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When did MPOX started?In November 2022, the World Health Organization, who is responsible for naming and renaming of diseases under the International Classification of Diseases (ICD), changed the name of the disease referred to as “monkeypox” to “mрох” INTRODUCTION Monkeypox virus (ΜРXV) is an οrthοрохvirus that is in the same genus as variola (the causative agent of smallpox) and vaccinia viruses (the virus used in the smallpox vaccine). Two distinct strains of МPΧV have existed in different geographic regions of Africa, as suggested by epidemiologic, animal, and molecular evidence. Geographic distribution Outbreak in Central and East Africa Transmission — Animal-to-human and human-to-human transmission can occur. Human-to-human transmission Routes of person-to-person transmission — Human-to-human transmission of МΡΧV can occur in several ways: ●Direct contact – Spread of ΜΡΧV is thought to occur primarily through direct contact with infectious sores, scabs, or body fluids. As such, mрοx can spread during activities that include close, personal contact with an infected individual. Transmission may be facilitated by touching infectious material and then the facial mucous membranes or any breach in the skin of the recipient. Persons who are already symptomatic; however, some people can spread ΜΡХV to others from one to four days before symptoms onset. ●Indirect contact through fomites – Transmission can occur through contact with materials or fomites that have become contaminated with infected material in the household or patient care environment, such as clothing or linens contaminated with infectious material from body fluids or sores. ●Respiratory secretions – It is unclear to what degree mpοх is spread through respiratory secretions. Most of the mpοх transmission studies in humans before 2022 were conducted in African households, and while droplet transmission was thought to have played a role, household settings involve various modes of acquisition such as caregiving and bed-sharing. ●Vertical transmission – The virus can cross the placenta from the mother to her fetus, which can lead to congenital mрοх, although the rate of transmission or risk by trimester is not known. ●Percutaneous inoculation – There have been case reports of transmission via needlestick injuries from supplies used to collect cutaneous lesion samples. The mрοх lesions appeared at the site of the needlestick. Transmission has also been associated with piercing or tattooing; in some of these cases patients presented with a systemic cutaneous rash. ●Risk of spread through other body fluids – At this time, it is not known if mрох can spread through semen, vaginal fluids, or other body fluids, although viral DNA has been detected in semen. Findings common in all outbreaks — Мроx has traditionally caused a systemic illness that includes fevers, chills, and myalgias, with a characteristic rash that is important to differentiate from that of other vesicular eruptions (eg, varicella, smallpox). However, during the 2022 to 2023 multi-country outbreak, some patients presented with genital, anal, and/or oral lesions without the systemic illness. Incubation period — The incubation period of mpоx is usually from 5 to 13 days but can range from 4 to 21 days. Systemic illness — Systemic symptoms are common and may occur before the rash appears (prodromal stage) or shortly thereafter (early clinical stage). These symptoms are attributable to a viremic phase of illness. Systemic symptoms typically last one to five days and are characterized by -fever -headache -sore throat -back pain -myalgia -fatigue. ●In endemic regions, these symptoms are common with fever in 85 to 90 percent of cases, myalgias in 65 to 85 percent, headache in 80 percent, and lymphadenopathy in 70 to 100 percent. Rash — The skin eruption usually occurs between one to two days before and three to four days after the onset of the systemic symptoms and continues for two to three weeks. The rash associated with mpоx progresses through several stages: ●The rash typically begins as 2 to 5 mm diameter macules. The rash associated with mрοх is often described as painful, but in the healing phase (crusts), it can become itchy. Clinical features specific to the multi-country outbreak in 2022 Location of rash — Patients who have developed mроx during the global outbreak of mрox that started in 2022 frequently present with lesions concentrated in the anogenital, oral, and perioral areas. ●Genital lesions may present in the form of one or two solitary penile lesions or multiple lesions that affect the penis, scrotum, and pubis. Females may present with vulvar lesions. ●Lesions in the perianal region may present in the form of lesions in the buttocks and/or lesions involving the anal margin and perianal skin. The latter are often associated with rectal pain or pain on defecation. ●Perioral lesions can occur. These can present as circular white lesions with a depression in the center or ulcerated lesions of the oral mucosa or lips. In some cases, a small number of lesions developed in the trunk, face, or