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Monkeypox diagnosis and treatment guidelines
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(2022 Edition) span>
Monkeypox is a zoonotic disease caused by monkeypox virus (MPXV) infection Toxic disease, the main clinical manifestations are fever, rash, and lymphadenopathy. The disease is mainly endemic in Central and West Africa. Since May 2022, monkeypox cases have also been reported in some non-endemic countries, with community transmission. In order to improve the clinician’s ability to identify monkeypox early and standardize the diagnosis and treatment, this diagnosis and treatment guideline is specially formulated.
I. Etiology
Monkeypox virus (MPXV) is classified as a poxvirus The family Orthopoxvirus is one of the four orthopoxvirus genera that are pathogenic to humans, the other three being smallpox virus, vaccinia virus and vaccinia virus. Under the electron microscope, the monkeypox virus particles are brick-shaped or oval-shaped, with a size of 200nm×250nm, with an envelope, structural proteins and DNA-dependent RNA polymerase in the virus particles, and the genome is double-stranded DNA with a length of about 197kb. Monkeypox viruses are divided into two subclades, the West African clade and the Congo Basin clade. The virus sequencing results of some cases in non-endemic countries this time are West African branches.
The main host of monkeypox virus is African rodents (including African squirrels, tree squirrels, Gambian kangaroos, dormouse, etc.).
Monkeypox virus is resistant to drying and low temperatures, and can survive for several months on soil, crusts and clothing. Sensitive to heat, it can be inactivated by heating to 56°C for 30 minutes or 60°C for 10 minutes. It can be inactivated by ultraviolet rays and general disinfectants, and is sensitive to sodium hypochlorite, chloroxylenol, glutaraldehyde, formaldehyde and paraformaldehyde.
II. Epidemiology
(1) Source of infection span>
The main source of infection is rodents infected with monkeypox virus. Primates (including monkeys, chimpanzees, humans, etc.) can also become sources of infection after infection.
(2) Transmission route
The virus invades the human body through mucous membranes and damaged skin. Humans are mainly infected by contact with infected animal lesion exudates, blood, and other body fluids, or by being bitten or scratched by infected animals. It is mainly transmitted through close contact between people, and it can also be transmitted through droplets. Contact with virus-contaminated items may also be infected, and it can also be transmitted vertically through the placenta. Sexual transmission cannot be ruled out.
(3) Susceptible population
The population is generally susceptible. There is a certain degree of cross-protection against monkeypox virus in people who have been vaccinated against smallpox in the past.
III. Clinical manifestations
The incubation period is 5-21 days, mostly 6-13 days sky. In the early stage of the disease, chills and fever occur, and the body temperature is mostly above 38.5 °C, which may be accompanied by symptoms such as headache, drowsiness, fatigue, back pain and myalgia. Most patients present with swollen lymph nodes in the neck, armpits, and groin. A rash appears 1-3 days after onset. The rash first appeared on the face and gradually spread to the extremities and other parts. The rashes were mostly distributed centrifugally. The rashes on the face and extremities were more common than on the trunk. The rashes could appear on the palms and soles of the feet, and the number of rashes ranged from several to thousands. etc.; can also involve the oral mucosa, digestive tract, genitalia, conjunctiva and cornea. The rash changes from macules, papules, herpes, pustules to scabs. Herpes and pustules are mostly spherical, about 0.5-1 cm in diameter, hard in texture, and may be accompanied by obvious itching and pain. It takes about 2-4 weeks from the onset to the scab shedding. Erythema or hyperpigmentation, or even scarring, may remain after the scab falls off, and the scarring may last for several years. Complications may occur in some patients, including secondary bacterial infection at the site of skin lesions, bronchopneumonia, encephalitis, corneal infection, and sepsis.
Monkeypox is a self-limiting disease with a good prognosis in most cases. Severe cases are common in young children and immunocompromised people, and prognosis is related to the viral branch of infection, the degree of virus exposure, previous health status, and the severity of complications. The case fatality rate in the West African branch is about 3%, and the case fatality rate in the Congo Basin branch is about 10%.
