Assignment Topic: Monkey Pox virus

Presented to: Madam Maryam Zafar

Presented by: Ayesha Rizwan
Roll no: L1F19BSMR0054
Subject: Medical virology
Section: BM8
 Assignment no 1: MONKEY POX VIRUS
Introduction:
The MPV virus causes monkey pox and is an enclosed, double-stranded DNA orthopox virus
belonging to the Poxviridae family. Currently, it is a global concern. A more virulent Congo
Basin (Central African) strain and a less virulent West African clade make up the MPV, which is
native to Central and Western Africa .Small African mammals like dormice, African rope
squirrels, Gambian pouched rats, and various primates are most likely the MPV's natural
reservoirs. Direct contact with infected animals, such as bites, scratches, or the preparation of
bushmeat, can result in zoonotic transmission. Human-to-human transmission includes direct
skin-to-skin (or mucosal) contact with infected lesions, infected bedding and clothing, and
infected respiratory secretions.

Most, but not all, of these cases were found to be among men who have sex with men (MSM),
and epidemiologic investigations determined that human-to-human transmission was probably
taking place through close physical contact, skin-on-skin contact, and/or sexual interaction over
social networks.

Epidemiology:
In 1958, a lab outbreak of vesiculopustular skin eruptions in crab-eating macaques in Denmark
led to the discovery of MPV. Subsequent years saw other outbreaks of MPV disease in lab
monkeys, with a major outbreak in 1964 among anteaters and other primates in the Rotterdam
Zoo. In the 1970s, the first human cases of MPV illness were discovered in Central and Western
Africa, mostly in children who had a diffuse vesiculopustular rash, lymphadenopathy, and fever.
The Congo Basin saw the majority of the succeeding decades' hundreds to thousands of new
human MPV disease cases. In 2003, a cross-infection outbreak due to pet prairie dogs kept with
imported African rats led to dozens of unexpected cases of human MPV illness in the Midwest of
the United States.

Prevalence:
Prior to 2022, human MPV disease was typically exclusively discovered in Central or Western
Africa (or associated with international travel or animal importation from these regions). A
number of human MPV illness cases were recorded in the UK in May 2022, albeit there were no
obvious travel or animal connections to these regions. Additional cases that surfaced by the end
of May in more than 20 non-endemic nations raise the possibility of a quick human-to-human
transmission. By the end of July, approximately 20,000 confirmed human MPV disease cases
had been recorded in more than 70 countries on six continents (including more than 5,000 in the
United States). Most, but not all, of these cases were found to be among men who have sex with
men (MSM), and epidemiologic investigations determined that human-to-human transmission
was probably taking place through close physical contact, skin-on-skin contact, and/or sexual
interaction over social networks.

Clinical manifestation:
A prodrome of fever, malaise, headache, myalgia, and/or lymphadenopathy appears 4–17 days
after exposure in the classic human MPV illness. This is followed by a typical maculopapular
rash that may be unpleasant or itchy and progresses into vesiculopustular lesions. These lesions
can be dispersed across the face, oral mucosa, trunk, and extremities (including the palms and
soles), and are often of similar size stage and stage of progression, well-circumscribed, and
possibly umbilicated. Typically, the illness lasts 2-4 weeks with a low death rate.
Infectious cycle of MPXV:

Replication cycle of a poxvirus. Key events are outlined: attachment (1), entry (2), early
viral gene transcription and translation (3), DNA replication (4), intermediate and late
transcription and translation (5), assembly (6), morphogenesis (7), envelopment by
intracellular membranes (8) and budding (10)
Diagnosis:
The primary method of confirming MPV infection is a positive PCR test of swabs from skin
lesions or mucosal lesions or scabs. Additionally confirmatory is a serum or CSF PCR test that is
positive. Although less sensitive, viral culture can occasionally help with confirmation. Although
it might not be able to differentiate between recent vaccination and other orthopox viral
infections, a positive anti-orthopox virus IgM test in the serum or CSF may be indicative of
recent MPV infection. In people who are unable to produce an antibody response but who
nonetheless have MPV infection, an anti-orthopox IgM test could also come back negative.
Other illnesses like syphilis, varicella zoster, herpes simplex, molluscum contagiosum, or acute
HIV should also be considered because they can mimic or potentially co-infect MPV.

Treatment:
Most MPV infections progress slowly and naturally without the need for specialized antiviral
therapy. Therefore, supportive care is the mainstay of treatment for mild cases, with an emphasis
on pain management, hydration, nutrition, and avoiding bacterial super infection of skin lesions.
Lesions on the skin need to be kept dry and clean. Both topical petroleum jelly and oral
antihistamines are effective treatments for pruritis.

Anesthetic gels or "magic" mouthwash, which frequently contains antihistamines, steroids,

lidocaine, and antimicrobials, can be used to treat oral sores. Topical anesthetic’s,
acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), neuropathic pain relievers, or
even opiate medications in severe situations can be used to treat painful genital sores. Stool
softeners and sitz baths are also effective treatments for proctitis. Hydration, acetaminophen,
NSAIDs, or other commonly used acute headache therapies may be used to manage headaches
symptomatically as necessary.

An FDA-approved treatment for human smallpox virus infection is tecovirimat (TPOXX), an

inhibitor of the orthopox viral VP37 envelope wrapping protein, which is now being used in an
expanded access investigational new drug (EA-IND) regimen for MPV infections during
outbreaks. Anecdotally, it has produced notable changes within days after beginning therapy.

Cidofovir and brincidofovir (inhibitors of many viral DNA polymerases) are other antiviral
medications that may have anti-orthopox virus efficacy. Vaccinia virus immune globulin
intravenous (VIGIV) may also be helpful in treating severe MPV infection, albeit there aren't any
clinical studies to support this claim yet.

References:

 Kmiec D, Kirchhoff F. Monkeypox: A New Threat? International Journal of Molecular

Sciences. 2022; 23(14):7866. https://doi.org/10.3390/ijms23147866
 Pastula, D. M., & Tyler, K. L. (2022). An overview of monkeypox virus and its
neuroinvasive potential. Annals of neurology, 92(4), 527-531.