Viruela símica: una revisión narrativa de la fisiopatología / Monkeypox: a narrative review of pathophysiology

La viruela símica es una enfermedad zoonótica identificada por primera vez en 1958. El virus es un miembro del género Orthopoxvirus, de la familia Poxviridae. Infecta a una amplia variedad de mamíferos, pero se desconoce su reservorio natural. El virus del brote de 2022 pertenece a los clados IIa y IIb. Es probable que la aparición del brote actual se deba a las importaciones del brote de Nigeria de 2017-2018. La propagación de persona a persona puede ocurrir a través del contacto cercano con lesiones, fluidos corporales, gotitas respiratorias y objetos contaminados. Una vez dentro del organismo, el virus infecta las mucosas, células epiteliales y células inmunitarias de los tejidos adyacentes. Luego, el virus se replica y disemina rápidamente a través del sistema hemático y linfático. Las células T desempeñan un papel importante en la regulación de la respuesta inmunitaria contra el virus. Sin embargo, los Orthopoxvirus han desarrollado varios mecanismos para la evasión de la respuesta inmunitaria. La vigilancia de la enfermedad es un factor crucial en la evaluación de riesgo del virus y del control del brote. Para esta revisión se realizó la búsqueda de los principales artículos relacionados a la patogenia del virus, publicados hasta la fecha. El artículo destaca la necesidad de nuevos estudios sobre transmisibilidad y patogenicidad de las cepas asociadas al brote de 2022.

Monkeypox is a zoonotic disease first identified in 1958. The virus is a member of the genus Orthopoxvirus, family Poxviridae. It infects a wide variety of mammals, but its natural reservoir is unknown. The virus in the 2022 outbreak belongs to clades IIa and IIb. The emergence of the current outbreak is likely to be due to importations from the 2017-2018 Nigerian outbreak. Person to person spread can occur through close contact with lesions, body fluids, respiratory droplets and contaminated objects. Once inside the body, the virus infects mucous membranes, epithelial cells and immune cells in adjacent tissues. The virus then replicates and spreads rapidly through the blood and lymphatic system. Tcells play an important role in regulating the immune response against the virus. However, Orthopoxvirus have evolved several mechanisms for evasion of the immune response. Disease surveillance is a crucial factor in virus risk assessment and outbreak control. For this review we searched for the main articles related to the pathogenesis of the virus published to date. The article highlights the need for further studies on transmissibility and pathogenicity of the strains associated with the 2022 outbreak.

Epidemia de Monkeypox humana 2022 em países não endêmicos: os primatas não humanos não são vilões! / Mpox epidemic in non-endemic countries, 2022: non-human primates are not villains!

A mpox (varíola dos macacos ou monkeypox) é uma zoonose causada por um orthopoxvírus, da espécie Monkeypox virus (MPXV). Historicamente, primatas não humanos (PNHs) e, principalmente, roedores selvagens participam da manutenção do ciclo de transmissão em regiões endêmicas da África. Na atual epidemia de mpox em países não endêmicos, incluindo o Brasil, o ciclo epidemiológico apresenta transmissão direta de MPXV entre seres humanos, sem a participação de PNHs. O objetivo da revisão é apresentar informações históricas e o estado-da-arte da mpox com o intuito de orientar e fornecer subsídios sobre a doença aos médicos-veterinários, outros profissionais de saúde e a população em geral, além de desmitificar a participação dos PNHs, uma vez que estes não participam do ciclo de transmissão da doença em países não endêmicos.(AU)

Mpox (monkeypox) is a zoonotic disease caused by an orthopoxvirus, species Monkeypox virus (MPXV). Historically, non-human primates (NHPs) and wild rodents participate in maintaining the transmission cycle in endemic regions of Africa. In the current epidemic of human mpox in non-endemic countries, including Brazil, the epidemiological cycle of human mpox shows direct transmission of the MPXV between humans, without the participation of NHPs. The objective of this review is to present historical information and the state-of-the-art of human mpox to guide and provide subsidies about the disease to veterinarians, other health professionals and the population in general, in addition to demystifying the participation of PNHs in the HM transmission cycle in non-endemic countries.(AU)

Viruela símica: una infección emergente desatendida / Monkeypox: an unattendedemerging infection

El virus de la viruela símica estrechamente relacionado al virus de la viruela humana, es una zoonosis endémica de África occidental y central. En los seres humanos, la infección puede provocar una enfermedad similar a la viruela humana, aunque de menor severidad, pese a ello se asocia a una letalidad reportada variable desde menos del 1% al 11%. La transmisión se produce principalmente a través de gotitas respiratorias o contacto directo con el exudado de lesiones. La transmisión persona a persona está bien descrita, tanto comunitaria como nosocomial. El cuadro clínico se caracteriza por un pródromo de fiebre, al cual se agrega exantema y linfadenopatía. Dentro de las complicaciones se pueden incluir neumonía, encefalitis y queratitis. No existe un tratamiento aprobado establecido, aunque se incluyen estrategias en base a antivirales y vacunas. (AU)

Monkeypox virus, closely related to human smallpox virus, is a zoonosis endemic to West and Central Africa. In humans, the infection can cause a disease similar to smallpox, although less severe, despite this it is associated with a variable reported lethality from less than 1% to 11%. Transmission occurs primarily through respiratory droplets or direct contact with exudate from lesions. Person-to-person transmission is well described, both in the community and nosocomial. The clinical picture is characterized by a prodrome of fever, to which is added rash and lymphadenopathy. Complications may include pneumonia, encephalitis, and keratitis. There is no established approved treatment, although strategies based on antivirals and vaccines are included. (AU)