Monkeypox: Causes, Symptoms & Treatment

Monkeypox, as the name implies, is a zoonotic disease that occurs primarily in monkeys. However, it is also transmissible to humans

What is monkeypox?

Monkeypox, as the name implies, is a zoonotic disease that occurs primarily in monkeys. However, it is also transmissible to humans. The virus is transmitted, for example, through the consumption of rhesus monkey meat. Monkeypox is an infectious disease transmitted by a virus called orthopoxvirus simiae or simian pox. This pathogen is particularly common in Africa. The main area of distribution is in West Africa and Central Africa. There, especially arboreal rodents such as various squirrel species and rats are infected. Through these animals, the virus is transmitted to the monkeys living in these areas, especially Javanese monkeys and rhesus monkeys. Monkeypox first appeared sporadically in American prairie dogs 14 years ago. They are thought to have been transmitted to a U.S. zoo by a large rat originating in Ghana. In recent years, outbreaks of monkeypox have occasionally occurred in Sierra Leone, Côte d’Ivoire, Liberia, Nigeria, Cameroon, Gabon, and the Republic of Congo. However, fortunately, the number of new cases is relatively low. The annual incidence is only 0.6 per 10,000 people.

Causes

Because monkey meat is often on the human menu in Africa, the disease is also transmitted to humans by this route, causing them to contract smallpox disease, which closely resembles human smallpox (caused by the virus orthopoxvirus variola). Infection is also possible through the secretions and blood of diseased animals, for example through bites and scratch wounds, but the risk of infection through this route is rather low. In contrast, monkeypox infection from person to person is extremely rare.

Symptoms, complaints and signs

Monkeypox breaks out after an incubation period of about two weeks on average. They first manifest themselves in high fever, chills and swollen lymph nodes. Sore throat, headache, joint pain, muscle aches and cough also occur. Later, infected individuals develop a skin rash of redness, pimples and blisters. From these, a pockmarked extensive rash forms on the affected areas of the skin, especially on the face, but also on the neck and groin. The bark dries out over the course of about two weeks. When they finally fall off, they often leave behind the typical indentations or pockmarks that are also seen in human pox. The disease has nothing to do with the so-called chickenpox. These are triggered by the varicella-zoster virus, which is not a smallpox virus. In the early stages of the disease, monkeypox is also often confused with measles, with scarlet fever, herpes zoster, mumps or cowpox.

Diagnosis and course

To diagnose monkeypox, the virus is detected by examining smallpox scabs, smallpox secretions, or throat swabs. With a cell culture, detection of the disease takes several days; with other specialized methods, it takes only a few hours. Diagnostics are always performed in specialized laboratories. The appearance of lymph node swellings on the lower jaw, in the neck and groin region is also quite typical for monkeypox. Monkeypox is a notifiable disease in many countries. The course of this form of smallpox is very similar to that of human smallpox, although often somewhat milder. A previously healthy person with an intact immune system rarely dies from the disease today. In contrast, the risk is greater in weakened old or poorly nourished people and in young children. The mortality rate for monkeypox is between one and a maximum of ten percent of infected persons, depending on the region of the outbreak. This is lower than the mortality rate for human smallpox.

Complications

Several complications occur as a result of monkeypox infection. Initially, the infection causes fever, chills, headache, and cough. Then, after a few days, painful nodules often develop and later become pustules, leaving scars. In addition, other skin changes such as generalized exanthema may occur. Existing skin diseases are aggravated by monkeypox, which can sometimes cause unbearable pain and itching.Rarely, myalgias and arthralgias develop as a result of the infection, i.e., diffuse muscle and joint pain that resolves only slowly after recovery. In the absence of vaccination, monkeypox can also cause laryngitis, tonsillitis and conjunctivitis. There is also often swelling of the lymph nodes, which is rarely accompanied by hormonal disturbances. If monkeypox is not treated in time, it initially leads to organ failure and circulatory collapse, and ultimately to death. Children and the elderly or debilitated are particularly at risk, as are cardiovascular patients and individuals with an existing smallpox vaccination. The mortality rate for monkeypox ranges from one to ten percent, depending on the region of the outbreak and the time between infection and treatment.

At what point should you see a doctor?

