Disease History, Pathogenesis, Diagnostics, and Therapeutics for Human Monkeypox Disease: A Comprehensive Review

Abstract

The monkeypox disease is a zoonotic-infectious disease that transmits between animals and humans. It is caused by a double-stranded DNA virus belonging to the Orthopoxvirus genus that is closely related to the variola virus –the causative agent of smallpox. Although monkeypox infections were endemic to Western and Central Africa, the newly emerging monkeypox outbreak spread to more than 90 non-African countries. With the exception of the PCR-confirmed case of a return from Nigeria to the United Kingdom, the ongoing outbreak is largely unrelated to travel. In the most recent wave, cases are characteristically males in their thirties. Risk factors include close and particularly sexual contact with an infected person, aerosolized-infectious material, and contact with fomites or infected animals. Clinical diagnosis of monkeypox is confirmed with nucleic-acid amplification testing of samples originating from vesicles or genital lesions and using real-time or conventional PCR. Other methods, such as electron microscopy, immunohistochemistry, and virus culture, are costly and time-consuming. In addition to timely diagnosis and contact tracing, restrictive measures to limit spread, such as isolation of infected patients, preventing contact with wild animals, and isolation of animals suspected to be viral reservoirs has shown promise. Although there are no specific treatments for monkeypox disease, the experience with smallpox suggests that the vaccinia vaccine, cidofovir, tecovirimat, and vaccinia immune globulin (IVG) may be beneficial for monkeypox treatment. In this review, we provide an update on the human-monkeypox disease with a special emphasis on its pathogenesis, prevention, diagnostics, and therapeutic measures.

How and when does monkeypox (mpox) transmit: Implications for prevention and treatments

“…Secondly, in HIV patients, some clinical characteristics of mpox might be different from non-those in non-HIV patients ( Amorosa and Isaacs, 2003 ; Saied et al, 2022 ). Although in general, well-controlled HIV was not associated with severity of the symptoms, HIV-positive patients were more likely to have fevers (60% of HIV patients vs. 50% of non-HIV patients; Català et al, 2022 ).…”

“…Thus, for those with low CD4 cell counts, the decision whether or not to vaccinate must be made within the context and circumstances of the mpox outbreak. Alternatively, the immuno-compromised people or the patients with atopic dermatitis should receive a third-generation non-replicating vaccine that was made based on modified vaccinia Ankara (MVA) ( Saied et al, 2022 ). It is interesting to note that some MVA vaccine may be considered for post-exposure prophylaxis, ideally within 4 days of high-grade exposure ( Vaughan et al, 2020 ).…”

“…The mainstay of clinical treatments for MPXV infections are supportive and/or symptomatic managements ( Reynolds et al, 2017 ). Although there are a few antiviral drugs have been prescribed for mpox patients, such as Cidofovir, Brincidofovir, and Tecovirimat ( Adler et al, 2022 ; Thornhill et al, 2022a ; Rizk et al, 2022 ; Saied et al, 2022 ), no prophylactic drug has been approved. Whether some drugs could be considered in mpox pre-exposure prophylaxis needs further investigations.…”

“…MPXV infection outbreak usually has a central point, and the original patient should have travelled to epidemic areas or have a clear history of exposure to infectious sources (such as some animals; Bunge et al, 2022 ). However, the current outbreak occurs in several non-endemic countries simultaneously, and the most reported cases have neither contacted with wild animals directly nor been to the endemic countries in Africa ( Perez Duque et al, 2022 ; Saied et al, 2022 ). Moreover, after the Corona Virus Disease 2019 (COVID-19), people’s social distance increases, and the probability of contact transmission was decreased.…”

“…Moreover, after the Corona Virus Disease 2019 (COVID-19), people’s social distance increases, and the probability of contact transmission was decreased. It is difficult to explain the current mpox epidemic with the common transmission pathways ( Saied et al, 2022 ).…”