What is Monkeypox Virus (Mpox)? Symptoms and Treatment

The question of what the monkeypox virus is has become a major health topic on many people's minds recently, with cases rising globally. Also known as Mpox, this disease is a zoonotic infection that typically spreads through direct contact with infected animals or humans, presenting with characteristic skin rashes and fever. Belonging to the Orthopoxvirus family, this virus paints a clinical picture similar to smallpox but runs a milder course. Although the illness generally tends to resolve on its own within two to four weeks, it can lead to more serious health issues in individuals with weakened immune systems.

In brief:

• The incubation period is usually between 3 and 21 days after exposure to the virus.
• Initial symptoms include fever, severe headache, muscle aches, and swollen lymph nodes.
• Rashes typically start on the face and spread to the hands, feet, and other parts of the body.
• The disease is contagious until the skin lesions have completely crusted over and fallen off.
• While there is no specific cure, supportive care is provided to alleviate the symptoms.

What is Monkeypox Virus (Mpox)?

Monkeypox is a viral disease caused by a double-stranded DNA virus belonging to the Orthopoxvirus genus of the Poxviridae family. It was first discovered in 1958 when outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, which is how the disease got its name. The first human case was recorded in 1970 in the Democratic Republic of the Congo. For many years, this disease was endemic only in regions close to the tropical rainforests of Central and West Africa. However, in recent years, due to international travel and global mobility, it has begun to be detected in many different countries around the world.

The virus has two distinct genetic clades: the Central African (Congo Basin) clade and the West African clade. The Central African variant generally causes more severe clinical outcomes, while the West African variant follows a milder course and is the type more frequently encountered in global outbreaks. Although the disease comes from the same family as the variola virus that causes smallpox, it is much lower in terms of transmissibility and the risk of being fatal compared to smallpox. The virus enters the body through the respiratory tract, mucous membranes, or areas of broken skin, reaches the lymphatic system, multiplies there, and enters the bloodstream.

Causes and Risk Factors of Monkeypox Virus

The primary cause of the disease is contact with an animal carrying the Mpox virus or a contaminated surface. Although it is not entirely certain which animal is the natural reservoir of the virus, it is known that rope squirrels, tree squirrels, Gambian pouched rats, and various primate species in Africa carry the virus. Transmission to humans usually occurs as a result of direct contact with the blood, bodily fluids, or skin lesions of these infected animals. Furthermore, consuming the meat of infected animals without cooking it thoroughly is also a significant cause of transmission.

Among the risk factors, traveling to or living in regions where the disease is endemic takes the top spot. In addition, living in the same household with infected individuals, unprotected sexual contact, healthcare workers caring for patients without using appropriate personal protective equipment, and researchers working with the virus in a laboratory setting are in the high-risk group. Having chronic diseases that weaken the immune system also increases the likelihood of catching the infection and experiencing a more severe course of the disease. As detailed in our article titled What is AIDS, How is it Transmitted, conditions that suppress the immune system create an extra risk factor for all types of viral infections.

What Are the Symptoms of Mpox?

Mpox symptoms begin after the end of the incubation period following the virus's entry into the body. While this period usually lasts 6 to 13 days, it can range from 5 to 21 days. The course of the disease is divided into two main phases: the invasion phase and the skin rash phase. The invasion phase generally lasts for the first 5 days, during which the patient experiences severe systemic complaints.

1. Fever and Chills: This is the first and most common symptom of the disease. Body temperature rises suddenly, accompanied by bouts of chills.
2. Severe Headache: A headache severe enough to affect daily life is observed in the vast majority of patients.
3. Lymphadenopathy (Swollen Lymph Nodes): Noticeable swelling of the lymph nodes in the neck, armpits, or groin area is the most important feature that distinguishes monkeypox from other similar rash-causing diseases.
4. Muscle and Back Aches: Widespread body aches and deep muscle pains leave the patient feeling quite exhausted.
5. Extreme Fatigue (Asthenia): Loss of energy and a feeling of exhaustion can last for weeks.

