Clinical Conundrums: Differentiating Monkeypox From Similarly Presenting Infections

Explainable AI for Symptom-Based Detection of Monkeypox: a machine learning approach

BACKGROUND

Monkeypox, a viral zoonotic disease, is an emerging global health concern, with rising incidence and outbreaks extending beyond its endemic regions in Central and, West Africa and the world. The disease transmits through contact with infected animals and humans, leading to fever, rash, and lymphadenopathy symptoms. Control efforts include surveillance, contact tracing, and vaccination campaigns; however, the increasing number of cases underscores the necessity for a coordinated global response to mitigate its impact. Since monkeypox has become a public health issue, new methods for efficiently identifying cases are required. The control of monkeypox infections depends on early detection and prediction. This study aimed to utilize Symptom-Based Detection of Monkeypox using a machine-learning approach.

METHODS

This research presents a machine learning approach that integrates various Explainable Artificial Intelligence (XAI) to enhance the detection of monkeypox cases based on clinical symptoms, addressing the limitations of image-based diagnostic systems. In this study, we used a publicly available dataset from GitHub containing clinical features about monkeypox disease. The data have been analysed using Random Forest, Bagging, Gradient Boosting, CatBoost, XGBoost, and LGBMClassifier to develop a robust predictive model.

RESULTS

The study shows that machine learning models can accurately diagnose monkeypox based on symptoms like fever, rash, lymphadenopathy and other clinical symptoms. By using XAI techniques for feature importance, the approach not only achieved high accuracy but also provided transparency in decision-making. This integration of explainable Artificial intelligence (AI) enhances trust and allows healthcare professionals to understand predictions, leading to timely interventions and improved public health responses to monkeypox outbreaks. All Machine learning methods have been compared with the evaluation matrix. The best performance was for the LGBMClassifier, with an accuracy of 89.3%. In addition, multiple Explainable Techniques tools were used to help in examining and explaining the output of the LGBMClassifier model.

CONCLUSIONS

Our research shows that combining explainable techniques with AI models greatly enhances the accuracy of case detection and boosts the trust of medical professionals. These models result in directly involving the reader and health care professional in the decision-making process, making informed decisions, and efficiently allocating resources by providing insight into the decision-making process. In addition, this study underscores the potential of AI in public health surveillance, particularly in enhancing responses to emerging infectious diseases such as monkeypox.

Navigating monkeypox: identifying risks and implementing solutions

Monkeypox is a zoonotic disease caused by the orthopox virus, a double-stranded DNA virus that belongs the Poxviridae virus family. It is known to infect both animals (especially monkeys and rodents) and humans and causes a rash similar to smallpox. Humans can become infected with monkeypox virus (MPXV) when they get in close contact with infected animals (zoonotic transmission) or other infected people (human-human transmission) through their body fluids such as mucus, saliva, or even skin sores. Frequently observed symptoms of this disease include fever, headaches, muscle aches, and a rash that initially looks like a tiny bump before becoming a lump that is filled with fluid. Monkeypox symptoms also include an incubation period of 5-21 days, divided into prodromal and eruption phases. Several contributing factors, such as smallpox vaccine discontinuation, widespread intake of infected animal products as a source of protein, and high population density, amongst others, have been linked to an increase in the frequency of monkeypox outbreaks. The best course of action for diagnosing individuals who may be suffering from active monkeypox is to collect a sample of skin from the lesion and perform PCR molecular testing. Monkeypox does not presently have a specific therapy; however, supportive care can assist in managing symptoms, such as medication to lower body temperature and pain. Three major orthopoxvirus vaccines have been approved to serve as a preventive measure against monkeypox: LC16, JYNNEOS, and ACAM2000. The discovery that the monkeypox outbreak is communicable both among humans and within a population has sparked new public health worries on the possibility of the outbreak of another viral pandemic. Research and studies are still being conducted to gain a deeper understanding of this zoonotic viral disease. This review is therefore focused on deciphering monkeypox, its etiology, pathogenesis, transmission, risk factors, and control.

Clinico-Dermoscopic Report of Molluscum Dermatitis: A Pearly Puzzle in Focus

We report an 18-year-old male who presented with a two-month history of a lesion over his right forearm with a one-week history of sudden increase in size associated with pain. General and systemic examinations were normal. Dermatological examination revealed a single tender, well-defined, pearly white to erythematous, dome-shaped nodule of approximately 6mm x 5mm x 5mm with central umbilication and surrounding erythema. Dermoscopy revealed a central poly lobular white-yellow amorphous structure with a peripheral punctiform vascular pattern, collarette of scaling, and circumferential homogenous red area. Intracytoplasmic eosinophilic and basophilic inclusion bodies were found on the Tzanck smear. With the above clinical and dermoscopic findings, a diagnosis of molluscum contagiosum (MC) with molluscum dermatitis was made. Following curettage and removal of the contents of the lesion, the surrounding inflammation resolved completely within 20 days. This report emphasizes the fact that curettage of the primary MC lesion itself leads to the resolution of molluscum dermatitis, negating the need for additional topical steroid therapy. The unreported dermoscopic features of molluscum dermatitis in this report provide valuable insights into distinguishing molluscum dermatitis from other dermatological conditions with similar presentations.

