INTRODUCTION
Human monkeypox (MPX) is caused by an orthopoxvirus similar to the variola virus (smallpox) and was initially discovered in central Africa in 1970 affecting impoverished communities. It typically presents with symptoms such as fever, rash, lymphadenopathy, and gastrointestinal disturbance.1 The cutaneous manifestations of MPX are distinctive but can be difficult to differentiate from smallpox as both exhibit a rash duration of 14-28 days, can be located on palms or soles, and can both present as hard umbilicated well-circumscribed lesions. Both viruses present with lesions in the same stage of development with slow progression of 1-2 days per stage.2 The rash typically begins on the face with a spread in a centrifugal fashion and lesions that progress from macular to papular, vesicular, and pustular.2 The number of lesions can also vary from one to thousands. Involvement of the oral mucosa can make it difficult for patients to eat or drink as well. Aside from serology testing, an algorithm that analyzes the major and minor smallpox criteria can be utilized to make a MPX diagnosis, especially in patients presenting with lymphadenopathy.2
No standardized treatments for MPX infection have been delineated. Two oral antiviral medications, however, have been approved for the treatment of smallpox in the United States, brincidofovir and tecovirimat. The two drugs are mechanistically different in that brincidofovir, a lipid conjugate of cidofovir inhibits viral DNA polymerase while tecovirimat inhibits the envelope wrapping protein (VP37) of the orthopoxvirus keeping the virus from escaping the infected cell.3 These drugs have not been studied in human clinical trials for treatment of orthopoxvirus infection, but be efficacious in animal models against both smallpox and MPX virus.1 Tecovirimat has additionally been utilized for compassionate use in severe debilitating cases of orthopoxvirus infections.1
In May 2022, the Monkeypox virus (MPX) was detected in multiple non-endemic countries resulting in an outbreak. Although there are no approved treatments for MPX, three antivirals (brincidofovir, cidofovir, tecovirimat) have been utilized in humans based on data from animal studies. Additionally, to the best of our knowledge, no large systematic review has been conducted documenting the most common
No standardized treatments for MPX infection have been delineated. Two oral antiviral medications, however, have been approved for the treatment of smallpox in the United States, brincidofovir and tecovirimat. The two drugs are mechanistically different in that brincidofovir, a lipid conjugate of cidofovir inhibits viral DNA polymerase while tecovirimat inhibits the envelope wrapping protein (VP37) of the orthopoxvirus keeping the virus from escaping the infected cell.3 These drugs have not been studied in human clinical trials for treatment of orthopoxvirus infection, but be efficacious in animal models against both smallpox and MPX virus.1 Tecovirimat has additionally been utilized for compassionate use in severe debilitating cases of orthopoxvirus infections.1
In May 2022, the Monkeypox virus (MPX) was detected in multiple non-endemic countries resulting in an outbreak. Although there are no approved treatments for MPX, three antivirals (brincidofovir, cidofovir, tecovirimat) have been utilized in humans based on data from animal studies. Additionally, to the best of our knowledge, no large systematic review has been conducted documenting the most common