Characteristic skin rashes appear 1 to 3 days after the onset of fever. Rashes usually start on the face and quickly spread to the palms of the hands, soles of the feet, torso, and genital areas. The development of the rashes follows a specific sequence: First, flat and red spots (macules) form. Then, these spots become slightly raised (papules). Within a few days, they fill with a clear fluid (vesicles), and later this fluid turns into yellowish pus (pustules). In the final stage, the pustules dry up, form crusts, and fall off. It can take 2 to 4 weeks for this process to complete and for new, healthy skin to form.

How is Monkeypox Transmitted and Diagnosed?

The answer to how monkeypox is transmitted is critical to understanding the ways the virus spreads. Human-to-human transmission generally occurs as a result of prolonged and close contact with the infected person's skin lesions, bodily fluids, or respiratory droplets. Direct physical contact such as kissing, hugging, or sexual intercourse maximizes the risk of transmission. Additionally, touching towels, bed sheets, clothing, or personal care items used by the patient (fomite transmission) can also cause the virus to pass to a healthy person. Although transmission via the respiratory route is possible, this usually requires prolonged face-to-face contact.

The diagnosis of the disease is made by combining the evaluation of clinical symptoms and laboratory tests. Your physician will first inquire about the structure of the rashes, swelling in the lymph nodes, and your travel history. The most reliable method for a definitive diagnosis is the Polymerase Chain Reaction (PCR) test. For this test, a swab sample is taken from the fluid-filled blisters, pustules, or dry crusts on the skin using a sterile cotton swab. The collected samples are examined under special laboratory conditions to detect the DNA of the virus. Blood tests generally do not provide as definitive results as PCR because the virus remains in the blood for a very short time, but they can be used as a supportive measure to check for the presence of antibodies.

What is the Difference Between Monkeypox and Chickenpox?

The difference between monkeypox and chickenpox is a frequently confused topic because both diseases cause skin rashes. However, these two diseases come from completely different virus families. Chickenpox is a disease caused by the Varicella-zoster virus, which belongs to the herpes virus family. The most prominent difference is that the swollen lymph nodes (lymphadenopathy) seen in monkeypox are not present in chickenpox. Furthermore, while chickenpox rashes can be found in different stages (some crusted, some newly emerged) simultaneously on different parts of the body, monkeypox rashes generally develop at the same stage in a specific area of the body. Chickenpox spreads much faster and usually heals within 10-14 days, whereas the recovery process for monkeypox can take up to 4 weeks.

Monkeypox Treatment and Recovery Process

There is no specific medication developed exclusively and widely used for the treatment of monkeypox. The disease is usually self-limiting and resolves on its own within a few weeks in individuals with a healthy immune system. Therefore, the treatment approach is primarily aimed at alleviating symptoms, improving the patient's quality of life, and preventing potential complications. Painkillers and antipyretics are used to control muscle aches and high fever. Topical creams or antiseptic solutions may be recommended to prevent scratching of the skin rashes and to reduce the risk of secondary bacterial infections.

In cases where the disease is severe, in individuals with suppressed immune systems, or in cases with dense rashes in risky areas (eyes, inside the mouth, genital area), antiviral drugs developed for smallpox (such as tecovirimat) can be used under the supervision of a physician. During the recovery process, it is of great importance for the patient to consume plenty of fluids, eat a balanced diet, and rest. Until the rashes completely crust over and fall off, revealing a new layer of skin underneath, it is essential for the patient to strictly follow isolation rules to prevent the virus from spreading to others.

Possible Complications and Risk Groups

Although the disease runs a mild or moderate course in most people, serious complications can arise in some cases. As a result of scratching or popping the skin lesions, bacteria can settle in these open wounds, causing secondary skin infections. The virus descending into the respiratory tract can lead to bronchopneumonia, and its entry into the bloodstream can cause sepsis. Lesions forming around the eyes or on the cornea can create serious infections that may lead to permanent vision loss if left untreated. Although rare, neurological complications such as brain inflammation (encephalitis) have also been reported.

