Differential Diagnosis, Prevention, and Treatment of mpox (Monkeypox): A Review for Dermatologists

Abstract

The current 2022 mpox (monkeypox) outbreak has been officially recognized as a public health emergency. The mpox clinical symptoms include high fever, fatigue, chills, headache, swollen lymph nodes, muscle aches, and a disseminated painful rash. However, recent cases of mpox have shown a shift in clinical symptoms, with anogenital skin lesions emerging as the predominant feature. Due to the predominant skin manifestations of mpox, dermatologists could be crucial in detecting new mpox cases and educating frontline healthcare professionals about mpox. The mpox virus is continuously evolving and has several variants. Genome sequencing has revealed that the Clade IIb variant is responsible for the 2022 mpox outbreak. Mpox spread may occur through animal-to-human and human-to-human transmission; however, unlike coronavirus disease 2019 (COVID-19), long-range airborne transmission has not been reported. Healthcare professionals are at higher risk of becoming infected since they are usually in close contact with both the patients and potentially contaminated fomites (e.g., examination table, gowns, gloves). Both public and healthcare professionals should take preventive and avoidance measures to limit the spread. Mpox is usually self-limiting and may require only symptomatic treatment; however, it may cause severe complications in special populations such as immunocompromised individuals. For severe infection, clinicians may consider antiviral drugs (off-label), tecovirimat and brincidofovir, originally approved for smallpox treatment. Two smallpox vaccines, ACAM2000 ® and JYNNEOS TM , can be used as pre-exposure prophylaxis against mpox. JYNNEOS TM , which carries approval for mpox use, has less adverse effect potential than ACAM2000 ® , and may also be used as post-exposure prophylaxis, preferably within 4 days of exposure. Key PointsGenital skin lesions are a dominant symptom in the recently reported mpox cases.Dermatologists and healthcare professionals should be more cautious and take certain preventive measures since they are usually in close contact with patients infected with the mpox virus.Clinicians usually recommend symptomatic treatment for mpox patients; however, tecovirimat and brincidofovir, two smallpox drugs, can be recommended off-label for severe mpox infections.

Resident Physicians’ Knowledge and Preparedness Regarding Human Monkeypox: A Cross-Sectional Study from Saudi Arabia

“…An important finding is that dermatology residents have a higher confidence in dealing with Mpox. Because of the predominant skin symptoms of Mpox (including anogenital skin lesions), dermatologists can play vital role in identifying new Mpox cases, assisting in the diagnosis and prevention of disease spread through identification and isolation, contact tracing, and education [ 29 , 30 ]. In the case of knowledge about Mpox, participants with medical specialisms in preventive medicine and dermatology have also showed a higher prevalence of good knowledge about Mpox.…”

Global Re-emergence of Monkeypox: A Synoptic Review

“…9 To ensure the appropriate transfer of exudate or lesion base specimens to testing media, it is imperative to employ swabs made of dacron, nylon, or polyester instead of cotton. 40 Both the individual collecting the specimen and the laboratory personnel should exercise caution and adhere to a risk-based approach in handling the specimen. 40 The detection of antibodies in plasma or serum alone does not provide a definitive diagnosis for mpox.…”

Monkeypox virus (MPXV): A Brief account of global spread, epidemiology, virology, clinical features, pathogenesis, and therapeutic interventions

“…Swab samples taken in a fluid medium from the rash are the most often used samples. PCR, RT-PCR, cell culture, and whole genome sequencing can be used to screen the remaining samples [ 49 ]. Thus, an organized laboratory with skilled persons requires to screen MPXV DNA.…”