Monkeypox: A psychiatrist’s guide
Steven Lippmann, M.D.
Infectious diseases are big in the news nowadays: monkeypox is spreading worldwide, including in our country. This comes despite rising coronavirus numbers and now we also hear about acute hepatitis affecting children. What if you see a person that might have monkeypox? Here is a quick guide.
Consider monkeypox currently if you encounter somebody with viral illness symptoms and a cutaneous eruption. Also, anyone who might have been in contact with a person or an animal exhibiting a pox-related illness. The rash usually starts on the face and spreads widely, but it could be focal and often involves the palms and soles. Remember that secondary syphilis, rocky mountain spotted fever, streptococcal cellulitis, erythema multiforme, and a host of other conditions are some additional disorders that also involve palms and soles. Expect a progression beginning with a macular presence, evolving to papular lesions, then vesicular ones, and then a pustular presentation – before disappearing. Contagion diminishes once lesions have healed.
Infections can follow close contact with a person or animal affected by monkeypox; that includes respiratory secretions and/or touching their fomites, such as clothing or bedsheets, etc. Airborne contagion may occur too; however, transmission is reportedly most commonly associated after sexual contact between males and other men. The incubation period is at 1-2 weeks; the disease lasts approximately three weeks and has some potential for significant mortality.
Fever and lymphadenopathy are reliable signs compatible with monkeypox. Typical illness symptoms include malaise, weakness, fatigue, diffuse pain or discomfort, and sometimes respiratory complaints. Infection varies from being self-limited to potentially fatal cases mandating hospitalization with emergent medical intervention.
Together with variola virus (smallpox), vaccinia virus, and cowpox, monkey pox is in the genus orthopox. Monkeypox evidences similarity with smallpox, thus those having had a smallpox vaccination might acquire some immunity; yet, the amount of and/or duration is currently unknown. Anything compromising immunity raises the risk of contagion; that can include a variety of illnesses or conditions, pregnancy, breast-feeding, very young persons, and/or older people, etc.
Immediate patient isolation is necessary when a monkeypox infection is suspected. This includes contact and airborne precautions, along with infectious disease protective gear and hygiene procedures. Infectious disease medical teams must be immediately alerted to the case and the diagnosis is confirmed by laboratory testing.
What about intervention? Assure proper hydration and supportive medical care. Antiviral drugs, approved for smallpox prescribing, might have efficacy for patients with monkeypox. Telcovirimat is the most prominent pharmaceutical under current advisement, and it is provided on a compassionate needs-based indication. Other antiviral agents (e.g., cidofovir) may be useful and vaccinia immunoglobulin infusions are another therapeutic option. Good luck!