MONKEYPOX
DISEASE SYMPTOMS, TRANSMISSION AND TREATMENT: AN OVERVIEW
“Mr. Rajnikant”,
Assistant Professor (Krishna Institute, Bijnor)
ABSTRACT:
The
current multicounty 2022 monkeypox outbreak is the biggest outside of Africa in
recorded history. The rising frequency of human outbreaks in recent years has
led to the perception that monkeypox, an emerging zoonotic disease, has a high
potential for epidemic spread. Healthcare practitioners worldwide are
attempting to become familiar with the varied clinical manifestations and
therapy of this infection as public health organizations seek to contain the
current outbreak. In light of the current outbreaks worldwide, we provide
updated information on monkeypox for healthcare professionals in this review.
Also, we attempt to outline the conventional and alternative therapies that can
effectively treat monkeypox in its most serious form. After researching the
most recent information on this devastating illness and its connections, we can
say that both conventional and alternative medicine offer excellent treatments.
Keywords:
Monkeypox, Zoonotic, Symptoms, Orthodox.
INTRODUCTION:
The
monkeypox virus, a zoonotic DNA virus closely related to the smallpox virus,
was initially discovered in humans in the Democratic Republic of the Congo
(formerly Zaire) in 1970. In Africa, sporadic outbreaks of the disease have
occurred, mainly due to interactions with wildlife reservoirs, particularly
rodents. It has been observed that human-to-human transmission is limited, and
most cases outside of Africa are associated with travel. Despite its historical
prevalence in certain regions, research on monkeypox has been neglected and
underfunded. However, the situation has changed since early May 2022, with more
than 3000 reported infections in over 50 countries across five continents.
Consequently, the World Health Organization has classified monkeypox as an
"evolving disease" and a "moderate public health concern"
as of June 23, 2022. The virus can spread through large respiratory droplets,
direct contact with skin lesions, and potentially contaminated objects (fomites).
While there is no definitive evidence of sexual transmission through seminal or
vaginal secretions, cases of fetal fatalities and vertical transmission have
been documented. [4,5]
In
the Democratic Republic of the Congo, where smallpox had been eradicated in
1968, a 9-month-old boy was the first person to be diagnosed with human
monkeypox. Since then, the Democratic Republic of the Congo in particular has
seen an increase in human cases, with the majority of cases coming from rural,
rain forest areas of the Congo Basin.
Since 1970, cases of monkeypox have been documented in
11 African countries, including Benin, Cameroon, the Central African Republic,
the Democratic Republic of the Congo, Gabon, Cote d'Ivoire, Liberia, Nigeria,
the Republic of the Congo, Sierra Leone, and South Sudan. The precise impact
and cost of monkeypox remain uncertain. For example, the Democratic Republic of
the Congo experienced an outbreak from 1996 to 1997 that exhibited a higher
attack rate and a lower-case fatality ratio compared to typical cases. The
simultaneous occurrence of monkeypox and chickenpox epidemics may have
influenced the transmission dynamics, although it is important to note that
chickenpox is caused by the varicella virus, which is not an orthopoxvirus.
Nigeria has reported a significant epidemic, with more than 200 confirmed cases
and over 500 probable cases.
Given its impact on
countries in West and Central Africa as well as the rest of the world,
monkeypox is a disease of global public health significance. The United States
of America experienced its first monkeypox outbreak outside of Africa in 2003,
which was traced back to contact with pet prairie dogs infected with the
disease. These pets had been in close proximity to dormice and pouched rats
imported from the Gambia, resulting in nearly 70 cases of monkeypox in the US.
Additionally, there have been reported cases of monkeypox among travelers from
Nigeria to Israel in September 2018, the United Kingdom in September 2018,
December 2019, May 2021, and May 2022, Singapore in May 2019, and the United
States of America in May 2019. In May 2022, multiple cases of monkeypox were
detected in several countries where the disease is not endemic. Ongoing studies
aim to enhance our understanding of the disease's epidemiology, sources of infection,
and transmission patterns.
Monkeypox
is a zoonotic viral illness, meaning it is a virus that can be transmitted from
animals to humans. The symptoms of monkeypox are similar to those observed in
smallpox patients, although the disease is generally less severe. Since the
eradication of smallpox in 1980 and the discontinuation of smallpox
vaccination, monkeypox has emerged as a significant public health concern. It
is primarily found in central and west Africa, particularly in regions near
tropical rainforests. There have been reported cases of monkeypox occurring in
urban areas as well. The disease can infect a variety of animals, including
rodents and non-human primates.