IV. Laboratory examination
(1) General examination span>
Peripheral blood leukocytes were normal or increased, and platelets were normal or decreased. Some patients may have elevated transaminase levels, lower blood urea nitrogen levels, and hypoproteinemia.
(2) Etiological examination
1. Nucleic acid detection: using nucleic acid amplification The detection method can detect monkeypox virus nucleic acid in specimens such as rash, blister fluid, crust, oropharyngeal or nasopharyngeal secretions.
2. Virus culture: Monkeypox virus can be isolated by collecting the above specimens for virus culture. Virus culture should be carried out in a biosafety laboratory of level 3 or above.
V. Diagnosis and Differential Diagnosis
(1) Diagnostic Criteria< /span>
1. Suspected cases
with the above clinical manifestations, and with any of the following epidemiological history Item:
(1) History of travel and residence in overseas areas where monkeypox cases were reported within 21 days before the onset of the disease;
(2) Close contact with monkeypox cases within 21 days before the onset of the disease;
(3) Contact with the blood, body fluids or secretions of monkeypox virus-infected animals within 21 days before the onset of the disease.
2. Confirmed cases
Suspected cases with positive monkeypox virus nucleic acid test or cultured isolated monkeypox virus.
For cases that meet the criteria for suspected or confirmed cases, infectious disease reports should be made according to relevant requirements.
(2) IdentificationDiagnosis
Mainly differentiate from chickenpox, herpes zoster, herpes simplex, measles, dengue fever and other febrile and rash diseases, but also from skin bacterial infection, scabies , syphilis and allergic reactions and other identification.
VI. Treatment
There is currently no specific anti-monkeypox virus drug in China. Mainly symptomatic support and treatment of complications.
(1) Symptomatic and supportive treatment. Bed rest, pay attention to supplement nutrition and water, maintain water and electrolyte balance. For those with high body temperature, physical cooling is the main method. If the temperature exceeds 38.5 °C, antipyretic analgesics should be given to reduce fever, but attention should be paid to prevent prostration caused by profuse sweating.
Keep the skin, mouth, eyes and nose clean and moist, and avoid scratching the skin on the rash to avoid secondary infection. Analgesics can be given if the pain at the rash site is severe.
(2) Complication treatment. Effective antibiotic treatment should be given in the case of secondary bacterial infection of the skin, and adjustments should be made according to the isolation and identification of pathogenic bacteria and the results of drug susceptibility. Prophylactic use of antimicrobials is not recommended. When corneal lesions appear, eye drops, supplemented with vitamin A and other treatments can be applied. When encephalitis occurs, sedation, dehydration and intracranial pressure reduction, and airway protection are given.
(3) Psychological support treatment. Patients often have psychological problems such as tension, anxiety, depression, etc., and psychological support, counseling and related explanations should be strengthened. Corresponding drug adjuvant therapy.
(4) Chinese medicine treatment. According to the principles of TCM “examination and treatment” and “three causes and measures”, the treatment is based on syndrome differentiation. Patients with clinical symptoms of fever are recommended to use Shengma Gegen Decoction, Shengma Biejia Decoction, Zixue Powder, etc.; patients with clinical symptoms of high fever, dense acne, sore throat, and multiple lymphadenopathy are recommended to use Qingying Decoction, Shengma Biejia Decoction, Xuanxue Powder, etc. Bai Chengqi Soup, etc.
VII. Discharge criteria
The following criteria can be discharged: normal body temperature, clinical symptoms Significant improvement, scabs fell off.
VIII. Infection prevention and control in medical institutions
Suspected and confirmed cases should be Placed in an isolation ward. Suspected cases are isolated in a single room.
Medical staff perform standard precautions, take contact precautions, droplet precautions, wear disposable latex gloves, medical protective masks, face shields or goggles, and disposable isolation gowns And so on, while doing hand hygiene.
Strictly disinfect the patient’s secretions, feces and blood pollutants in accordance with the “Technical Specifications for Disinfection in Medical Institutions”.
(Source: National Health Commission official website)