Mpox (Monkeypox) | Transmission, Pathophysiology, Signs & Symptoms, Diagnosis, Treatment

Summary

This video covers Mpox (previously known as Monkeypox), a viral disease caused by the Mpox virus, part of the Orthopoxvirus genus, similar to smallpox but less severe. It discusses the virus's zoonotic origins, its transmission from animals to humans, and the 2022 outbreak that led to global human-to-human transmission, primarily through skin contact. Symptoms include a flu-like prodromal stage followed by a distinctive rash. Diagnosis is through lab tests, and treatment focuses on supportive care, with antivirals in severe cases. The video also touches on the impact of smallpox vaccination and the risks for immunocompromised individuals.

Takeaways

• 🦠 Mpox, formerly known as monkeypox, is caused by the Mpox virus, which is related to the smallpox virus but less severe and less infectious.
• 🐒 The virus is zoonotic, meaning it spreads from animals to humans. Humans are incidental hosts, and African rodents are the primary reservoirs.
• 🌍 The first known case was in lab monkeys in 1959, but the first human case was reported in Zaire (now the Democratic Republic of Congo) in 1970.
• 📈 Mpox cases increased after the discontinuation of the smallpox vaccine, which helped protect against the virus. An outbreak occurred in 2022 with over 30,000 cases in the US by early 2023.
• 🤝 The virus spreads through respiratory droplets, prolonged close contact, direct contact with infected animals or humans, and contaminated surfaces. Skin-to-skin contact, particularly sexual transmission, has driven recent outbreaks.
• 🧬 The virus enters the body through mucous membranes or the skin, replicates in lymph nodes, and eventually enters the bloodstream, causing a flu-like illness before a rash appears.
• 💉 The incubation period ranges from 4 to 21 days, with symptoms like fever, chills, swollen lymph nodes, and a rash that develops in stages over 14 to 21 days.
• 🧪 Diagnosis can be made through lab tests like PCR, viral culture, or electron microscopy. In some cases, clinical symptoms and exposure history are enough to diagnose.
• 🩺 Treatment is mostly supportive as the infection is self-limiting, though antiviral therapies like tecoviromat may be used in severe cases or for immunocompromised patients.
• ⚠️ Mpox can lead to complications like secondary bacterial infections, respiratory distress, eye infections, and encephalitis, with higher mortality risks in immunocompromised individuals.

Q & A

What is mpox, and how is it related to monkeypox?

Mpox, formerly known as monkeypox, is a viral infection caused by the mpox virus, which belongs to the genus Orthopoxvirus, the same genus as smallpox. However, mpox is less severe and less infectious than smallpox.

How is mpox transmitted between humans?

Mpox can be transmitted between humans primarily through close, prolonged face-to-face contact via respiratory droplets, direct skin-to-skin contact, sexual transmission, or contact with contaminated objects, such as clothing or furniture. Vertical transmission from a pregnant person to the fetus is also possible.

What are the primary animal hosts of the mpox virus?

The mpox virus is zoonotic, meaning it is spread from animals to humans. Its natural reservoirs are African rodents, including species like Gambian rats. Monkeys and humans are incidental hosts, meaning they are not the virus's intended hosts.

When was the mpox virus first discovered, and how did it get its name?

The mpox virus was first isolated in lab monkeys in Denmark in 1959, which is how it earned the name 'monkeypox.' The first human case was reported in Zaire (modern-day Democratic Republic of Congo) in 1970.

What are the symptoms of mpox, and how does the infection progress?

Mpox begins with a flu-like prodromal stage, including fever, chills, headaches, muscle aches, and swollen lymph nodes. This is followed by a rash that begins on the mouth or face and spreads to other parts of the body, including the palms and soles. The rash progresses from macules and papules to pustules, which eventually scab and heal over several weeks.

How long is the incubation period for mpox, and what does this period involve?

The incubation period for mpox ranges from 4 to 21 days, with an average of 12 days. During this time, the virus enters through mucous membranes or skin, spreads to local lymph nodes, multiplies, and eventually enters the bloodstream.

What factors contributed to the increased prevalence of mpox in recent years?

The decline in the use of the smallpox vaccine, which offers cross-protection against mpox, has led to an increase in cases. The 2022 outbreak was largely driven by human-to-human transmission, especially through sexual contact.

What complications can arise from mpox infections?

Complications of mpox can include secondary bacterial infections, respiratory distress, eye issues like keratitis, and, in severe cases, septicemia or encephalitis, especially in immunocompromised individuals.

