Abstract

Monkeypox is a disease caused by the monkeypox virus. It is similar to small viruses belonging to the genus Orthodox virus. The disease was first detected in monkeys in 1958. It is transmitted from both animals and humans. We conducted a bibliometric analysis of the treatment of MPOX disease using data from various repositories such as PubMed, Scopus, Google Scholar, Springer, etc. More than 16,000 cases of measles have been recorded in countries where the disease was not common until this year, and the gradual increase in measles cases in Africa over the past few years has not attracted much attention from the international scientific community. The World Health Organization (WHO) has declared smallpox a public health emergency of international concern. Although most of the current cases are caused by men who have sex with other men, the risk of infection is higher in the general population. The disease is characterized by a short-term fever and a red rash accompanied by swelling of the glands.

Keywords

Introduction

Mpox, commonly known as smallpox [1].it was first discovered and isolated in 1959 when dogs were sent from Singapore to the Din Amaka Research Facility that became ill [2]. Chikungunya was suspected when the virus was isolated from a child in the Democratic Republic of Congo [3]. However, the eradication of Mosca minor and the subsequent lack of vaccination opened the door for MPOX to become a major clinical focus [4].

Etiology:

 Monkeypox (MPX) virus is a double-stranded DNA virus belonging to the genus Ortho poxvirus of the family Poxviridae [5]. It is associated with mild disease but is not more severe. However, unlike minor viruses, it has a reservoir that allows it to survive and spread. This virus was first discovered in monkeys in Denmark in 1958 [6]. The first human case was reported in a child in the Democratic Republic of the Congo (DRC) in 1970 [7]. Since then, scarlet fever has emerged in Central and West Africa, and two distinct clades have emerged: the Congo Basin or Central African clade (clade 1) and the West African clade (clade 2). The former is more toxic and has a higher mortality rate [8]. As a DNA virus, MPX viruses are unlikely to undergo major mutations and their genetic structure changes frequently. The disease can be transmitted from both animals to humans and from humans to humans [5]. Hosts include monkeys, squirrels, Gambian wallabies, dormice, non-human primates and other species. It is transmitted to humans through animal bites/scratches, close contact, and eating raw meat. Human-to-human transmission occurs through direct contact and fomites for many respiratory pathogens. The secondary infection rate among household members is less than 10%, compared to 35% to 88% for smallpox [9]. The role of direct sex is unclear, but Indian Journal of Pediatrics (October 2022) 89(10): 955-960 transmission may be facilitated by skin-to-skin contact of muscle and mucosa during sexual intercourse. Transmission from mother to fetus or neonate has also been reported to cause congenital MPX [10].

Epidemiology:

Since 1970, cases have been reported in 10 African countries. The Democratic Republic of the Congo is the most affected country, with cases increasing from 38 in 1970 and 1979 to 511 between 1990 and 1999 and 18,788 between 2010 and 2019. The Republic of the Congo (97 cases) and the Central African Republic (67 cases) follow with 181 cases. More than 90% of these cases had no history of smallpox vaccination. The median age of those infected increased from 4 years in 1970 to 21 years in 2010. The cumulative case fatality rate (CFR) was 8.7%. When divided by class, the case fatality rate for class 1 disease is 10.6%, while the case fatality rate for class 2 disease is 3.6%. Children account for only 37.5%. The increase in cases in Africa is due to immunodeficiency following smallpox vaccination and increased human access to forested areas. The rise in cases in Africa has raised alarm in the literature for many years but has been largely ignored [12]. Cases outside Africa were first reported in the United States in 2003, when 53 people (mean age 26 years, range 4–53 years) contracted West African disease after exposure to a pet groundhog, which is spread by exotic animals. In Ghana [13], 21 percent are vaccinated against smallpox. Twenty-six percent were hospitalized, including a 10-year-old child with nonfatal encephalitis; between 2018 and 2021, many countries reported small cases but no deaths (1 in Israel, 1 in Singapore, 7 in the United Kingdom); Since then, the number of cases among people with no travel history to the disaster area has increased. Between 1 January 2022 and 22 July 2022, 16 016 laboratory-confirmed measles cases and five deaths were reported to WHO from 75 countries across all six WHO regions [16]. The five countries with the most cases worldwide are Spain (n=3125), the United States (n=2316), Germany (n=3125), Germany (n=2316) (2268), and Great Britain and Northern Ireland (n=2137). The Africa region reported only 301 confirmed cases but five deaths. However, the Africa Surveillance Network reported approximately 1400 cases with 63 deaths in 2022 [17]. Given the increasing number of patients worldwide, the World Health Organization declared MPX as a Health Security Initiative (PHEIC) on July 23, 2022 [18]. A recent multicity study examined 528 MPX patients (527 males and 1 female) in 16 countries across five countries between June 27, 2022 and July 24, 2022. The mean age of the patients was 38 years (range, 18–68 years) [19]. Ninety-eight percent of the patients were gay or bisexual men, 75% were white, and 41% were HIV positive. Remarkably, 95% of people living with HIV were receiving antiretroviral therapy, and the vast majority had undiagnosed infections. Twenty-eight percent had a history of international travel, and 29% had a sexually transmitted infection. 95% of cases are usually transmitted through sex. MPX DNA was detected in 29 of 32 people whose semen was analyzed in this study; Nine percent of study patients reported a history of smallpox vaccination. No one died. As of July 24, 2022, 4 cases of MPX have been reported in India; All four were male. The first three cases were from Kerala and had a history of international travel, but the latest case from Delhi had no history of international travel [20]. The reasons for the re-emergence of scarlet fever in infected and uninfected areas include changes in the pathogenesis of the disease, climate change, waning immunity after smallpox vaccination, international travel, and high risk of sexual intercourse after transportation. Regarding COVID-19 restrictions [twenty-one]. Phylogenetic analysis showed that the cause of this outbreak was MPX in clade 3, and that the disease was related to the 2021 outbreak in Maryland, USA, which was related to clade 2 viruses in Nigeria [twelve]. The genetic codes of each associated disease are now close to each other, indicating the origin of the phenomenon.

