Advancements and challenges in the medical treatment of monkeypox: A recent focused review
Hamza M. Alasbily, Abeer M. Albarasi, Arwa M. Ibrahim, Intisar N. Omran
Abstract
Monkeypox, an infectious disease caused by the Orthopoxvirus, was identified in humans in 1970. It has recently emerged as a global health concern due to outbreaks beyond its endemic regions in Central and West Africa. This review examines the current state of medical treatments for monkeypox as of 2024, focusing on antiviral agents, immunotherapies, and supportive care measures. Monkeypox manifests with symptoms including fever, rash, and lymphadenopathy, with severe cases more common in immunocompromised individuals. Antiviral therapies such as tecovirimat and brincidofovir are central to treatment strategies, with tecovirimat demonstrating efficacy in alleviating symptoms and reducing viral shedding. Emerging treatment strategies involve novel lipid-based formulations and combination therapies that integrate antivirals with immune-modulating agents. Supportive care remains essential, involving analgesics and antibiotics for secondary infections, while the MVA-BN vaccine plays a critical role in prevention. Research emphasizes the need for a deeper understanding of viral pathogenesis and host immune responses to improve therapeutic and preventive measures. Despite significant advancements, challenges remain, including potential antiviral resistance, disparities in healthcare access, and the necessity for enhanced diagnostic and surveillance capabilities. This review highlights the imperative for ongoing research, international collaboration, and investment in healthcare infrastructure to advance the management and prevention of monkeypox and to prepare for future outbreaks.
Keywords
References
- Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, Steffen R (2022) The changing epidemiology of human monkeypox: A potential threat? A systematic review. PLoS Neglected Tropical Diseases. 16 (2): e0010141. doi: 10.1371/journal.pntd.0010141
- Adler H, Gould S, Hine P, Snell LB, Wong W, Houlihan CF, Osborne JC, Rampling T, Beadsworth MB, Duncan CJ, Dunning J, Fletcher TE, Hunter ER, Jacobs M, Khoo SH, Newsholme W, Porter D, Porter RJ, Ratcliffe L, Schmid ML, Semple MG, Tunbridge AJ, Wingfield T, Price NM; NHS England High Consequence Infectious Diseases (Airborne) Network (2022) Clinical features and management of human monkeypox: A retrospective observational study in the UK. The Lancet Infectious Diseases. 22 (9): 1153-1162. doi: 10.1016/S1473-3099(22) 00372-3
- Mellou K, Tryfinopoulou K, Pappa S, Gkolfinopoulou K, Papanikou S, Papadopoulou G, Vassou E, Kostaki EG, Papadima K, Mouratidou E, Tsintziloni M, Siafakas N, Florou Z, Katsoulidou A, Sapounas S, Sourvinos G, Pournaras S, Petinaki E, Goula M, Paparizos V, Papa A, Zaoutis T, Paraskevis D (2023) Overview of Mpox Outbreak in Greece in 2022-2023: Is It Over? Viruses. 15 (6): 1384. doi: 10.3390/v15061384
- Ullah M, Li Y, Munib K, Zhang Z (2023) Epidemiology, host range, and associated risk factors of monkeypox: an emerging global public health threat. Frontiers in Microbiology. 14: 1160984. doi: 10.3389/fmicb.2023.1160984
- Kaler J, Hussain A, Flores G, Kheiri S, Desrosiers D (2022) Monkeypox: A comprehensive review of transmission, pathogenesis, and manifestation. Cureus. 14 (7): e26531. doi: 10.7759/cureus.26531
- Brown B, Fricke I, Imarogbe C, Padrón González AA, Batista OA, Mensah P, Chacon-Cruz E (2023) Immunopathogenesis of Orthopoxviridae: Insights into immunology from smallpox to monkeypox (mpox). Explor Immunology. 3: 525-553. 3. doi: 10.37349/ei.2023.00119
- Li H, Huang QZ, Zhang H, Liu ZX, Chen XH, Ye LL, Luo Y (2023) The land-scape of immune response to monkeypox virus. EBioMedicine. 87: 104424. doi: 10.1016/j.ebiom.2022.104424
