Thanks to Dr. Palmore who gave us an update at Grand Rounds in July 2023
Background #
- Zoonotic pox virus (DNA virus)
- Cases are underdiagnosed, with vast majority of cases in MSM
- Vaccine is not 100% effective in prevention – but does reduce severity
- Transmission
- Contact with mucosa or non-intact skin with open lesions/respiratory droplets/aerosolization from FOMITES
- Needlesticks
- Aerosolized spread from lesions in the upper airway
- Unknown if semen/vaginal fluid spreads the virus
- Incubation: 7-14d
- Infectious: Beginning of symptoms – new skin growth over scabs
- Signs/Symptoms: 1-3d of viral prodrome – fevers, HA, fatigue, body aches, swollen glands
- Lesions predominate at site of inoculation (but can spread everywhere)
- Can be on the EYE (fluoroscein stain)
- Can cause severe symptoms: sepsis, pneumonia, encephalitis (especially if immunocompromised), pregnant women, young children
- Lesions predominate at site of inoculation (but can spread everywhere)
- Infection Control: Isolate into a private room, PPE (gown, gloves, respirator, face shield/goggles)
Testing/Treatment #
- Who to test
- Viral prodrome with skin lesions (mimics STIs)
- Consider in any case of proctitis
- Testing: Lesion fluid from 2 or more sites (orthopoxvirus PCR > DC state lab, confirmatory MPX sequencing at CDC)
- DO NOT UNROOF SKIN LESIONS
- Treatment
- Supportive careOutpatient – Send patients to MFA ID if they may need outpatient tecovirimat (202-741-3440)
- If inpatient – consult infectious disease for tecovirimat
- Tecovirimat
- A patient with clinically suspected mpox infection who meets below criteria can be offered tecovirimat AT THE TIME OF TESTING, you don’t have to wait for test results (talk to ID)
- Any host with:
- Severe disease: eye/periocular, many/confluent lesions, hemorrhagic disease, sepsis, encephalitis, other conditions meriting hospitalization
- Mucosal infection that could result in scarring/stricture: proctitis, pharyngitis, penile, vaginal, urethral
- Severe infection that require surgical intervention
- Vulnerable hosts at risk of progressing to severe disease:
- Immune compromise (advanced HIV CD4<350), transplant, and immunosuppressive chemotherapy
- Children, especially <1 yo
- Pregnant/Breastfeeding
- Impaired skin integrity (eg atopic dermatitis, psoriasis, etc)
- Any host with:
- A patient with clinically suspected mpox infection who meets below criteria can be offered tecovirimat AT THE TIME OF TESTING, you don’t have to wait for test results (talk to ID)