Although it now mostly affects older gay men, the disease will spread to the general population, women, and children. Healthcare workers are at high risk of infection, and there are also concerns about humans infecting animals and animals being re-infected [23].

Pathophysiology:

After infection by any route (oropharyngeal, nasopharyngeal, or intradermal), mpox virus multiplies at the site of inoculation and spreads to regional lymph nodes. Primary viremia then causes infection and seeding of other organisms. This represents the incubation period, which usually lasts 7 to 14 days with a maximum of 21 days. Onset of symptoms is associated with other viremia, which causes prodromal symptoms such as fever and lymphadenopathy 1 to 2 days before onset of lesions. Persons currently infected will be contagious. Infection begins in the oropharynx and later appears in the skin. Anti-diabetic antibodies are often seen when a wound is present [24].

Clinical feature:

The incubation period ranges from 5 to 21 days, usually 6 to 13 days. All age groups are affected, but the mean age has increased over time [11]. Males are more affected than females. Clinical features are similar to other poxviruses, including mild disease [25]. The prodromal phase usually lasts 0–5 days and is nonspecific. Fever, headache, fatigue, myalgia and swollen lymph nodes are symptoms. The fever is often preceded by swollen lymph nodes in the groin, arms or neck, which may be unilateral or bilateral. A rash appears and lasts two to four weeks. The disease has a painful and polymorphic course until the formation of crusts (26). The stages of development of the rash are as follows: Dark spots first appear on the tongue and in the mouth. This is different from measles, which has a centripetal distribution. The lesions are of the vesiculopustular type. Unlike measles, which can present in several stages simultaneously, all human lesions are similar. However, polymorphic masses may occur in vaccinated patients. (28%) and conjunctiva (20%). Involvement of both hands and feet is the hallmark of MPX. From the 3rd day onwards the lesions turn into papules, from the 4th to the 5th day the lesions become vesicles (filled with fluid) and from the 6th to the 7th day the lesions turn into hard pustules that rise sharply and are filled with opaque fluid. deep-seated. They may be umbilical or confluent. The rash will remain for a week before falling off. Hyperpigmented atrophic scars, hypopigmented atrophic scars, patchy alopecia, hypertrophic skin scars and facial muscle contracture/deformity occur after treatment of ulcerative facial lesions. It stops and heals within 2-4 weeks. Make the most of it. Factors that increase the risk of severe disease include young age (childhood), immunosuppression (such as HIV and other chronic diseases), and lack of vaccines that historically prevented smallpox. Complications include secondary infection, bronchopneumonia, sepsis, encephalitis, and bone involvement leading to blindness. Mortality rates range from 1% to 10% and vary by species (discussed earlier), host, vaccination status, and access to care. In a case study of 282 patients from the Democratic Republic of the Congo, no deaths occurred in patients who received smallpox vaccine, whereas 11% of unvaccinated patients died [27]. In the most recent data published during the current outbreak, from 23 individuals with a clear history of exposure, the median time from onset was 7 days (more: 3 to 20 days) [19]. Symptoms preceding the rash included fever (62%), lethargy (41%), myalgia (31%), headache (27%), and lymphadenopathy (56%). Ninety-five percent of rashes occur; approximately two-thirds have ?10 lesions, 73% have anogenital lesions, and 41% have mucosal lesions. Approximately 10% of patients develop genital ulcers. Contrary to what has been reported previously, some patients present with more than one form of disease simultaneously. Severe pain due to anorectal pain occurred in 11.5% of patients, which has not been reported previously. Thirteen percent were hospitalized. Most claims were for pain management, reduction of oral sores due to oral ulcers, treatment of superinfections, and isolation. Three patients developed serious complications: 1 epiglottitis and 2 myocarditis. All patients recovered and there were no deaths. There is a history of going to Turkey without skin removal, but MPX has no known injuries. Family members are unaffected. There were 20 lesions all over the body but no physical features or lymphadenopathy. Routine tests were negative and bacterial DNA was detected by PCR from the wound, throat and blood. This is a Clade 3 strain B.1 but is not related to the current virus in Amsterdam. The child returned to normal. The origin of this disease is unknown. In the Democratic Republic of Congo, two out of four pregnant women with measles had an early pregnancy loss and one had a second pregnancy loss [10]. Childbirth still causes a rash, and MPX virus has been detected in the tissues of the uterus, umbilical cord, and placenta. Remember, this is worse than part 1;

