In article <t1llgs$348po$195@news.freedyn.de>
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Monkeypox, a zoonosis, is caused by the monkeypox virus (MPXV)
from the Poxviridae family. The vaccinia, variola, and cowpox
viruses are from the same family. According to the United States
(US) Centers for Disease Control and Prevention (CDC), more than
30,000 monkeypox cases have been identified in the current
outbreak from over 80 countries/territories.

Most cases have been detected in Europe, the Americas, Africa,
the Western Pacific, and the Eastern Mediterranean. Preliminary
reports suggest that most patients are bisexual, gay, and men
who have sex with men (MSM). More than 8000 cases of monkeypox
have been reported in the US. Developing appropriate strategies
to prevent secondary transmission is crucial, yet it is
overlooked in the US even as cases soar in numbers.

The study and findings
In the present study, researchers described the case of a 26-
year-old patient with monkeypox. The patient was a polygamous,
homosexual male with a previous history of syphilis and pre-
exposure prophylaxis for human immunodeficiency virus (HIV). The
patient visited the emergency room (ER) due to a progressively
worsening rash around the mouth and on the tongue, which began
five days previous.

The subject reported having unprotected intercourse a day before
symptom onset and woke up the next day with lesions on the face,
tongue, and around the mouth. Lesions worsened a day later, and
the subject experienced a low-grade fever. Upon seeking care,
the patient was prescribed nystatin, and Valtrex for suspected
infection with herpes simplex virus (HSV).

Symptoms deteriorated despite the ongoing treatment; the number
of lesions increased, and the subject had a sore throat, burning
sensation in the mouth, swollen tongue, and difficulty
swallowing solid food. Physical examination revealed multiple
umbilicated pox-like oral and perioral lesions, with oral thrush
and palpable lymphadenopathy in the neck.

A cardiac examination revealed tachycardia and regular rhythm.
Multiple bilateral enlarged posterior jugular and submandibular
lymph nodes were identified in computed tomography of the
head/neck with contrast. There was no evidence of swelling of
soft tissues in the epiglottis, larynx, or oropharynx. Due to a
sepsis alert, the patient was started on antibiotics, including
intravenous vancomycin, piperacillin/tazobactam, intravenous
dexamethasone with acyclovir, and fluconazole in the ER.

After admission, the infectious diseases and ENT teams were
consulted for recommendations. Polymerase chain reaction (PCR)
tests were performed to rule out HSV, monkeypox, varicella, and
the coronavirus disease 2019 (COVID-19).

All tests were negative except for monkeypox. The fluorescent
treponemal antibody absorption (FTA-ABS) test and a follow-up
rapid plasma reagin test for syphilis returned positive.
Intravenous antiviral and antibiotics were discontinued. The
patient was given magic mouth wash, intravenous fluconazole for
oral thrush, and intramuscular penicillin.

The patient had no history of recent international travel.
Symptoms did not improve much over time, with significant tongue
swelling and increased lesions on the third day of
hospitalization. The patient was started on tecovirimat (ST-
246), and symptoms began improving by the fifth day, with the
lesions crusting.

The subject was discharged in a stable condition and instructed
to follow up in one week and take ST-246 twice daily for two
weeks and fluconazole once daily for five days. The ER and
admitting providers evaluated the subject using only surgical
masks and gloves, and they remained free from symptoms even
after 21 days of exposure to the virus.

Conclusions
Although monkeypox has been endemic in Africa, many countries
that have historically not reported monkeypox have been
witnessing outbreaks lately. The current outbreak is driven by
the West African clade of MPXV, which is less contagious/severe
than the Congo Basin clade. The US Food and Drug Administration
(FDA) has licensed two smallpox vaccines for monkeypox. The CDC
recommends against mass vaccination and suggests limiting it for
pre-exposure prophylaxis in high-risk individuals and post-
exposure prophylaxis.

Monkeypox treatment is mainly supportive care as most cases are
self-limiting and mild. Although no specific drug has been
developed, the FDA has approved ST-246 and brincidofovir for
pregnant patients, children younger than eight years, and
immunocompromised subjects. Overall, MPXV is spreading at an
unprecedented rate; thus, it is critical to comprehensively
understand the disease epidemiology and improve global
cooperation for disease surveillance, better epidemic
preparedness, and mitigation of monkeypox.

Journal reference:
Ajmera KM, Goyal L, Pandit T, Pandit R. (2022). Monkeypox � An
emerging pandemic. IDCases. doi: 10.1016/j.idcr.2022.e01587
https://www.sciencedirect.com/science/article/pii/S221425092
2002153?via%3Dihub#fig0005

https://www.news-medical.net/news/20220810/Researchers-describe-
case-report-of-male-monkeypox-patient.aspx