Monkeypox is a zoonotic viral disease that can cause not only high fever and chills after an incubation period of about two weeks. Rather, symptoms include sore throat, headache, joint and muscle pain, as well as cough and swollen lymph nodes (especially on the lower jaw), which must first be discussed with an internist. The latter will probably refer to a virologist for co-treatment or further treatment. If a rash of vesicles, pimples and redness with extension to an extensive rash occurs, particularly on the face, neck and groin, in most cases treatment will be followed or continued by a dermatologist. If the course is characterized only by mild fever and cough and a non-expanding rash, a visit to the doctor is often not necessary. However, the infected person should observe himself very closely, and in the event of a worsening directly consult the doctor. If the harmless course of monkeypox persists and the bark falls off on its own after drying, the worst is over. This final stage requires a period of about two weeks. People who are physically weakened or suffering from deficiency symptoms (malnutrition) should not forgo medical diagnosis and treatment. The same applies if children have been infected.

Treatment and therapy

Treatment of monkeypox is generally limited to management of the presenting symptoms and prevention of secondary infections. In addition to strict bed rest, fever-reducing medications are generally prescribed, and headache medications and medications for the sore throat, joint and muscle pain are also given. In case of a so-called superinfection, patients are usually also given special antibiotics. Once the disease is over, there is lifelong protection against re-infection with the monkeypox virus but also with the human smallpox virus. Cross-immunity with variola virus is present.

Outlook and prognosis

Monkeypox causes various symptoms that resemble a febrile illness. Monkeypox is very dangerous for humans and must therefore be treated immediately in any case. First and foremost, there is a strong fever and further chills and fatigue. The affected person feels tired and sick and the resilience decreases enormously. Furthermore, there is also pain in the muscles and joints and the lymph nodes swell strongly. A reddish rash forms on the skin, which is often covered with blisters and pimples. The diagnosis of monkeypox is not always easy for a medical professional, because the symptoms are not always clearly assigned to a disease. For this reason, treatment of monkeypox cannot be given early in every case. Without treatment, inflammation occurs in various regions of the body, leading to organ failure. In this case, the patient eventually dies. The treatment of monkeypox is not associated with any particular compilations. The administration of antibiotics relieves the symptoms and the disease can be completely controlled.

Prevention

Because monkeypox is relatively often transmitted via the intermediate host monkey, people should approach wild monkeys, as well as captive monkeys, with the necessary caution and approach the animals only in a protected manner to avoid bites or scratches. However, the same applies to first carriers of the virus. For example, African tree squirrels are very cute, but can still scratch and bite, spreading the virus.It is also very important to educate Africans living in the African jungle that eating rodent meat and monkey meat carries the risk of contracting monkeypox. There is a ban throughout the EU on the importation of non-domesticated rodents and squirrels from tropical Africa and prairie dogs from the United States. Another means of preventing monkeypox is also preventive vaccination against human smallpox (variola). After some vaccination fatigue in recent decades and fewer people getting vaccinated against smallpox, overall outbreak numbers with monkeypox increased again. Researchers also fear that monkeypox viruses could change genetically, making it easier for human-to-human transmission to occur in the future.

Follow-up

As a rule, no direct follow-up is possible for monkeypox. The disease must be treated by a physician as soon as possible to prevent further complications. In the worst case, monkeypox left untreated can lead to the death of the affected person or significantly reduce the patient’s life expectancy. In most cases, the disease is treated with the help of medication. In doing so, the affected person must pay attention to taking the medication regularly and to possible interactions with other medications in order to avoid complications. Especially in the case of children, parents must force their children to take the medication so that the disease can be cured. Similarly, antibiotics can also be taken. When taking antibiotics, alcohol should be avoided because the alcohol would limit the effect of the antibiotics. The patient generally needs to rest and take it easy on his or her body. Strenuous activities or sports activities should be avoided if possible. In case of inflammation, a doctor must be consulted immediately. Usually, with early diagnosis and treatment, there is a positive course of the disease and no particular complications. Contact with the triggering animals should be interrupted in the case of monkeypox.

What you can do yourself

Persons diagnosed with monkeypox require immediate medical treatment. In addition to medical therapy, which consists of the administration of various medications and regular check-ups by the doctor, the patient must take it easy. The doctor will order strict bed rest and also advise a change in diet. Especially in the acute phase of the disease, the diet should consist of gentle foods such as rusks or chicken broth. The patient must also drink plenty of fluids and avoid stimulants such as coffee or alcohol. If a superinfection has already occurred, treatment in hospital is necessary. Depending on how the disease progresses, the patient may need several days to weeks of bed rest after hospitalization. In addition, it must be ensured that the disease has been completely cured. This is achieved on the one hand by medical examinations and on the other hand by good observation. Patients who notice unusual symptoms or complaints should immediately speak to the responsible medical professional. In the event of serious complications, it is best to alert the emergency physician or the affected person must be taken to the hospital immediately. Other self-help measures focus on identifying the trigger for monkeypox and taking preventive measures.