MONKEYPOX SYMPTOMS:
People
with monkeypox get a rash that may be located on or near the genitals (penis,
testicles, labia, and vagina) or anus (butthole) and could be on other areas
like the hands, feet, chest, face, or mouth. The rash will go through several
stages, including scabs, before healing. The rash can initially look like
pimples or blisters and may be painful or itchy.
Other symptoms of monkeypox can include:
Ø Fever
Ø Chills
Ø Swollen
lymph nodes
Ø Exhaustion
Muscle aches and backache
Ø Headache
Ø Respiratory
symptoms (e.g., sore throat, nasal congestion, or cough)
You
may experience all or only a few symptoms Sometimes, people have flu-like
symptoms before the rash. Some people get a rash first, followed by other
symptoms. Others only experience a rash.6
Generally,
it is the more fetal when gone to last stage, similarly according to the stage
normally six stages have covered this disease. In first stage the rashes
started on the infected area or all over the skin is possibly this condition is
known as the macule. In second stage the spots become hard, raised bumps last
for 1-2 days, this is the papule stage. Other stage given in the below diagram
accordingly.
MODE
OF TRANSMISSION: -
Person to person:
Monkeypox
is transmitted from person to person through close contact with an individual
displaying a monkeypox rash. Close contact includes face-to-face interactions,
such as talking, breathing, or singing near each other, which can generate
droplets or short-range aerosols. It also includes skin-to-skin contact, such
as touching or engaging in vaginal/anal sex, as well as mouth-to-mouth contact
like kissing, or mouth-to-skin contact such as oral sex or kissing the skin.
The exact mechanisms of airborne transmission for monkeypox are not yet fully
understood, and ongoing studies are being conducted to gain more knowledge.
The
duration of infectiousness for individuals with monkeypox is still being
studied. Generally, they are considered infectious until all their sores have
formed crusts, the scabs have fallen off, a new layer of skin has developed
underneath, and all sores in the body (including the mouth, throat, eyes,
vagina, and anus) have completely healed.
Contamination
of the environment with monkeypox virus can occur when an infected person
touches items like clothing, bedding, towels, devices, and surfaces. If another
person with cuts, abrasions, or accidental contact with their eyes, nose,
mouth, or other mucous membranes comes into contact with these contaminated
objects, they are at risk of infection. This type of transmission is known as
fomite transmission. It can be prevented by promptly washing hands after
handling anything that may be infected. There is also a possibility of
contracting the virus from contaminated clothing, bedding, towels, or inhaling
skin flakes. Experts are still investigating whether this mode of transmission
plays a significant role in the ongoing pandemic.
The
virus can also be transmitted from a parent with monkeypox to a fetus during
pregnancy, during or after birth through skin-to-skin contact, or from an
infected parent to an infant or child during close contact.
While
asymptomatic infections have been reported, it is unclear whether individuals
without symptoms can transmit the disease or if it can spread through other
bodily fluids. Live monkeypox virus has been isolated from semen, but it is not
yet determined whether infection can occur through semen, vaginal fluids,
amniotic fluids, breast milk, or blood. Research is currently underway to
gather more information about the potential transmission of monkeypox through
the exchange of these fluids during and after symptomatic infection. It should
be noted that animals can also be affected by this virus, although there have
been limited reported cases in animals.
ANIMAL TO HUMAN TRANSMISSION:
When individuals come
into contact with an infected animal, such as a non-human primate, terrestrial
rodent, antelope, gazelle, or tree squirrel, through actions like bites,
scratches, hunting, skinning, trapping, cooking, or handling carcasses, there
is a risk of contracting the disease. Consumption of inadequately cooked meat
from infected animals can also lead to the transmission of the virus through
ingestion. To reduce the likelihood of contracting monkeypox from animals, it
is advisable to avoid unprotected contact with wild animals, particularly those
that appear sick or dead, including monkeys. In regions where monkeypox is
prevalent among animals, it is crucial to ensure that any food containing
animal parts or meat is thoroughly cooked before consumption.
IS
MONKEYPOX FATAL?
The less severe West African clade is
causing the current world outbreak (2022). No one has died from this outbreak
to date. But monkeypox can lead toother problems (complications) like pneumonia
and infections in your brain(encephalitis) or eyes, which can be fatal.
PATHOPHYSIOLOGY OF MONKEYPOX:
With
the exception of the fact that the virus most likely enters the body through
microscopic skin lesions or oral mucous membranes, the pathophysiology of
monkeypox in humans is virtually the same as that of smallpox. Viral invasion
may also occur through the respiratory system in exceedingly rare cases of
transfer from one person to another.
