human case: Reported in 1970 in Democratic Republic of the Congo (DRC) during a period of intensified effort to eliminate smallpox
  • Now reported in several other central and western African countries as well as outside of Africa linked to international travel or imported animals
• Testing
  • PCR is the preferred laboratory test for monkeypox
  • Best diagnostic specimens are directly from the rash
    • Skin | Fluid or crusts | Biopsy where feasible
  • Antigen and antibody detection methods may not be useful as they do not distinguish between orthopoxviruses

Learn More – Primary Sources:

General Resources Including Lesion Images

• CDC: Monkeypox
• CDC: Monkeypox information specifically for healthcare professionals
• WHO: Monkeypox
• JAMA: Monkeypox in 2022—What Clinicians Need to Know
• AMA: New CPT Codes for Monkeypox

Pregnancy-Related Resources

• Professor Jim Thornton: Monkeypox Reports in Pregnancy
• Expert Opinion (White Journal): Monkeypox and pregnancy: what do obstetricians need to know?
• Expert Opinion (Green Journal): Primer on Monkeypox Virus for Obstetrician–Gynecologists
• SMFM: Monkeypox guidance
• Expert Opinion (Lancet): Guidelines for pregnant individuals with monkeypox virus exposure