Mpox

Background

MPX (MPox) is notifiable a zoonotic viral disease caused by the enveloped double‐stranded DNA Monkeypox virus (MPXV)
Others in its Orthopoxvirus genus include Vaccinia, Cowpox and Variola viruses
The Central African (Congo Basin) strain is typically more infectious and associated with more sever disease
Transmission via direct contact
Some cases globally (2022) in gay or bisexual men. Most do not have a Hx of travel
Clinical presentation similar to smallpox

Fever (>38° ±rigors), headache(±severe), marked asthenia, adenopathy, myalgia
1-3 days post fever the rash appears (face→trunk→hands & feet and mucous membranes)
Macules→papules→vesicles→crusts/scabs
Lesions all appear at the same stage, distinguishing them from chicken pox (varicella chicken pox)
Most MPX patients have significant prodromal lymphadenopathy (varicella chicken pox usually don't)
Most MPX patients have a significant prodromal fever (most varicella don't)
For most, (not immunocompromised) MPX is a self-limiting disease lasting up to 4 weeks with full recovery
< 10%, (age extremes or immunocompromised), resp. distress, 2° bacterial infections and encephalitis may develop

Appropriate swabs for the following investigations at CUH.

Swabs available from Serology lab and stock kept in Controlled drug cupboard ED (advised 5 swabs in stock at all times)
Remove blue swab from packet. Rub the blue swab along the gum line for time indicated on packet (currently 60sec)
Place wet swab back inside the clear tube and replace the cap. Write patient's name, DOB and today's date on it- clear sample bag- check/ complete request form/order

Test for mpox if deemed necessary following clinical assessment
Use viral swab in viral transport medium (red topped swab)
Swab a cutaneous lesion (ulcer/vesicular fluid), if there are no cutaneous lesions a throat swab may be taken
Clearly label the sample, double bag at the site of collection and take to the microbiology lab. Inform laboratory staff of suspected clade I mpox
*Please Note Not suitable for pneumatic shute system, hand deliver

If a varicella zoster swab is indicated for a blister test please gently press a cotton swab on a blister to collect a sample of fluid for testing
Use viral swab in viral transport medium (red topped swab)
Clearly label the sample, double bag at the site of collection and take to the micro. lab
*Please Note Not suitable for pneumatic shute system, hand deliver

Contact, droplet and airborne precautions
PPE with FFP2/3 mask, eye protection, disposable nitrile gloves, long-sleeved gown
Discuss with ID
The majority can be discharged and managed in the community
In the exceptional cases requiring admission, care is supportive
If very unwell/requiring admission, consider prevention / treatment of 2° bacterial infections
If admitted, I may consider empiric treatment of HSV or early syphilis while awaiting test results
Inform Public Health