How is mpox diagnosed by clinicians?

Mpox is diagnosed through laboratory methods such as isolating the virus, PCR testing, electron microscopy, and blood work. A diagnosis can also be made if symptoms appear within 21 days of exposure to a confirmed case.

What treatments are available for mpox infections?

Most mpox cases resolve on their own with supportive treatment. In severe cases, antiviral therapies such as tecovirimat (Tpoxx) may be used, particularly for immunocompromised patients or those with ocular symptoms.

Outlines

00:00

🦠 Introduction to Mpox: History and Characteristics

This paragraph introduces mpox, previously known as monkeypox. It details that mpox is caused by the mpox virus, which is a zoonotic double-stranded DNA virus related to smallpox but less severe and less contagious. It discusses the virus's history, including its identification in monkeys in 1959 and its first human case in Zaire (now the Democratic Republic of Congo) in 1970. It outlines the recent 2022 outbreak, noting that the virus has spread widely with over 30,000 cases in the U.S. by early 2023.

05:02

🧬 Modes of Transmission: Animal and Human Spread

This paragraph focuses on how mpox is transmitted. Initially, it was primarily spread from animals to humans (zoonotic transmission), but in the 2022 outbreak, human-to-human transmission became more common, primarily through skin-to-skin contact, especially during sexual activity. Other transmission methods include direct contact with infected animals or their products, contact with contaminated surfaces or clothing, and vertical transmission from pregnant women to their fetuses.

10:04

🧪 Pathophysiology: How Mpox Infects the Body

Here, the focus shifts to how the mpox virus enters and spreads within the human body. It can enter through mucosal membranes or skin and first infects the local lymph nodes, then enters the bloodstream in an initial viremia stage, followed by secondary viremia when symptoms typically appear. The incubation period is typically 4 to 21 days. It highlights the virus’s use of viral proteins to infect cells and describes the progression through the blood to other organs.

15:05

🤒 Clinical Signs and Symptoms: Stages of Mpox Infection

This section explains the clinical symptoms of mpox. Patients first experience flu-like symptoms such as fever, chills, headache, muscle aches, fatigue, and sore throat during a prodromal stage that occurs 1 to 4 days before a rash appears. Swollen lymph nodes (lymphadenopathy) are a key symptom distinguishing mpox from other pox viruses. Afterward, the rash begins on the face or oral mucosa and spreads to other parts of the body, developing through stages from macules and papules to pustules.

🦠 Rash Development and Complications

The skin rash characteristic of mpox spreads from the face to other areas of the body, including the trunk, extremities, palms, and soles, and may begin in the genital and perianal areas in recent outbreaks. The rash progresses from macules and papules to vesicles, pustules, and then scabs, which may result in scarring. Complications include secondary bacterial infections, respiratory distress, eye problems, and, in severe cases, encephalitis or septicemia. Immunocompromised individuals are at higher risk of these complications.

🔬 Diagnosis and Treatment of Mpox

This paragraph covers the diagnosis and treatment of mpox. Diagnosis is typically made through laboratory methods such as viral cultures, PCR tests, and electron microscopy. Symptoms can also help confirm the diagnosis, particularly if there has been contact with a known mpox case within 21 days. Most infections are self-limiting and resolve within 2 to 4 weeks, but antiviral treatments like tecovirimat may be used in severe cases, especially in immunocompromised patients.

🛡 Prognosis and Mortality

The final paragraph discusses the prognosis of mpox, including its potential fatality, particularly in immunocompromised patients or those with secondary infections. Early estimates suggest a 1-10% mortality rate in African populations, but this may be lower in other regions. Vaccination against smallpox (vaccinia) offers some protection against mpox, and newer vaccines are available to reduce the severity of the disease.

Keywords

💡Mpox

Mpox, previously known as monkeypox, is a viral disease caused by the mpox virus. It shares similarities with smallpox but is less severe and less infectious. The term 'mpox' reflects the rebranding of the disease, distancing it from the initial association with monkeys. In the video, it is described as a zoonotic infection that can spread from animals to humans and, in recent years, has seen human-to-human transmission.

💡Zoonotic infection

A zoonotic infection is a disease that spreads from animals to humans. Mpox is described as zoonotic, with animal reservoirs, especially African rodents, being the primary hosts of the virus. Human infections are incidental, occurring when the virus crosses the species barrier. This concept highlights the origins of the disease and its transmission dynamics.

