Archive About Mpox

Mpox is much less severe and contagious than smallpox.

HISTORY

Mpox, formerly known as monkeypox, is a zoonotic disease caused by the monkeypox virus, which belongs to the genus Orthopoxvirus within the family Poxviridae. The disease was first discovered in 1958 in monkeys used for research, leading to its name. Despite this, the disease is more commonly found in wild animals, such as rodents and primates, but can be transmitted to humans. The first documented human case of mpox was identified in 1970 in the Democratic Republic of the Congo (DRC) when global efforts were focused on eradicating smallpox, also an orthopoxvirus. More cases were reported in several Central and West African countries, but it remained rare and primarily confined to rural areas until many years later, notably in 2003 in the United States and then on a global level in 2022.

VIRAL CLADES AND DISEASE SEVERITY

Scientists have identified two distinct viral clades of the mpox virus: Clade I and Clade II.

Clade I is primarily found in Central Africa and is associated with more severe disease outcomes, including higher mortality rates. Clade I has been linked to more extensive human-to-human transmission and tends to cause more pronounced symptoms, such as severe rash, fever, and complications like secondary infections.
Clade II is generally found in West Africa and has been associated with milder disease presentations than Clade I. Most mpox cases in the United States and other non-endemic countries have been Clade II, often resulting from spillover events, when the virus is transmitted from one species to another, mainly involving imported animals or travelers returning from endemic regions. Clade II outbreaks have generally been less severe and more contained.

SYMPTOMS

Symptoms usually start about seven days after exposure to the virus, although they may start as early as three or as late as 21 days. The most common symptom is a rash or lesions that look like pimples or blisters. They may be painful or itchy, and there may only be a few or hundreds of marks on the body. Additionally, these lesions may appear on the face, inside the mouth, on the hands, feet, chest, genitals, or anus. They are usually concentrated on the extremities and face. In cases of sexual transmission, lesions may appear in areas exposed during intercourse.

Other common symptoms include:

Fever
Headache
Muscle aches and backache
Exhaustion
Swollen lymph nodes
Chills
Respiratory symptoms (e.g., shortness of breath, sore throat, nasal congestion, or cough)

HOW IT SPREADS

A person with mpox can spread through several forms of contact, including:

Direct contact with an infected animal: This includes touching, handling, or being bitten or scratched by an infected animal.
Close or intimate contact with an infected person: This includes talking/breathing, kissing, touching, hugging, sex, mucus, and snot, among others.
Direct contact with contaminated materials: This can involve touching clothing, bedding, towels, medical needles, tattoo equipment, or surfaces that have been in contact with an infected person or animal.
Maternal-fetal transmission: Mpox can be transmitted from an infected mother to her child during pregnancy.

LESION PROGRESSION

Diagnosing mpox requires an understanding of the stages of lesion progression.

Rash: The most common manifestation of mpox.
Location: Lesions can appear anywhere on the body, including the face, hands, feet, genitals, and mucous membranes.
Progression: Lesions typically progress through six distinct stages over 2-4 weeks.
Development: Different lesions may be at varying stages of development simultaneously.

Source: National STD Curriculum, project funded by the Centers for Disease Control and Prevention.

Condition	How It Differs from Mpox
Allergic reactions	Widespread rashes, but without the progression seen in mpox.
Herpes / syphilis (STIs)	May cause sores, but with a less defined progression.
Scabies	Intense itching, but lesions appear differently and in different locations.
Bacterial skin infections	Swelling and redness but no firm, deep-seated lesions.
Measles	Typically accompanied by cough, runny nose, and red eyes.
Chickenpox	Lesions are more superficial and lack a central dot (umbilication).

DIAGNOSTIC TESTING IN THE U.S.

In the United States, 23 manufacturers currently provide mpox tests (FIND, 2024). Additionally, new testing methods, such as Next-Generation Sequencing (NGS), antigen detection, and serological tests, are under development to further enhance diagnostic capabilities.

Current Testing Methods

Polymerase Chain Reaction (PCR) – PCR tests are the preferred way to diagnose mpox and are commonly used for Clade IIb mpox. The qPCR test from Quest Diagnostics (2023) is popular as it allows testing from lesion crusts rather than requiring lesion fluid.
Clade-Specific Testing — In the U.S., four manufacturers produce tests for Clade I; however, only one test can inform clinical care. Limited availability poses a potential risk if the more severe Clade I spreads to non-endemic regions. For Clade II, multiple, well-supported testing options are available across the U.S.

BRIDGING DIAGNOSTIC GAPS THROUGH AI AND INFRASTRUCTURE ENHANCEMENT

The scarcity of Clade I diagnostics in the U.S. presents a significant challenge, as limited testing options increase the risk of potential outbreaks. Addressing this gap requires an immediate focus on enhancing testing infrastructure, especially for Clade I, to ensure rapid detection and response.

Advancements in artificial intelligence (AI) and machine learning are transforming the way mpox is diagnosed. By leveraging web-based platforms, AI models can now analyze skin images to identify signs of mpox with an accuracy rate of up to 85%. These innovations present a promising future for rapid and efficient diagnosis, but challenges remain.

Growing AI's Capabilities
AI diagnostic tools need more image data to increase accuracy. Expanding datasets will improve the precision of mpox detection.

Data Collection & Validation
To keep AI effective, continuous data input from a variety of sources is essential for improving diagnostic reliability.

The Role of Mobile Technology
By enabling smartphone image uploads, AI can access more data, making diagnosis faster and more accessible for patients. Mobile uploads will help strengthen AI's accuracy and diagnostic power.

MPOX PATIENT MANAGEMENT

Supportive Care for Pain

Pain is a common symptom of mpox, especially from the rash or lesions, and can be managed.

For mild pain: Over-the-counter pain relievers like ibuprofen or acetaminophen can help.
For severe rectal pain or proctitis: Topical treatments like lidocaine, sitz baths, and even prescription medications like gabapentin can be effective.
For mouth lesions: Rinsing with saltwater or using viscous lidocaine can reduce discomfort.
Always consult with a healthcare provider before using prescription medications.

When to Consider Medication Treatment

Certain individuals may need medication, particularly if:

They have severe symptoms like large lesions or infections.
They have underlying conditions like being immunocompromised, pregnant, or breastfeeding.

If You're Waiting for Test Results

While waiting for your test results, it’s important to:

Isolate yourself from others, stay home, and avoid public transportation.
Wear a mask and cover lesions if you must leave the house.
Let your healthcare provider know you've been tested.

Keep pets like dogs away to prevent any potential spread.

If You Test Positive for Mpox

If your test results are positive:

Continue isolating until your lesions are fully healed (this usually takes 2-4 weeks).
Avoid physical contact with others and, if possible, use a separate bathroom.
Wear a mask if you can't fully isolate and wash your hands frequently.
Clean any personal items like clothing or bedding.

Stay isolated until all scabs have fallen off and new skin has formed.