The groups at the highest risk of experiencing a severe course of the disease include newborns, young children, pregnant women, and individuals whose immune systems are weakened for any reason. In particular, those undergoing cancer treatment, organ transplant recipients, and individuals with uncontrolled HIV infection must be extra careful during this period. An infection contracted during pregnancy can lead to the virus passing to the baby through the placenta, resulting in congenital monkeypox or pregnancy loss.

What to Do in Case of Suspected Monkeypox? When to See a Doctor?

If you observe symptoms of monkeypox in yourself or a loved one, the first thing you should do is stay calm and isolate yourself immediately. Stay away from other individuals and pets in the house. Use a separate room and, if possible, a separate bathroom. Absolutely do not touch the blisters on your skin, and do not try to pop or scratch them; this can lead to both scarring and bacterial infections. Do not share your belongings with others and pay maximum attention to your personal hygiene.

If you experience any of the following warning signs, you should consult a healthcare institution without delay or call 112 in emergencies:

• Experiencing difficulty breathing or chest pain.
• Confusion, severe drowsiness, or difficulty waking up.
• Neck stiffness or having a seizure.
• Inability to take fluids due to sores in the mouth and showing signs of severe dehydration.
• Noticing a rash, redness, or blurred vision around or inside the eyes.

Diagnosis and Treatment Process at BHT CLINIC

At BHT CLINIC İstanbul Tema Hastanesi, we provide reliable, internationally standardized, JCI-accredited services in the diagnosis and treatment of infectious diseases. When you apply to our hospital with a complaint of a suspicious rash or fever, you will undergo a detailed physical examination by our Infectious Diseases specialists. If deemed necessary, your PCR tests are rapidly processed in our state-of-the-art laboratories to make an accurate diagnosis. Our hospital's 24/7 emergency department is always by your side in case of sudden complications.

Your treatment process is personalized according to the severity of your illness and your general health status. In cases requiring isolation, your treatment continues in our specially ventilated rooms, ensuring the safety of other patients and staff. Additionally, the immune management of our patients with metabolic disorders such as diabetes and obesity is carried out in coordination with our Endocrinology and Metabolism department. To avoid risking your health and to get support from our expert physicians, you can book an appointment right away.

Frequently Asked Questions

Is the monkeypox virus fatal?

Although rare, the disease can lead to fatal complications, especially in people with weakened immune systems, young children, and pregnant women. However, when symptoms appear, the chances of recovery are quite high with early diagnosis and correct supportive treatment.

How long is the recovery period?

Following the incubation period of the disease, the onset of symptoms and the complete healing of the rashes usually take 2 to 4 weeks. When all the crusts on the skin fall off and a new, healthy layer of skin forms underneath, contagiousness ends, and the patient is considered recovered.

How is human-to-human transmission prevented?

The most effective way to prevent transmission is to avoid direct and close contact with people showing symptoms. Isolating the patient, stopping the use of shared items, washing hands frequently with soap and water, or using an alcohol-based sanitizer play a major role in protection.

Is the virus new?

No, the virus is not new. It was first discovered in monkeys in 1958, and the first case in humans was recorded in 1970. The reason it has come to the forefront in recent years is that the virus has spread to countries outside the African continent where it is endemic, causing cases on a global scale.

Is it transmitted through sexual contact?

Yes, the virus can be transmitted through close physical contact, skin-to-skin contact, and bodily fluids during sexual intercourse. However, monkeypox is not exclusively a sexually transmitted disease; being exposed to an infected person's skin, clothing, or respiratory droplets is also sufficient for transmission.

This article is for informational purposes only; please be sure to consult your physician for diagnosis and treatment.