💡Prodromal stage

The prodromal stage refers to the early phase of mpox infection, characterized by flu-like symptoms such as fever, muscle aches, and lymphadenopathy (swollen lymph nodes). This stage occurs 1-4 days before the appearance of the skin rash. Recognizing this stage is crucial in diagnosing mpox, especially distinguishing it from other viral infections.

💡Lymphadenopathy

Lymphadenopathy is the swelling and tenderness of lymph nodes, a common symptom during the early stages of mpox. This symptom, which occurs 2-3 days after fever onset, is an important distinguishing factor for mpox as it differentiates it from other similar poxvirus infections. It often appears in areas such as the cervical (neck), submandibular (jawline), and inguinal (groin) regions.

💡Human-to-human transmission

Human-to-human transmission refers to the spread of the mpox virus between people, primarily through close physical contact, such as skin-to-skin interactions or sexual transmission. This method of transmission became more prominent in the 2022 outbreak, with cases rising globally, highlighting a shift from the animal-to-human transmission typically associated with zoonotic diseases.

💡Incubation period

The incubation period is the time between exposure to the mpox virus and the appearance of symptoms. In the case of mpox, this period ranges from 4 to 21 days, with most cases showing symptoms around 12 days. This period is crucial for understanding the timeline of infection and aiding in early diagnosis and quarantine measures to prevent further spread.

💡Viremia

Viremia refers to the presence of the virus in the bloodstream. In mpox infections, there are two stages: initial viremia, when the virus first enters the blood, and secondary viremia, which occurs after the virus spreads to and from organ systems. The secondary viremia coincides with the onset of symptoms, marking the end of the incubation period.

💡Eruptive stage

The eruptive stage, also called the exanthem stage, is when the characteristic rash of mpox appears, typically after the prodromal phase. The rash often starts on the oral mucosa, spreading to the face, and can cover the trunk, extremities, palms, and soles. In recent outbreaks, rashes have been seen in the perianal and genital regions, which contributes to transmission via skin-to-skin contact.

💡Vertical transmission

Vertical transmission is the transfer of the mpox virus from a pregnant female to her developing fetus. The virus can cross the placental barrier, potentially leading to infection in the infant. This transmission route underscores the virus's impact on vulnerable populations, including pregnant women and their unborn children.

💡Tecoviromat

Tecoviromat is an antiviral treatment initially developed for variola virus (smallpox) but also used to treat mpox. It works by blocking the F13 viral protein, which is involved in the virus's ability to spread. While most mpox cases are self-limiting, tecoviromat may be necessary in severe cases, particularly for immunocompromised patients or those with complications such as ocular mpox.

Highlights

Mpox, formerly known as monkeypox, is caused by the mpox virus, which belongs to the Orthopoxvirus genus, the same genus as smallpox.

Mpox is less severe and less infectious than smallpox, but it shares similarities in symptoms like a flu-like illness followed by a rash.

The mpox virus is zoonotic, meaning it spreads from animals to humans, though human-to-human transmission can occur.

The first outbreak in humans was recorded in Zaire (now the Democratic Republic of Congo) in 1970, with cases rising after the cessation of the smallpox vaccine.

Mpox outbreaks in the Western Hemisphere began in 2003 due to the transportation of infected animals from Africa.

The most recent outbreak, starting in 2022, saw over 30,000 cases reported in the United States by early 2023.

Mpox can be transmitted through droplets from prolonged close contact, direct contact with infected animals, or human-to-human skin-to-skin contact, often through sexual transmission.

Indirect transmission can occur via contaminated clothing, bedding, or surfaces (fomites).

The incubation period for mpox is typically between 4 to 21 days, with an average of 12 days.

The prodromal stage of mpox includes flu-like symptoms such as fever, muscle aches, headaches, and swollen lymph nodes, which help distinguish it from other poxviruses.

Mpox rash usually begins in the mouth and spreads to the face, trunk, hands, and feet, with recent cases showing lesions primarily in the genital and perianal areas.

The rash evolves through stages from macules to pustules and can leave scars, taking 2 to 4 weeks to heal.

Complications of mpox include secondary bacterial infections, respiratory distress, and even encephalitis, particularly in immunocompromised individuals.

Mpox is diagnosed through laboratory tests, including PCR and electron microscopy, with leukocytosis and serology tests supporting diagnosis.

Treatment for mpox is primarily supportive, but antiviral therapies like tecoviromat can be used, especially in severe or ocular cases.

