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Emergency department approach to monkeypox.

Catherine V Levitt1, Quincy K Tran2,3, Hashem Hraky1

  • 1Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington DC 20037, USA.

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|November 1, 2023
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Summary

Monkeypox (mpox) presents with non-specific symptoms, but lymphadenopathy can aid diagnosis. Early recognition and treatment, including tecovirimat and JYNNEOS vaccination, are crucial for managing severe mpox cases and preventing complications.

Keywords:
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Area of Science:

  • Viral Infections
  • Public Health Emergencies
  • Epidemiology

Background:

  • Monkeypox (mpox) is a viral disease endemic to Africa, with rare large outbreaks outside the continent.
  • The 2022 global mpox outbreak prompted a public health emergency of international concern declaration by the WHO.
  • Emergency providers require foundational knowledge for mpox prevention and control.

Purpose of the Study:

  • To review the clinical presentation of mpox.
  • To outline diagnostic approaches for mpox.
  • To summarize prevention and treatment strategies for mpox.

Main Methods:

  • Literature review of PubMed and SCOPUS databases up to July 2023.
  • Inclusion of studies on adult patients, emerging infections, public health emergencies, systematic reviews, clinical guidelines, and retrospective studies.
  • Exclusion of studies not published in English.

Main Results:

  • Fifty studies were included in the review.
  • Initial mpox symptoms are non-specific (fever, malaise, myalgias, sore throat).
  • Rash typically appears 2-4 weeks post-prodrome; lymphadenopathy may differentiate mpox from other Poxviridae infections. Severe complications and co-infections (e.g., HIV) can increase morbidity.

Conclusions:

  • Mpox diagnosis can be challenging due to non-specific initial symptoms.
  • Tecovirimat is preferred for severe or high-risk mpox cases; JYNNEOS vaccination is recommended.
  • Prompt diagnosis relies on careful clinical evaluation; various prevention and treatment options exist.