The Diagnostic Department and the National Measles and Measles Reference Laboratory is ready for the diagnosis of rash diseases such as smallpox of monkeys, the Hellenic Pasteur Institute (EIP) announced.
Here is a detailed information about the monkey pox he did Dr. Manolis Angelakis, biopathologistclinical microbiologist, director of the Diagnostic Department and the National Public Health Reference Laboratories of the EIP.
Transmission
Monkey pox is a zoonotic disease with occasional human infections commonly occurring in forested areas of Central and West Africa. It is caused by the monkeypox virus, which belongs to the Orthopoxvirus family. The main reservoirs remain unknown, although they are likely to be found in rodents. Contact with live and dead animals through hunting and eating wild game meat are known risk factors. Transmission from animal to human (zoonotic agent) can occur through direct contact with blood, body fluids, skin wounds or the mucous membranes of infected animals. Secondary – or human – to – human transmission is relatively limited. Infection can result from close contact with respiratory secretions, skin lesions of an infected person, or from recently infected objects. Transmission through droplets and respiratory particles usually requires prolonged face-to-face contact, which puts health workers and household members at greater risk of active infection. The largest documented transmission chain in a community was six consecutive person-to-person infections. Vertical transmission from mother to fetus can also occur through the placenta (congenital smallpox of monkeys).
Symptoms
The incubation period – the period from infection to the onset of symptoms – of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days. The infection can be divided into two stages:
* The first stage (lasts 0-5 days) is characterized by fever, severe headache, lymphadenopathy (swelling of the lymph nodes), back pain, myalgia (muscle aches) and severe exhaustion (lack of energy). Lymphadenopathy is a hallmark of monkey pox compared to other diseases that may initially present with similar symptoms (chickenpox, measles, smallpox).
In the second stage, the skin rash usually appears within 1-3 days of the onset of fever. The rash tends to be more concentrated on the face and extremities. It affects the face (in 95% of cases) and the palms of the hands and the soles of the feet (in 75% of cases). Also affected are the oral mucosa (in 70% of cases), the genitals (30%), the conjunctiva (20%), as well as the cornea. The rash develops sequentially from spots (lesions with a flat base) to papules (slightly elevated permanent lesions), vesicles (lesions filled with clear liquid), blisters (lesions filled with yellowish fluid) and drying crusts. The number of damage varies from a few to several thousand. In severe cases, the lesions may coalesce until large areas of skin are removed.
Smallpox is usually an autoimmune disease with symptoms lasting from 2 to 4 weeks. Serious cases are more common among children and are related to the extent of exposure to the virus, the patient’s state of health and the nature of the complications. Complications of smallpox in monkeys can include secondary infections, bronchopneumonia, sepsis, encephalitis, and corneal infection with consequent loss of vision. The mortality rate of monkey pox has ranged between 0 and 11% in the general population and was higher among younger children.
Diagnosis
The clinical differential diagnosis, which must be considered, refers to other rash diseases such as chickenpox, measles, bacterial skin infections, scabies, syphilis and drug allergies. The best clinical specimens for the diagnosis of monkey pox are from skin lesions. Samples should be stored in a dry, sterile tube (without virus carriers) and kept at a low temperature. Polymerase chain reaction (PCR) is the preferred laboratory test for diagnosis given its accuracy and sensitivity. Molecular examination in blood samples is not recommended due to the short duration of viremia.
Tips of EIP Diagnostic Department
In addition to continuously tracking contacts and locating sources, incident search and local surveillance should be strengthened in the wider community, as well as in primary and secondary health care settings. Any patient suspected of having smallpox in monkeys should be investigated and isolated with supportive care during the infectious period – incubation and infection stages – respectively. Early detection of contacts, surveillance measures and awareness raising of healthcare providers are essential to prevent further secondary cases and to effectively manage the current outbreak. In addition, the development of drug alternatives in the context of research protocols may be considered.
Health care providers and caregivers of suspected or confirmed monkey pox should apply standard precautionary and contamination control precautions. Samples taken from individuals suspected of being infected or from animals suspected of being infected with the smallpox virus should be administered under safe conditions by trained personnel and in properly equipped level three biosafety laboratories.
The importance of hand hygiene with the use of soap and water or alcohol-based disinfectant should be emphasized.
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