Transcripts

in this session we're talking about mpox

which was previously known as monkey pox

so this is a disease caused by infection

with a virus known as the impox virus

and this impacts virus is a pox viridae

virus and it's in the genus Ortho pox

virus is in the same genus as smallpox

so it can cause a prodromal or a

flu-like illness at first and then cause

a rash later so it looks like smallpox

but it's not going to be as severe and

it's going to be less infectious than

smallpox now mpox virus is a relatively

large virus and it's often described as

brick-alike in appearance and it is a

double-stranded DNA virus now mpox is a

zoonotic infection meaning that it is

spread from animals to humans but when

it gets into the human population it can

spread from Human to human but humans

are incidental hosts meaning that

they're not the hosts that this virus

actually is looking for the virus is

looking for particular animal hosts

which we'll discuss in the next slide

now there has been an increasing

prevalence recently of infections with

this particular virus and an outbreak

did start in 2022 and as of early 2023

there have been over 30 000 cases

reported in the United States now let's

discuss a brief history of this virus

some of the first known cases and how it

has spread so this particular virus was

actually first isolated in lab monkeys

that were sent from Singapore to Denmark

in 1959. these monkeys arrived in

Denmark and became ill and this

particular virus was actually the cause

of their illness this is the first known

case of this virus so that was in a

monkey and this is why the term monkey

pox came to be but the first human

infection was actually reported in Zaire

which is modern day Democratic Republic

of Congo in 1970. there were then

additional cases in Cote devoir Liberia

Nigeria and Sierra Leone so some of the

earliest cases started in central Africa

and then we started seeing more on the

West Coast of Africa then over the next

couple of decades cases of this virus

start to increase in Central and western

Africa and this increase in cases may be

due to the cessation of the use of the

smallpox vaccine the smallpox vaccine is

known to actually suppress or limit the

ability of impacts to cause infection or

it leads to a milder form of infection

so smallpox was eliminated in the world

in 1977 and then afterwards the use of

smallpox vaccine started to be in

Decline and then after that point we

start seeing more cases of mpox even

with these increasing case numbers it

was still limited to Western Africa

until 2003 when the first cases started

to appear in the Western Hemisphere so

this was due to transportation of

animals from Africa to the United States

then we start seeing cases appear in the

United States but we don't really see a

large amount of human-to-human

transmission most of it is from animals

to humans but starting in May 2022 we

start seeing more human to human trans

Mission this is when we start seeing

increasing Global case numbers initially

we start seeing cases in the United

Kingdom that first came from a traveler

from Nigeria so initially there's only a

handful of cases but by the end of 2022

there's thousands of cases that have

been identified on all inhabited

continents and as we previously

mentioned over 30 000 cases have been

identified and reported in the United

States alone let's discuss how this

particular virus is transmitted so one

way that this virus can be transmitted

is through droplets so droplet contact

is going to be from close contact so if

you're up close with an individual and

they are talking to you there can be

some respiratory droplets that are

exuded out but you would need prolonged

face-to-face contact it's not going to

be something where you walk by an

individual and you get infected you have

to be in close contact for a long period

of time another very important way that

this virus can be transmitted is through

direct contact so some of the ways that

this has been previously transmitted via

direct contact is through contact with

infected animals so these include

prairie dogs or squirrels or monkeys or

pigs or other animals as well including

hedgehogs and it does seem to be the

case that the natural reservoir for this

particular virus is African rodents we

mentioned before that humans are

incidental hosts monkeys are also

incidental hosts as well so they're not

the host that the virus is looking for

they just simply can cross a species

barrier infect monkeys or humans and

then that can be an incidental host but

the natural reservoirs are the main

hosts that this virus is going to use

along with contact with infected animals

you can have contact with the animal

reservoirs themselves these again

include African rodents like gambian

rats is one of those species

another way of getting this by direct

contact is through ingestion of

contaminated animal products and then

what's been driving the most recent

outbreak from May of 2022 has been human

to human spread and this human human

spread is going to be via skin-to-skin

contact and the majority of these cases

have been through sexual transmission so

skin to skin contact especially through

sexual transmission this has been the

main driver of the most recent outbreak

and other ways that this can be

transmitted is through indirect contact

so indirect contact is going to be

contact with clothing or other Fabrics

that have had contact with the skin

lesions or other bodily fluids and

another one would be fomites fomites

would be furniture for instance if

there's bodily fluids or if there's been

contact with the fluid from skin lesions

this can all be ways that transmission

can occur and then another method of

spread is through vertical transmission

so vertical transmission is going to be

