Monkeypox is a rare disease caused by monkeypox virus infection. This virus belongs to the Orthopoxvirus genus, Poxviridae family(1). Other viruses that are part of the Orthopoxvirus genus are cowpox virus, smallpox virus and vaccinia virus (from smallpox vaccine)(1). Monkeypox virus was identified in monkeys, in 1958, in a Danish laboratory(2). The first case of human monkeypox was reported in 1970, in the Democratic Congo Republic, in a child initially suspected of smallpox. This infectious disease is currently endemic in Central and Western Africa(1). Although the natural reservoir is still unknown, the transmission of this virus to humans appears to be from African rodents and monkeys(1),(3).
On 21 May 2022, the World Health Organization (WHO) has reported 92 confirmed cases and 28 suspected cases of monkeypox in 12 states, which are not endemic for this virus (Australia, Belgium, Canada, France, Germany, Italy, Netherlands, Portugal, Spain, Sweden, United Kingdom, United States of America)(4). The virus can be transmitted through close contact with skin lesions, body fluids or respiratory droplets from infected animals(4). However, the existing data in the specialized literature also emphasize the possibility of interhuman transmission of this virus(4). The incubation period can vary between 5 and 21 days(4). Monkeypox is usually self-limiting, with clinical manifestations being very similar to those in smallpox(4). However, in certain categories of individuals, such as pregnant women, children and persons with immune suppression, this disease may have a more severe evolution(4). Signs and symptoms that patients with monkeypox virus may experience include headache, fever, myalgia, back pain, asthenia and lymphadenopathy(4). After 1-3 days, the patients develop a rash on the face and extremities, which may progressively expand(1). The skin lesions evolve in several successive stages: macules, papules, vesicles, pustules and scabs(1). Patients are no longer considered possible vectors of transmission of the infection at the time when all crusts fall off. In general, the duration of the disease varies between 2 and 4 weeks(1).
To establish a positive diagnosis, it is necessary to evaluate epidemiological indicators such as trips to endemic areas, interaction with animals imported from endemic areas, contact with infected animals or infected people(5),(6). Clinical and epidemiological criteria may differ depending on the geographical area(5). The diagnosis of monkeypox requires laboratory confirmation (isolation in viral culture or Polymerase Chain Reaction (PCR) for monkeypox deoxyribonucleic acid (DNA) from a patient specimen)(5).
There is currently no pathogenic treatment for monkeypox. Therapeutic management includes symptomatic treatment and measures to prevent the spread of the virus(5). For severe cases, certain drugs that have been shown to be effective against orthopoxviruses in animal studies and severe vaccinia vaccine complications, can be used: brin cidofovir, tecovirimat, intravenous vaccinia immune globulin (VIG)(5).
In conclusion, monkeypox is a new public health issue. WHO expects that new cases of monkeypox will be reported in several non-endemic regions(4). A vaccine is currently available (Ankara vaccine) and the WHO is evaluating the need to administer it to special categories of individuals such as close contacts and health workers. The Centre for Disease Control and Prevention (CDC) claims that vaccination in the first 4 days after exposure can prevent the disease and vaccination within 14 days can reduce the severity of the disease(4).
Address for correspondence:
Camelia C. DIACONU