Monkeypox

Question 1

What is Monkeypox?

Answer 1

Rare disease caused by the Monkeypox virus

Orthopoxvirus

Question 2

First human case?

Answer 2

1970 in DRC

Question 3

How is Monkeypox spread?

Answer 3

1. Close/Direct contact with:
   lesions, bodily fluids, or resp secretions
2. Spread from an infected animal or animal products
3. Vertical transmission from mother to fetus

Question 4

T/F: Monkeypox can be spread by OBJECTS that have had contact with lesion crusts or body fluids-current outbreak

Answer 4

TRUEE

Question 5

How to clasify the sx?

Answer 5

Similar to but milder than symptoms of smallpox

Question 6

Monkeypox Sx being with:

Answer 6

Fever
Headache
Muscle aches
Backache	
Lymphadenopathy 
Chills
Exhaustion

Question 7

How to distinguish Monkeypox from Smallpox?

Answer 7

LAD

Question 8

What sx develop w/in 1-3 days after appearance of fever?

Answer 8

Rash

Question 9

Lesions progress through the following stages over 2-3 weeks:

Answer 9

Enanthem
Macules
Papules
Vesicles 
Pustules 
Scabs
"Ew, Monkey pox, very pus-y & scary"

Question 10

Can the lesions be umbilicated?

Answer 10

yes

Question 11

DDx:

Answer 11

• Molluscum contagiosum
• Syphilis
• VZV
• Smallpox
• Chickenpox

Question 12

T/F: Smallpox is an agent of bioterrorism

Answer 12

True

Question 13

Chickenpox

Answer 13

• Starts inward and grows out.

- Body wide

Question 14

Smallpox

Answer 14

• Papule to pustule to vesicle
• Can be umbilicated
• No LAD

Question 15

T/F: hard to determine clinical diff b/w monkeypox & smallpox?

Answer 15

True

Question 16

Has smallpox been erradicated?

Answer 16

Yes

Question 17

Key Characteristics of ID Monkeypox

Lesions are:

Answer 17

• Lesions well circumscribed, deep seated, and often umbilicated
• Lesions are relatively the same size and stage on a single body site
• Lesions on palms and soles
• Lesions are painful until crust appears when they become itchy

Question 18

Key Characteristics of ID Monkeypox

___ prior to ____

Answer 18

Fever prior to rash

Question 19

Key Characteristics of ID Monkeypox

Disseminated rash is ______

Answer 19

Disseminated rash is centrifugal (more lesions on face and extremities)

Question 20

Key Characteristics of ID Monkeypox

Differentiator from Smallpox

Answer 20

Lymphadenopathy

Question 21

Incubation of Monkeypox
Sx?
Contagious?

Answer 21

average 7-14 days, Range 5-21 days
Asymptomatic during this time
Not contagious

Question 22

Enanthem vs Exanthem

Answer 22

Exanthem: “breaking out,”
used to describe cutaneous eruptions that arise abruptly and on several skin surfaces at once.
Enanthem: refers to mucous membrane (tongue & mouth) involvement

Question 23

Prodrome phase
Characterized by:
time?
Contagious?

Answer 23

Prodrome of fever after the incubation phase
1-3 days
contagious

Question 24

Onset of the rash phase
Characterized by
Time?
Contagious?

Answer 24

Enanthem (mouth & tongue) then macules then papules then vesicles then pustule then scab
Lasts 2-3 weeks
Contagious until all scab have fallen off AND a fresh layer of intact skin has formed underneath

Question 25

Unroofing a lesion: how is transmission spread?

Answer 25

- Respiratory spread | - By scab

Question 26

Testing

Answer 26

PCR test of lesion material available through State Health Department/CDC

Question 27

When is pt no loger contagious?

Answer 27

when scab falls off and new layer of skin grown

Question 28

T/F: Monkeypox can cause hemorrhagic PNA

Answer 28

True

Question 29

Severe dizeases caused by Monkeypox that need hospitalization?

Answer 29

confluent lesions, sepsis, encephalitis,

Question 30

Pt education

Answer 30

Isolation at home is necessary until case is confirmed | If case confirmed, isolate until no longer contagious ie scabs fall off

Question 31

T/F: Most cases are relatively mild and self limiting

Answer 31

True

Question 32

Pts at high risk for severe dz?

Answer 32

- Immunocompromise (HIV/AIDS, leukemia, lymphoma, generalized malignancy, solid organ transplant, tx w/ alkylating agents, antimetabolites, radiation, TNF inhibitors, high-dose corticosteroids, hematopoietic stem cell transplant <24mo) - Patients <8yo - Pregnant or breastfeeding - AD - Pt w/ eczema, burns, impetigo, VZV, infection,HSV, severe acne, severe diaper dermatitis with extensive areas of denuded skin, psoriasis, or Darier disease [keratosis follicularis]) - Pts w/ secondary bacterial skin infection; gastroenteritis with severe N/V/D or dehydration; bronchopneumonia; concurrent disease or other comorbidities

Question 33

``` Is there a Monkeypox specific treatment? What drug class can we use? ```

Answer 33

No specific treatment BUT antivirals developed for smallpox may be beneficial: Tecovirimat Cidofovir (FDA approved for CMV) Vaccinia Immune Globulin

Question 34

Prophylaxis recommendations:

Answer 34

- Avoid skin to skin close contact if lesions present - If respiratory symptoms present, those in contact should mask (N95) - Avoid contact with objects that may have come into contact with monkeypox

Question 35

contact with objects that may have come into contact with monkeypox

Answer 35

Bedding/linens Towels Sex gear and toys

Question 36

Monkeypox PEP

Answer 36

Jynneos vaccine

Question 37

Is Jynneos vaccine available in colorado?

Answer 37

Yes

Question 38

Is monkeypox an extremely contagious dz?

Answer 38

Yes

Question 39

Shoudl we wear an N95 for Monkeypox?

Answer 39

yes

Question 40

Who should get Monkeypox PEP?

Answer 40

Close contacts | after consultation with the State Health Dept

Question 41

Progression of Monkey Pox lesions

Answer 41

``` Enanthem, Macule Papule Vesicle Pustule Scab Marissa- "Ew, Moneky Pox, Very Pus-y & Scary" ```

Question 42

Rash/Scab is ____ then ______.

Answer 42

Painful | itchy