from pregnant female to developing fetus

or infant so it can be in the blood of

the pregnant patient it can cross the

placental barrier and infect the develo

helping fetus in all of these methods of

transmission are going to be due to the

fact that this virus can be at high

levels or high concentrations in not

only the fluid from the skin lesions

themselves but can also be in high

amounts in the bodily fluids of patients

who are infected this can include the

saliva the blood vaginal fluid and semen

so all of these can have high amounts of

this virus that can Aid in transmission

of the virus to other individuals let's

talk about the pathophysiology of

infection with mpox virus so if you're

exposed to this virus either through

droplets or through skin contact it can

enter into and penetrate through the

oropharynx or the nasopharynx so some of

those mucosal membranes can also get in

through the skin as well so again we

talked about that skin to skin contact

before and the inbox virus is going to

use particular viral surface proteins to

enter into host cells and one of those

viral proteins is known as f-13

and when it actually enters into its

site of inoculation it can then spread

into local lymph nodes so local lymph

nodes are going to be the first site

we're going to see this virus going to

and then it can multiply in those lymph

nodes and then eventually enter into the

blood it will enter into the blood in

what we call the initial viremia stage

so this is the first time it enters the

blood it's going to be the initial

vairmia so viremia is just a word for

virus in the blood

and then after this initial viremia

stage is going to enter into other organ

systems it can spread into other

organist systems via the blood and then

it will stay in those organ systems and

then it will eventually leave those

organ systems and enter into the blood

again and that is what we would call

secondary viremia and this is when we

actually have symptom onset of this

particular condition which means that

the time at which we get the virus and

it goes through the lymph nodes initial

viremia and goes into the organ systems

and then leaves the other organ systems

to enter the blood for the second time

that secondary viremia that is the

incubation period and that incubation

period can go anywhere from 4 to 21 days

and approximately most cases are going

to be around 12 days so the incubation

period is going to be the time at which

you first get infected and then you

start seeing symptoms so again it takes

up to 21 days now let's talk about the

clinical findings or the signs and

symptoms of an mpox virus infection so

we're first going to have a

pre-erruptive or prodromal stage this is

going to be a stage where the patient

feels like they have a flu-like illness

and it's going to occur one to four days

prior to onset of the rash so when we

think about mpox virus infections we're

thinking about the rash but there's

actually going to be this prodromal

stage that occurs before the rash so one

to four days prior to onset of the rash

we're going to have these symptoms these

include a fever so the fever can be 38.5

to 40.5 degrees Celsius so it can be a

relatively high fever so this is

actually going to be the most often the

first sign of infection and then

patients can often have chills and

sweats as well they can also have a

severe headache myalges and back pain so

myalges are going to be muscle aches and

pains they can also have anorexia

reduced appetite so all very common with

a viral infection they can also have

malaise and fatigue so feeling generally

unwell and tired and then they can have

pharyngitis or sore throat dyspnea or

shortness of breath in a cough so again

very vague and non-specific flu-like

symptoms but something also very

important with regards to this prodromal

stage is that they can have

lymphadenopathy we talked about the fact

that the virus can enter into the lymph

nodes and then more multiply in those

lymph nodes they can cause

lymphadenopathy again lymphadenopathy is

going to be swollen tender lymph nodes

and it occurs within two to three days

of fever onset this is actually going to

be the most important sign to

distinguish monkey pox from other pox

virus infections in the locations where

we can have these swollen tender lymph

nodes are often going to be related to

the initial place of infection and some

of them can include the cervical chain

so some lymph nodes in the neck the

submental so this would be under the

chin submandibular so along the jawline

and then inguinal in the groin area

so again the cervical chain the

submandibular and submental lymph nodes

and then the inguinal lymph nodes can

all be places where we can see these

swollen tender lymph nodes and then

after those one to four days of the

prodromal stage we can have what we call

the eruptive or xantham stage this is

where we see a skin rash so the skin

rash is going to look like this the rash

is often going to begin on the oral

mucosa so inside the mouth and then

spread to the face and other areas of

the body so very key and interesting

point to make note of here we can see it

on the trunk the extremities and the

scalp and then it also may have a

predilection for occurring on the palms

of the hands and the soles of the feet

as well in cases in the most recent

Outbreak The lesions seem to first

appear on the perianal and genital areas

so this can contribute to that skin to

skin transmission the skin rash is going

to slowly develop into a vesicular or

vesicle pustular rash we'll talk about

this in more detail in the next slide

and the lesions can be anywhere from 3

to 15 millimeters in diameter emitter

and the skin lesions can be up to

thousands of them and these particular

skin lesions will develop in stages over