acral areas of the body. Proctitis/tonsillitis — During the outbreak that started in 2022, patients with mрοx have presented with рrοсtitis or tоnѕillitiѕ. Ocular manifestations — Ocular mpоx can present as conjunctivitis, blepharitis, periocular cellulitis, keratitis, and loss of vision. Neurologic manifestations — Neurologic complications (eg, encephalitis/encephalomyelitis) have been described in the outbreak that started in 2022. Complications in immunocompromised patients — Severe disease, including a necrotizing form of mpox, may be seen in the context of advanced HIV. The disease is reminiscent of progressive vaccinia that was seen when replication-competent smallpox vaccines were inadvertently given to patients with immunodeficiencies. Presentation in people with past infection or complete vaccination course — Patients with mpох tend to develop milder symptoms if they have been previously vaccinated or have had prior infection. When to suspect the diagnosis — The diagnosis of mpox should be suspected in patients who: ●Present with a rash or other symptoms that could be consistent with mрox (eg, рrοctitis) and ●Have epidemiologic risk factors for infection (eg, close or intimate in-person contact with individuals who have suspected or confirmed mрοх or are part of a social network or community experiencing mрох; recent travel to Central or West Africa or other areas where large οutbreaks of mpox have been reported). Suspected case The patient has a new characteristic rash or Meets one of the epidemiologic criteria and there is

Interesting facts: -Usually monocular vision loss occurs. -Optic neuritis is the presenting feature of multiple sclerosis in 15-20% of the patients. -Females are more prone to develop the disease. -20 to 40 years of age group with acute/recurrent vision loss should be suspected with optic neuritis. Introduction It is an inflammatory, demyelinating condition that causes acute, usually monocular visual loss. When to suspect the disease? 1. Monocular vision loss (Vision loss typically develops over a period of hours to days, peaking within one to two weeks) 2. Eye pain that often worsens with eye movement, the onset of pain generally coincided with the visual acuity loss and improved along with it. Common visual symptoms and signs include: The acute phase includes: – Afferent pupillary defect – The visual field defects in optic neuritis is typically characterized as central scotoma – Papillitis with hyperemia and swelling of the disk, blurring of disk margins, and distended veins is seen in one-third of patients with optic neuritis. – Loss of color of vision out of proportion to the loss of visual acuity is specific to optic nerve pathology. – Photopsias(flickering or flashes of light) – Other signs of ocular inflammation can be observed by the ophthalmologist on fundoscopic or slit lamp examination. The Chronic phase includes: – Persistent visual loss – Color desaturation – Temporary exacerbations of visual problems – Optic atrophy How is the diagnosis of optic neuritis made? -Optic neuritis is clinical findings based on the history and examination findings. -An MRI should be done ( For confirmation of the diagnosis of acute demyelinating optic neuritis and important prognostic information regarding the risk of developing MS). -Lumbar puncture ( It is not an essential diagnostic test but should be considered in atypical cases in those with bilateral presentation and <15 years of age of individuals) – Antibody testing Is treatment available for optic neuritis? * Intravenous Corticosteroids are used in selected patients. Intravenous methylprednisolone 250mg four times a day for three days in acute phase of treatment. Some randomized trials have suggested that : High-dose Oral corticosteroids ( Methylprednisolone 500mg; prednisolone 1250mg) might have similar efficacy to intravenous agents in regard to vision outcomes and their small size precludes definitive conclusions. *Alternative therapy: Intravenous immune globulin and plasma exchange but these do not have established efficacy in the treatment of optic neuritis. Prognosis of the disease includes: Prognostic concerns in patients with optic neuritis are visual recovery, recurrence of optic neuritis, and risk of multiple sclerosis (MS). Recovery of vision — Without treatment, vision begins to improve after a few weeks. Improvement can continue over many months; 90 percent have 20/40 or better vision at one year. Some patients may have a more or less favorable prognosis: 1. Lower visual acuity at the time of presentation is associated with less complete recovery. 2. Longer lesions in the optic nerve, as demonstrated by magnetic resonance imaging (MRI), particularly those extending into the optic canal, are associated with poorer visual outcomes. approximately 20 percent will have a persistent functional visual impairment 3. Patients with MS may have a somewhat less favorable prognosis than those without Does the case of optic neuritis re-occur? – A randomized trial suggests that there was a 35% recurrence at 10 years, 14% in the original eye, 12% in the other eye, and 9% in both eyes.