Although monkeypox causes more
lymphadenopathy than smallpox, it can also spread through lymphoid tissue. The
virus first localizes in mononuclear phagocytic cells after being discharged
into the bloodstream, and then it localizes again in skin cells. For more
detailed information, please refer to the pathophysiology
section of the smallpox virus.
The
monkeypox orthopoxviral is responsible for causing the disease. The lipoprotein
layer has tubules or filaments that cover the viral DNA, and the viruses are
oval brick-shaped. It is a zoonotic virus, and the main routes of transmission
are thought to be direct contact with infected animals or, less likely,
consumption of their undercooked flesh. In particular, when the skin barrier is
weakened as a result of bites, scratches, or other trauma, vaccination may
occur through cutaneous or mucosal sores on the animal. [7]
PRECAUTION
AND TREATMENT:
How
is monkeypox diagnosed?
Because
monkeypox is rare, a healthcare provider may first suspect other rash
illnesses, such as measles or chickenpox. But swollen lymph nodes usually
distinguish monkeypox from other poxes.
To
diagnose monkeypox, your healthcare provider takes a tissue sample from an open
sore (lesion). Then, they send it to a lab for polymerase chain reaction (PCR)
testing (genetic fingerprinting). You may also need to give a blood sample to
check for the monkeypox virus or antibodies your immune system makes in defence
of it.
In countries where animals carry monkeypox, protect yourself by avoiding
unprotected contact with wild animals, especially those that are sick or dead
(including their meat and blood). Any foods containing animal parts or meat
should be cooked thoroughly before eating.
Reduce your risk of catching monkeypox from other people by limiting
close contact with people who have suspected or confirmed monkeypox. Keep
yourself informed about monkeypox in your area or social group and have open
conversations with those you come into close contact (especially sexual
contact) with about any symptoms you or they may have. Clean your hands
frequently with soap and water or an alcohol-based hand rub.
Frequently clean and disinfect commonly touched surfaces in the
environments that could have been contaminated with the virus from someone who
is infectious. Common household disinfectants or bleach products are
enough to kill the monkeypox virus.
If you think you might have monkeypox, you can act to protect others by
seeking medical advice and isolating from others until you have been evaluated
and tested. If you have probable or confirmed monkeypox, you should isolate
from others until all of your sores have crusted over, the scabs have fallen
off and a new layer of skin has formed underneath, and all the sores inside
your body have also healed. This will stop you from passing on the virus to
others. Get advice from your health worker on whether you should isolate at
home or in a health facility. Until more is understood about transmission through
sexual fluids, use condoms as a precaution whilst having sexual contact for 12
weeks after you have recovered.
General
precaution to protect monkeypox:
A
smallpox vaccine provides protection against monkeypox, but its use is
currently limited to clinical trials. Prevention depends on decreasing human
contact with infected animals and limiting person-to-person spread. The Bestway
to help prevent the spread of monkeypox virus is to:
Ø Avoid
contact with infected animals (especially sick or dead animals).
Ø Avoid
contact with bedding and other materials contaminated with the virus.
Ø Thoroughly
cook all foods that contain animal meat or parts.
Ø Wash
your hands frequently with soap and water.
Ø Avoid
contact with people who may be infected with the virus.
Ø Practice
safe sex, including the use of condoms and dental dams.
Ø Wear
a mask that covers your mouth and nose when around others.
Ø Clean
and disinfect frequently touched surfaces.
Ø Use
personal protective equipment (PPE) when caring for people infected with the
virus.
MEDICAL
TREATMENT:
Diagnosis:
Before the treatment of any disease that
should be diagnosed properly for better selection of the treatment.
The
monkeypox clinical presentation other rash illnesses like chickenpox, measles,
bacterial skin infections, scabies, syphilis, and medication-related allergies
must be taken into account during the clinical differential diagnosis. When an
infection is in the prodromal stage, lymphadenopathy can tell monkeypox from
chickenpox or smallpox. Tests for the virus can confirm the diagnosis. [8]
The
primary laboratory test is the polymerase chain reaction (PCR) analysis of
samples from skin lesions. Because the virus only stays in the blood for a
brief period of time, PCR blood tests are typically inconclusive. The onset
dates of the fever, rash, specimen collection date, current stage of the rash,
and patient age must be known in order to interpret test results. [8]
Monkeypox
is not the fetal condition but it may be complicated in several cases so many
of the prevention and proper treatment is applicable. Generally, when the 5th
stage of this virus has occurred in human body that is the complicated
condition. So, patient can easily recover with self-medication and also can
recommendation of medical practitioner or any prescriber.
