Written by Denrick Cooper
Spoon Feed
Since the outbreak in 2022, mpox (formerly monkeypox) has become more prevalent in the United States. A second wave of infections has been ongoing since 2024, affecting patients of multiple demographics. Here’s how to diagnose and treat it.
Decoding the mpox puzzle again
The 2022 mpox outbreak saw an unprecedented spread beyond Africa, primarily through direct sexual contact, largely affecting men who have sex with men. A new strain, clade Ib, identified in the Democratic Republic of Congo, has proven more virulent, with transmission through contact with lesions, body fluids, droplets, and contaminated clothing. Household transmission is also more common with this strain. Diagnosis typically follows observation of the classic vesicular rash (see figure from CDC image library) and a viral-like prodrome, with PCR testing of skin lesions used for confirmation. Mpox is a reportable disease. In immunocompetent individuals, the illness is self-limiting and generally lasts 2-4 weeks. Mortality rates differ between strains, with clade IIb at 0.2% and clade Ib reaching 10%. Lower-income countries face higher mortality due to limited resources for surveillance and treatment. There is currently no FDA-approved treatment for mpox. Most therapies are derived from smallpox treatments, making prevention crucial. Vaccines and behavioral modifications are effective but often inaccessible or costly in lower-income regions.
How will this change my practice?
Mpox is once again on the rise globally, with clade Ib showing higher mortality than the strain in the 2022 outbreak. Although the disease initially showed a higher prevalence in men who have sex with men, it is now more widespread. I will be sure not to limit diagnostic efforts to any specific group, as mpox knows no demographic boundaries. Vigilance is especially crucial for vulnerable groups, including the immunosuppressed, pregnant women, and children. Clinicians should consider mpox in cases of the classic vesicular rash, especially among high-risk populations.
Source
Mpox Clinical Presentation, Diagnostic Approaches, and Treatment Strategies: A Review. JAMA. 2024 Nov 19;332(19):1652-1662. doi: 10.1001/jama.2024.21091. PMID: 39401235
