Monkey-pox: Another threatening virus | By Zainab Inam, Madiha Durrani


Monkey-pox: Another threatening virus

MONKEYPOX virus (MPXV) has currently swept the world in the endemic areas of West and Central Africa.

World Health Organization has declared the outbreak as a public health emergency of International concern.

The virus may cause eye infection as red eye-leading to visual loss in some cases. But how common are these complications and when patients should contact a doctor is our major concern.

Monkeypox is closely related to smallpox, but far less deadly and contagious. This virus is not a new entity, and was first identified in 1958 in monkeys and later spread to humans.

In fact, these monkeys were transported to Denmark for scientific research, but the scientists believe that it has been circulating since thousands of years. Interestingly, it has now been identified in wild monkeys and many other rodents.

The infection in humans has created an alarming situation worldwide. The first case was reported in 1970 in Republic of the Congo and in 2003 in USA.

Recently, the cases are swiftly spreading over 50 countries and has affected 5115 people in European countries: the United Kingdom1076 (21.03%),Germany 874 (17.08%),France 440 (8.60%), Portugal 391 (7.62%), United States 350 (6.84), Canada 276 (5.39%), Netherlands 257 (5.02%), Italy 159 (3.10), Belgium 117 (1.59%), Switzerland 81 (1.58%), Israel 33 (0.64%), Ireland 31 (0.64%),Spain 800 (15.64%), including North and South America, Asia, Australia, and in Middle Eastas confirmed cases.

The infection is swiftly shifting from endemic regions to non-endemic countries. So far, no case has been reported in Pakistan. The health authorities must remain conscious about the onslaught of Monkeypox and take priority-based preventive measures to stop the disease.

The symptoms usually start within 3 weeks of exposure to the virus and the illness typically lasts 2-4 weeks, but it can spread to anyone through close, personal, often skin-to-skin contact, through body fluids, fabrics (clothing, bedding, or towels), contact with respiratory secretions, scratched or bitten by the infected animals or using the same utensils of the patient.

A pregnant lady can spread the virus to the fetus through the placenta. Monkeypox virus has also been detected in children through close skin-to-skin contact from a caregiver, or transmission through a needle as well as through tattooing.

The symptoms occur as painful or itchy rash, blisters or pimples may erupt on the face, genitals, chest, hands or feet with flu-like symptoms, such as fever and headache.

The monkeypox rash have a characteristic appearance, and shares some similarities with other infections such as herpes simplex, zoster, chickenpox with typical red eyes. Watch for any lesions around the skin of the eyes.

Avoid touching your face or rubbing your eyes, especially if you have blisters on or near your eyelids, which can increase the risk to the eye infection, which has been far less common in the current outbreak.

People who have been vaccinated against smallpox or monkeypox have a relatively low risk of developing visual-threatening problems.

According to current research the eye complications could be an infection of the cornea that could lead to loss of vision but permanent blindness is an extremely rare complication.

If the patient develop pain in the eye or decreased vision, contact an eye specialist as soon as possible.

The FDA has not approved any eye medications specific to monkeypox, but doctors may use antiviral medications, antibiotics or anti-inflammatory drugs.

If the patient has mild symptoms without pain or blurred vision, try the common remedies like refrigerated artificial tears to soothe the eyes and if you have eyelid swelling, try applying cold compresses to the closed eye, avoid wearing contact lenses.

Use a new pair once you have fully recovered and stop wearing eye makeup until your eyes are fully recovered.

If monkeypox infection is confirmed, isolate the patient at home until the rash has completely healed, and follow the precautions: Avoid sharing fabrics such as bedding, towels or clothing with other people, try not to touch your face or rub your eyes, use hand sanitizer or wash your hands with soap for at least 20 seconds.

Don’t share the utensils, if you are caring the patient, and be sure to wear gloves and a properly fitted mask.

Avoid intimate contacts which make up the majority of cases in the current outbreak especially handling the urine or feces.

If the signs and symptoms are compatible with monkeypox, patient should be referred for urgent evaluation and initiation of monkeypox treatment, and public health officials should be promptly notified to proper authorities.

Clinicians should consider initiation of prompt systemic antiviral therapy as well as topical trifluridine to prevent complications.

Timely medical treatment will certainly help to prevent threatening complications. Fever, chills, headache, and swelling of lymph glands have also been frequently reported by patients.

Detection of virus by PCR test of skin lesions (e.g., vesicles, ulcers, crusts). It is the recommended method to confirm infection in affected people because skin lesions contain the highest concentration of virus and are most likely to yield positive results as in throat and nasal swabs, even in saliva too.

Several studies have detected monkeypox virus by PCR in tears, eyelid vesicles, blood plasma and feces.

However, no epidemiologic data are presently available to support exposure to breast milk, working instruments such as tweezers and scissors as sources of infection.

Based on the available evidence, it is also possible that after recovery some persons might shed infectious virus for a week or two, while feeling well.

—Amongst authors former is a Medical Student at Foundation University Medical College, Rawalpindi while the latter is a practicing Eye Specialist at Maroof Int’al Hospital, F-10, Islamabad.


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