Treatment:

Treatment of MPX includes symptomatic and supportive measures such as diet, antibiotics/antibiotics, early detection of secondary infections and timely treatment with appropriate antibiotics [28]. Several anti-inflammatory drugs are available for MPX. Cidofovir works by inhibiting viral polymerase and has in vitro antipoxic virus activity. However, it is highly nephrotoxic. Bricidofovir (CMX-001) is a modified version of cidofovir that is less nephrotoxic. However, three MPX patients in the UK reported no improvement after cidofovir treatment in Brin [29]. Recently, the drug ST-246 or tekovirimat has been approved in the United States, Canada and Europe for the treatment of Orthopoxvirus, including smallpox, cowpox, monkeypox and cowpox [28]. The envelope protein prevents the virus from exiting the cell, preventing it from infecting other cells. It has been shown to be effective in protecting animals against rabbit and scarlet fever without serious side effects. The US government has stockpiled 2 million doses of the orthopox vaccine in case of a bioterrorism attack. It is sold under the trade name TPOXX® and is widely accepted. Children who weigh more than 13 kg can take this medication. It is also considered safe for pregnant women. Vaccinia immune globulin is obtained from the blood of patients who have been vaccinated against smallpox. It has historically been used to treat infections that develop after smallpox vaccination, but it was also used to treat measles during the 2003 measles outbreak in the United States. antiviral therapy. Antiviral therapy is a suitable option for patients with severe and serious infections, people with weakened immune systems, and expectant mothers [25]. Antibiotics are used to treat MPX in endemic countries. In a recent study, only 5% of patients received antiretroviral therapy (2% antibiotics/topical cidofovir, 2% tekovimab, and <1>

Prevention and control:

Improved disease prevention, including continuous surveillance and isolation of new animals, will help prevent the spread of animals. Improved hygiene is needed to prevent fomites from spreading and developing into a new infection. Vaccination is an option to protect animals. Since admixture has been reported in Asian monkeys and African primates, care should be taken to separate these species. Anyone infected with measles should avoid contact with animals, especially rodents and non-human animals, to prevent transmission [30]. In an outbreak, transmission of monkeypox can be controlled by isolating infected animals (at least 6 weeks from the date of last contact) and monitoring the approach of contacts. The premises where these animals are kept should be thoroughly cleaned and disinfected. Specific instructions from your state or local health department or the CDC website should be followed.

CONCLUSION:

The burden of the disease is expected to increase as MPX is considered a global crisis. Since there have been no previous reports of MPX in India, doctors know little about its transmission, limited diagnostic resources, the course and treatment modalities of the disease are unclear, and treatment and prevention are poorly understood. In addition to following procedures for diagnosis, reporting, and patient isolation, doctors must maintain a high level of suspicion for the disease and work to isolate it based on perceptions and concerns in the community. Although the disease has received international attention in non-endemic countries, control of the disease in Africa, where mortality is highest, should be a priority. Future research should not focus on tropical diseases. The saying, “No one is safe unless everyone is safe” applies to today’s global business world.

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