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mpox answer GoposuAI Search results
Mpox, formerly and often colloquially referred to as monkeypox, is an orthopoxvirus infection that primarily affects primates, including humans, distinguished by a characteristic zoonotic origin, meaning it is transmitted from animals to humans, most frequently through contact with infected rodents or non-human primates. The causative agent belongs to the *Orthopoxvirus* genus, a family encompassing several significant human pathogens such as vaccinia and variola viruses, the latter responsible for the now-eradicated smallpox, suggesting a complex immunological relationship between these closely related viruses. The clinical presentation of mpox in humans typically manifests in two distinct phases: the prodromal phase and the eruptive phase, often separated by a short incubation period which can range from five to twenty-one days, though shorter or longer periods have been documented in certain transmission scenarios or populations. The prodromal phase is characterized by non-specific, flu-like symptoms, including fever, intense headache, lymphadenopathy—swollen lymph nodes, which is a hallmark distinguishing feature from smallpox—myalgia (muscle pain), and profound asthenia (lack of energy). Crucially, the appearance of the characteristic rash usually follows the onset of fever by one to three days, marking the transition into the eruptive phase, where lesions develop sequentially through a predictable set of morphological stages. This progression moves from macules (flat, discolored spots) to papules (raised bumps), then vesicles (small, fluid-filled blisters), followed by pustules (lesions filled with opaque, yellowish fluid), before finally crusting over, ulcerating, and subsequently scabbing before healing. The distribution of the lesions is often centripetal, meaning the rash tends to start on the face and spread centrifugally to the limbs and trunk, although atypical presentations, particularly those observed during the 2022 global outbreak, have shown lesions concentrating disproportionately in the anogenital and perioral regions, especially among MSM (men who have sex with men). The number of lesions can vary dramatically, ranging from just one or two isolated lesions to several thousand covering the entire body surface. Historically, two distinct phylogenetic clades of the virus have been recognized: the Congo Basin clade (West African clade), generally associated with more severe disease, particularly in unvaccinated populations and children, and the West African clade, historically responsible for less severe illness confined primarily to West and Central Africa. The nomenclature changed to mpox to mitigate stigma and align with international health standards following recent epidemiological shifts. Transmission routes are multifaceted, primarily involving direct contact with the skin lesions, scabs, or body fluids of an infected person or animal, including sexual contact, which has been a major driver in recent non-endemic spread. Indirect transmission can occur via contaminated materials, such as bedding, towels, or fomites, that have been in contact with infectious lesions or respiratory secretions. Aerosol or droplet transmission over short distances is possible, particularly during prolonged, close, face-to-face contact, which explains transmission within households, but sustained airborne transmission over long distances, as seen with SARS-CoV-2, is generally considered less efficient for mpox. Vertical transmission from mother to fetus in utero or during delivery is a recognized, albeit less common, complication. Diagnosis relies heavily on clinical suspicion based on the characteristic rash morphology, coupled with laboratory confirmation, which is primarily achieved through Polymerase Chain Reaction (PCR) testing of lesion material, specifically fluid aspirated from intact vesicles or pustules, or swabs taken from the base of excised lesions. Serological testing plays a lesser role due to cross-reactivity with other orthopoxviruses. Complications of mpox range in severity and often depend on the clade, the immune status of the host, and whether secondary bacterial infections have occurred; potential serious sequelae include severe mutilating scarring, vision loss if the eyes are involved, pneumonia, encephalitis, and sepsis in severely immunocompromised individuals. Treatment for typical, uncomplicated cases of mpox is primarily supportive, focusing on pain management, prevention of secondary bacterial skin infections, and isolation to prevent further spread, alongside meticulous wound care to minimize scarring. Severe cases or those in high-risk groups necessitate antiviral intervention. The primary antiviral agent utilized for the treatment of severe mpox or for prophylaxis in high-risk exposures is tecovirimat (TPOXX), a drug specifically developed to inhibit the viral envelope protein required for the release of infectious virions from the host cell, demonstrating efficacy in animal models and human compassionate use cases. Vaccinia-based vaccines remain the most effective tool for both pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). The strategic deployment of established smallpox vaccines, such as JYNNEOS (MVA-BN), which is non-replicating and therefore safer for immunocompromised individuals, has proven critical in rapidly dampening transmission dynamics during recent outbreaks outside of endemic regions by targeting populations at high risk of exposure. Endemic transmission is historically confined to several countries in Central and West Africa, where the virus cycles naturally between animal reservoirs—often involving rodents—and human populations, creating an ongoing public health challenge complicated by limited surveillance infrastructure and accessibility to vaccines and therapeutics in these regions. The global recognition of mpox escalated significantly in 2022 when multi-country outbreaks emerged outside of established endemic areas, predominantly characterized by rapid person-to-person spread concentrated within specific sexual networks, prompting the World Health Organization to declare a Public Health Emergency of International Concern (PHEIC) to coordinate a global response. Immunological cross-protection exists between the vaccinia virus, used in smallpox vaccination, and mpox virus, conferring a degree of protection to older populations who received smallpox vaccination decades ago, a factor that has influenced outbreak dynamics and risk assessment in different age cohorts across various global settings.