the course of 14 to 21 days let's talk

about those stages of this particular

skin rash so it's going to start out as

macules and papules so macules are going

to be flat skin lesions and papules can

be slightly raised skin lesions so they

can start off flat or slightly raised

and then they're going to go through a

set of different stages so they can

become vesicles which are raised skin

lesions with a little bit of fluid in

them they can then become pustules or

pus-filled so they can have a little

white head on them they can then undergo

umbilication which is the formation of

little dot in the middle so umbilication

is connected to umbilicus which is a

belly button so these skin lesions can

be described as having a little belly

button or a spot on them or a little

indentation on them over time they will

then start to dry out they'll cross over

and then they will start to de-squamate

or start to sloth off so they can have

their skin start to peel off over time

this can occur over two to four weeks

and some of these skin lesions can leave

scarring so we can see pitting scars on

some patients now there are other

important complications with impox viral

infections these include secondary

bacterial infection you can imagine that

if you've got these open wounds on

different parts of your body you're more

likely to have a secondary bacterial

infection so bacteria getting into those

open wounds and causing a skin infection

some patients can also have respiratory

distress some patients can also have eye

issues like keratitis and corneal

ulceration and then in other patients

the infection can be so severe that we

can have septicemia or an infection in

the blood and then there can also be in

some cases infection into the brain

leading to Encephalitis or an

inflammation of the brain these other

complications are going to be more

likely to occur in patients who are

immuno compromised so very young

patients very old patients patients on

chemotherapies or who have cancer or

patients who are diabetic or have

co-infection with HIV or Aids so all

very important to make note of when we

talk about these complications now let's

discuss how clinicians make the

diagnosis of mpox viral infection

actions so the diagnosis is going to be

via laboratory methodology so taking a

sample from a suspected case and then

looking at that sample either in culture

so if the m-pox virus is isolated this

is one way to make the diagnosis other

ways include PCR identification of the

impacts virus and then electron

microscopy if there's electron

microscopy that demonstrates an orthodox

viruses can be enough to make the

diagnosis as well and then other

diagnostic criteria can be used without

laboratory investigation although this

would be less preferred this way of

making the diagnosis can involve the

fact that if the patient has had contact

with a known infection or known infected

individual and they have symptoms that

are the symptoms we just talked about in

this lesson at up to 21 days after

exposure that can be enough to make the

diagnosis as well if it's past 21 days

or if there have been no symptoms after

21 days then we don't have to worry

about this as we mentioned before the

incubation period goes up to 21 days and

then other blood work can be performed

which can show leukocytosis this is a

high white blood cell count and then

serology testing can be performed to see

if the patient has antibodies against

impox virus how do clinicians treat this

particular viral infection so the

treatment of mpox viral infections is

often not going to be required because

this particular infection is going to be

self-limiting so it's going to typically

resolve on its own over the course of

two to four weeks most of the time what

is going to be used is supportive

treatment so just helping the patient

along with some of their signs and

symptoms we talked about before so

treating the symptoms because oftentimes

this is going to resolve on its own if

it is in one of those cases where there

is a complication if it's in a patient

who has immunocompromise oftentimes

we're going to need other treatments

these can include antiviral therapies so

one of them is going to be tecoviromat

or teapots this was initially a

treatment for variola virus and it works

by blocking that f-13 Viral protein we

talked about before so this is a

potential antiviral treatment for this

condition and then in patients who have

ocular mpox so if they have those ocular

findings we talk before systemic

antivirals can be important again

tachoviramate and adding trifluridine

can be important as well and some other

important prognostic information with

regards to empox viral infections

include the fact that having impox

infections can be fatal it can lead to

mortality so some of the earlier

estimates before the last outbreak

showed that in African populations who

were infected with mpox there was

approximately one to ten percent

mortality rate but what's important to

point out is that the mortality is most

often going to be due to a secondary

infection or in patients who have

immunocompromise we talked about some of

those complications before septicemia

and Encephalitis for instance so the

mortality rate is definitely going to be

higher if co-infected with HIV or being

immunocompromised and we did talk

earlier about the smallpox vaccination

which is known as vaccinia if you were

vaccinated with vaccini you're likely to

have a milder form of this particular

disease and there are some vaccinations

for mpox that can be utilized as well

help reduce the severity of infection

please check my lesson on vaginal

candidiasis and gonorrhea and if you

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thanks so much for watching and hope see

you next time