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Human monkeypox disease has most commonly occurred
following the consumption of an infected food source
(such as primates or rodents in Africa) or from the
direct contact with body fluids from an infected individual
or animal. Our understanding of the histopathology of
monkeypox virus infections in humans is limited but
it is believed to be similar to that observed with smallpox.
The incubation period of the disease following exposure
to the onset of fever is about 12 days. The disease
course progresses quickly once the patient becomes viraemic.
Clinical signs include:
- Fever of >99.30F/37.40C
- Productive cough, sore throat, shortness of breath,
headache, backache, malaise, chills and/or sweats,
- Generalized lymphadenopathy (not observed with
smallpox) is more frequently observed in primary cases.
- Centralized or localized rash which evolves shortly
after the onset of fever (macular, papular, vesicular
- Hyper-pigmentation or scarring are uncommon following
the desquamation of resolved lesions, and corneal
lesions leading to blindness occur rarely
- Enanthem in the oral cavity may occur more often
in primary than secondary cases
- Like smallpox infection, patients should be considered
infectious until all scabs separate
Diagnosis & Treatment
Diagnostic Samples : Pharyngeal swab, scab material,
Differential Diagnosis : varicella, molloscum
- Victim (overt attack): Undress, soap, and shower.
- Responder: Surveillance and containment (maintain
minimum 17d or until all scabs separate)
- Environment: 0.5% bleach or hot soapy water
- Fomites: Exercise respiratory and skin contact precautions
when handling infected bedding or clothing prior to
- Scabs separated from patients may remain infectious
for several days or longer under ideal conditions.
- Smallpox vaccine Give immediately, unless
contraindicated, if previous vaccination was > 3y
before. Even in previously unvaccinated individuals,
effective if given within 3 to 4 days following exposure.
- Cidofovir (pediatric dosage is not yet established)
possibly effective, at least prophylactically, based
on in vitro and animal data. Cidofovir therapy is
not FDA licensed for the treatment of Orthopoxvirus
- Supportive therapy plus antibiotics to preclude
secondary infection may be indicated.
- Steroid therapy may exacerbate the disease and
is contraindicated for Orthopoxvirus infections.
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