Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
Monkeypox is a viral disease that
produces pox lesions on the skin and is closely related to smallpox but is not
nearly as deadly as smallpox was.
The history of monkeypox is new (1958), and the first human cases were diagnosed and differentiated from smallpox in the early
1970s.
Monkeypox virus causes monkeypox. The majority of cases are transmitted
from animals (rodents) to humans by direct contact; person-to-person transfer,
probably by droplets, can occur but not frequently.
Risk factors for monkeypox
include close association with African animals (usually rodents) that have the
disease or caring for a patient who has monkeypox.
During the first
few days, symptoms are nonspecific and include fever, nausea, and malaise. After about
four to seven days,
lesions (pustules, papules) develop on the face and trunk that ulcerate, crust
over, and begin to clear up after about 14-21 days and
lymph nodes enlarge;
there may be some scarring.
The diagnosis of monkeypox is often made presumptively
in Africa by the patient's history and the exam that shows the pox lesions,
however, a definitive diagnosis is made by PCR,
ELISA, or Western blotting tests
that are usually done by the CDC or some state labs. Definitive diagnosis is
important to rule out other possible infectious agents like smallpox.
Treatment
may consist of immediate vaccination with smallpox vaccine because monkeypox is
so closely related to smallpox; treatment with an antiviral drug or human immune
globulin has been done.
In general, the prognosis for monkeypox is good to excellent as most
patients recover. The prognosis may decrease in
immunocompromised patients, and patients with other problems such as malnutrition
or lung disease may have a lower prognosis.
Monkeypox is
preventable as long as people avoid direct contact with infected animals and
people. Vaccination against smallpox seems to afford about an 85% chance of
avoiding the infection. There is no commercially available vaccine specifically
for monkeypox.
Research is ongoing to study antivirals, genetics, and rapid
tests for monkeypox.
What is monkeypox?
Monkeypox is a relatively rare disease that was first detected in monkeys in
Africa in 1958 and resembles smallpox in terms of the skin lesions (pox) seen in
humans as part of the symptoms and also because the cause is a virus that is
closely related to the smallpox (variola) virus. Monkeypox, smallpox,
cowpox,
and vaccinia viruses all belong to the same family of viruses, the Poxviridae.
Monkeypox belongs to same genus (Orthopoxvirus) as smallpox. The disease is
different from smallpox. Monkeypox may be transferred from animals to people (or
person to person) and has far less mortality (death rate) than smallpox had.
Monkeypox virus is endemic in rodent populations in Africa; smallpox did not
infect any endemic animal population. The press and bloggers have
occasionally tried to link monkeypox to other diseases such as mad cow disease,
Ebola, leprosy, yellow fever, and other viral and immunological diseases, but
there is no scientific evidence for this.
The word "rash" means an outbreak of red bumps on the body. The way people use this term, "a rash" can refer to many different skin conditions. The most common of these are scaly patches of skin and red, itchy bumps or patches all over the place.
Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly. They can sometimes be tender, painful or disfiguring. The treatment of swollen lymph nodes depends upon the cause.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease. Treatment of chronic cough is dependant upon the cause.
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. The causes of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting.
Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.). Fever is part of the body's own disease-fighting arsenal: rising body temperatures apparently are capable of killing off many disease- producing organisms.
Travelers should prepare for their trip by visiting their physician to get the proper vaccinations and obtain the necessary medication if they have a medical condition or chronic disease. Diseases that travelers may pick up from contaminated water or food, insect or animal bites, or from other people include malaria, meningococcal meningitis, yellow fever, hepatitis A, typhoid fever, polio, and cholera.
Smallpox is a disease caused by the variola virus. Symptoms and signs include a characteristic rash and high fever. Treatment focuses on supporting the patient. Smallpox may be prevented with the ACAM2000 smallpox vaccine.
Why should travelers see a physician before they leave
on a trip?
Travelers should see a physician before leaving for a trip if
they are going
to developing countries,
they are visiting sites that are not on the usual tourist routes or traveling to high altitudes,
they have
chronic diseases that could be affected by travel,
they are visiting countries that require vaccinations before they allow travelers to enter the country.
The goal of a pre-travel medical evaluation is to help travelers protect themselves against
(1) common diseases that may be mild but that will disrupt their trip, and (2) less common diseases that may be serious or even fatal. All travelers need to be up to date on routine vaccines they would normally get if they were not traveling. For example, an annual influenza vaccination (flu shot) is recommended if traveling during influenza season. Travelers should also be up to date on te...
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