- Kumar S, Guruparan D, Karuppanan K (2023) Recent advances in monkeypox (mpox): characterization, diagnosis, and therapeutics - a multidimensional review. Preprint: Corpus ID: 262907153. doi: 10.22541/au.168846306. 66701439/v1
- Mitjà O, Ogoina D, Titanji BK, Galvan C, Muyembe JJ, Marks M, Orkin CM (2023) Monkeypox. Lancet. 401 (10370): 60-74. doi: 10.1016/S0140-6736(22)02414-X
- Gul I, Liu C, Yuan X, Du Z, Zhai S, Lei Z, Chen Q, Raheem MA, He Q, Hu Q, Xiao C, Haihui Z, Wang R, Han S, Du K, Yu D, Zhang CY, Qin P (2022) Current and perspective sensing methods for monkeypox virus. Bioengineering. 9 (10): 571. doi: 10.3390/bioengineering9100571
- Saied AA, Dhawan M, Metwally AA, Fahrni ML, Choudhary P, Choudhary OP (2022) Disease history, pathogenesis, diagnostics, and therapeutics for human monkeypox disease: A comprehensive review. Vaccines. 10 (12): 2091. doi: 10.3390/vaccines10122091
- Da Silva SJR, Kohl A, Pena L, Pardee K (2023) Clinical and laboratory diagnosis of monkeypox (mpox): Current status and future directions. iScience. 26 (6): 106759. doi: 10.1016/j.isci.2023.106759
- Chen Y, Wu C, A R, Zhao L, Zhang Z, Tan W (2023) Perspective on the application of genome sequencing for monkeypox virus surveillance. Virologica Sinica. 38 (2): 327-333. doi: 10.1016/j.virs.2023.03.006
- Bruno G, Buccoliero GB (2023) Antivirals against monkeypox (mpox) in humans: An updated narrative review. Life. 13 (10): 1969. doi: 10.3390/life13101969
- Siegrist EA, Sassine J (2023) Antivirals with activity against mpox: A clinically oriented review. Clinical Infectious Diseases. 76 (1): 155-164. doi: 10.1093/cid/ciac622
- Pourkarim F, Entezari-Maleki T (2024) Clinical considerations on monkeypox antiviral medications: An overview. Pharmacology Research and Perspectives. 12 (1): e01164. doi: 10.1002/prp2.1164
- Dash SR, Kundu CN (2023) Advances in nanomedicine for the treatment of infectious diseases caused by viruses. Biomaterials Science. 11: 3431-3359. doi: 10.1039/D2BM02066A
- Li P, Al-Tawfiq JA, Memish ZA, Pan Q (2023) Preventing drug resistance: combination treatment for mpox. Lancet. 402 (10414):1750-1751. doi: 10.1016/S0140-6736(23)01673-2
- Sun Y, Nie W, Tian D, Ye Q (2024) Human monkeypox virus: Epidemiologic review and research progress in diagnosis and treatment. Journal of Clinical Virology. 171: 105662. doi: 10.1016/j.jcv.2024.105662
- Wang X, Gu Z, Sheng S, Song R, Jin R (2024) The current state and progress of mpox vaccine research. China CDC Weekly. 6 (7): 118-125. doi: 10.46234/ccdcw2024.025
- Ghazy RM, Elrewany E, Gebreal A, ElMakhzangy R, Fadl N, Elbanna EH, Tolba MM, Hammad EM, Youssef N, Abosheaishaa H, Hamouda EEM, Mehana ZEE, Al Zomia AS, A Alnami RA, Salma EAS, Alqahtani AS, Alshehri AF, Hussein M (2023) Systematic review on the efficacy, effectiveness, safety, and immunogenicity of monkeypox vaccine. Vaccines. 11 (11): 1708. doi: 10.3390/vaccines11111708
- Eslami A, Alimoghadam S, Khoshravesh S, Shirani M, Alimoghadam R, Darazam IA (2024) Mpox vaccination and treatment: A systematic review. Journal of Chemotherapy. 36 (2): 85-109. doi: 10.1080/1120009X. 2023.2289270
- Nyame J, Punniyakotti S, Khera K, Pal RS, Varadarajan N, Sharma P (2023) Challenges in the treatment and prevention of monkeypox infection: A comprehensive review. Acta Tropica. 245: 106960. doi: 10.1016/ j.actatropica.2023.106960
- Fortier JC, Marsalisi C, Cordova E, Guo HJ, Verdecia J (2024) Challenges in managing treatment-resistant mpox complicated by severe superinfection. Open Forum Infectious Diseases. 11 (4): ofae138. doi: 10.1093/ofid/ofae138
- Patel M, Adnan M, Aldarhami A, Bazaid AS, Saeedi NH, Alkayyal AA, Saleh FM, Awadh IB, Saeed A, Alshaghdali K (2023) Current insights into diagnosis, prevention strategies, treatment, therapeutic targets, and challenges of monkeypox (Mpox) infections in human populations. Life (Basel). 13 (1): 249. doi: 10.3390/life 13010249
Submitted date:
08/24/2024
Reviewed date:
09/10/2024
Accepted date:
09/10/2024
Publication date:
09/10/2024