If
have monkeypox symptoms, there are over-the-counter medications that can help
you feel better, including:
Pain
relievers and fever reducers. Medicines like
ibuprofen (Advil®,Motrin®) and acetaminophen (Tylenol®) can help you feel
better.
Oatmeal
baths. Soaking in a warm bath with colloidal
oatmeal can relieve the dry, itchy feeling that comes with skin rashes.
Isolate
yourself if you’re infected. Avoid contact with others
until all of your lesions have scabbed.
Cover
single or local lesions. Use gauze or bandages to
limit the spread toothers and the environment.
Take
good care. It’s important to stay home and rest
when you’re sick, wear a mask around others and drink plenty of fluids.
Avoid
contact with pets (especially rodents).
Currently,
tecovirimat, cidofovir, and VIGIV are available from the Strategic National
Stockpile under Expanded Access Investigational New Drug (EA-IND) protocols
held by the Centers for Disease Control and Prevention (CDC) for treatment of
OPXV infections in an outbreak scenario. In the United States, these
medications can be accessed through the CDC via requests from state and
territorial health departments. As of this writing, the CDC is developing
EA-IND for use of Brin cidofovir for treatment of OPXV infections.[9]
HERBAL
REMEDIES BY PLANET AYURVEDA FOR MONKEYPOX
As
examples of natural herb preparations offered by Planet Ayurveda are curcumin
capsules and maha sudarshan kwath, which are made in accordance with
traditional methods and effectively treat monkeypox, These formulations are
extremely successful at promoting the patient's health and effectively managing
the diseased state because they contain valuable ayurvedic herbs and are made
strictly in accordance with the instructions provided in the samhitas
(classical scriptures). The following is a list of the ayurvedic remedies for
monkeypox that are effective.
1. PLANT
CURCUMIN:
Curcumin
is a bright yellow chemical produced by plants of the Curcuma longa
species. It is the principal curcuminoid of turmeric (Curcuma longa), a member
of the ginger family, Zingiberaceae. It is sold as a herbal supplement,
cosmetics ingredient, food flavoring, and food coloring.
Curcumin
capsule:
Curcumin
capsules by planet ayurveda are prepared using natural extracts of a very
beneficial ayurvedic component namely haridra (Curcuma longa). It contains
numerous medicinal properties. Haridra helps to balance all the three dosha of
the body. It is kushta hara (manages skin diseases), kandu hara (manages
itching), and vrana hara (improves healing of wounds). Haridra is also useful
in detoxifying the blood and contains anti-inflammatory properties. These
medicinal properties will help to manage the condition of monkeypox
effectively.
Dosage –
One capsule two times a day, after meals.
2. Septrin tablet:
Septrin
tablets prepared by Planet ayurveda contains natural extracts of various health
benefiting ayurvedic components such as guggul (Commiphora mukul), tulsi
(Ocimum sanctum), marich (Piper nigrum), etc. The combination of these herbs
will help to fight off the disease-causing pathogens and establish the hindered
equilibrium between the dosha, hence bringing back the healthy state. It
promotes a healthy digestive system and a healthy respiratory system also.
Hence, it helps to improve the overall condition of the patient with monkeypox.
Dosage –
One tablet two times a day, after meals.
3. Maha sudarshan kwath
Maha sudarshan kwath is being prepared by planet ayurveda using
beneficial extracts of various ayurvedic components such
as amla (Emblica officinalis), haridra (Curcuma longa), pippali (Piper longum),
shigru (Moringa oleifera), etc. These are presented in the form of decoction
exhibiting numerous health benefits. It is beneficial in various acute and
chronic fevers, weakness, reduced digestion, etc.
Dosage –
Two teaspoon two times a day, after meals.
4. Gandhak Rasayan
Gandhak
Rasayan is an Ayurvedic formulation presented by planet ayurveda. It is
prepared using pure extract of a very beneficial ayurvedic component namely
gandhak (Sulfur (purified)). It shows great results on the overall health of
the body. It helps to detoxify the blood of the body. It acts as an antibiotic
and anti-inflammatory agent. Hence, will help to improve the condition of
monkeypox. It is also beneficial in various other skin related disorders such
as urticaria, acne etc.
Dosage –
One tablet two times a day, after meals.[10]