Mpox Virus and its ocular surface manifestations

The Mpox virus (MPXV) is the causative agent of human Mpox disease - a debilitating rash illness similar to smallpox. Although Clade I MPXV has remained endemic to West and Central Africa, Clade II MPXV has been responsible for many outbreaks worldwide. The most recent outbreak in 2022 resulted from the rapid spread of a new clade of MPXV, classified into Clade IIb - a distinct lineage from the previously circulating viral strains. The rapid spread and increased severity of Mpox disease by the Clade IIb strain have raised the serious public health imperative of better understanding the host and viral determinants during MPXV infection. In addition to typical skin rashes, including in the periorbital area, MPXV causes moderate to severe ophthalmic manifestations - most commonly, ocular surface complications (e.g., keratitis, conjunctivitis, blepharitis). While ocular manifestations of Clade I Mpox within the Congo basin have been well-reported, global incidence trends of ocular Mpox cases by Clade IIb are still emerging. Given the demonstrated ability of all MPXV strains to auto-inoculate ocular tissue, alongside the enhanced transmissibility of the Clade IIb virus, there is an urgent need to elucidate the mechanisms by which MPXV causes ocular anomalies. In this review, we discuss the viral and genomic structures of MPXV, the epidemiology, and pathology of systemic and ocular Mpox, as well as potential prophylactic and therapeutic interventions.

A Label-free Optical Biosensor-Based Point-of-Care Test for the Rapid Detection of Monkeypox Virus

Diagnostic approaches that combine the high sensitivity and specificity of laboratory-based digital detection with the ease of use and affordability of point-of-care (POC) technologies could revolutionize disease diagnostics. This is especially true in infectious disease diagnostics, where rapid and accurate pathogen detection is critical to curbing the spread of disease. We have pioneered an innovative label-free digital detection platform that utilizes Interferometric Reflectance Imaging Sensor (IRIS) technology. IRIS leverages light interference from an optically transparent thin film, eliminating the need for complex optical resonances to enhance the signal by harnessing light interference and the power of signal averaging in shot-noise-limited operation to achieve virtually unlimited sensitivity. In our latest work, we have further improved our previous 'Single-Particle' IRIS (SP-IRIS) technology by allowing the construction of the optical signature of target nanoparticles (whole virus) from a single image. This new platform, 'Pixel-Diversity' IRIS (PD-IRIS), eliminated the need for z-scan acquisition, required in SP-IRIS, a time-consuming and expensive process, and made our technology more applicable to POC settings. Using PD-IRIS, we quantitatively detected the Monkeypox virus (MPXV), the etiological agent for Monkeypox (Mpox) infection. MPXV was captured by anti-A29 monoclonal antibody (mAb 69-126-3) on Protein G spots on the sensor chips and were detected at a limit-of-detection (LOD) - of 200 PFU/ml (~3.3 attomolar). PD-IRIS was superior to the laboratory-based ELISA (LOD - 1800 PFU/mL) used as a comparator. The specificity of PD-IRIS in MPXV detection was demonstrated using Herpes simplex virus, type 1 (HSV-1), and Cowpox virus (CPXV). This work establishes the effectiveness of PD-IRIS and opens possibilities for its advancement in clinical diagnostics of Mpox at POC. Moreover, PD-IRIS is a modular technology that can be adapted for the multiplex detection of pathogens for which high-affinity ligands are available that can bind their surface antigens to capture them on the sensor surface.

Monkeypox (Mpox): Evolution of Transmission and Comprehensive Review

The human monkeypox (mpox) virus is an orthopox virus that can be transmitted to humans. Though the disease has been endemic in Africa, the recent mpox outbreak since May 2022. We attempted to examine differences between the endemic form of mpox and the current outbreak. Review of electronic medical database with relevant keywords. The current outbreak of mpox has disproportionately impacted the gay, bisexual and other men who have sex with men (MSM) community. This is also the first time that widespread semen testing has turned up evidence of mpox viral deoxyribonucleic acid (DNA). Cases in the present outbreak are more likely to affect adults, involve the genitalia, and have no prodrome. Close diagnostic differentials include varicella and hand-foot-mouth disease. The disease is usually self-limiting; though secondary infections, anorectal pain, pharyngitis, ocular lesions and rarely, renal injury and myocarditis may occur. This review focuses primarily on the novel clinical characteristics and emerging sexual transmission route of the mpox virus, which, although unconfirmed, appears extremely likely as the route of spread. Dermatologists have an important role in this health emergency, as early diagnosis can cause a significant reduction in disease transmission.

Knowledge of Medical Students Towards the Re-emergence of Human Monkeypox Virus

INTRODUCTION

Declaration of human monkeypox(HMPX) virus as Public Health Emergency of International Concern (PHEIC) by World Health Organisation (WHO) has raised concerns among the public andlack of knowledge is a prominent challenge in curbing this outbreak. Therefore, assessment ofknowledge level on this outbreak among the medical students is also necessary due to the fact that they are the future healthcare practitioners who will be directly involved in the disease management as well as a major source of knowledge dissemination to the public.

AIM

The main objective of this study is to assess the knowledge level of medical students at Universiti Sultan Zainal Abidin (UniSZA) regarding the emergence of HMPX. Additionally, the study aims to investigate potential associations between socio-demographic characteristics and knowledge levels, while also identifying factors that predict a high level of knowledge in this context..

METHODS

A descriptive cross-sectional study was conducted among UniSZA undergraduatemedical students from Year 1 to Year 5. A validated questionnaire comprising six socio-demographic variables and 27 knowledge items was shared online. Descriptive statistics, non-parametric tests and multivariate logistic regression were performed using SPSS software.

RESULTS

A total of 138 medical students out of 300 participated in this study. Overall, the average knowledge score was 73.95% ±4.43, which indicates that the medical students have moderate knowledge level. Nearly half of them had good knowledge level (n= 68; 49.3%), 43 of them had moderate knowledge level (31.2%), and 27 of them had poor knowledge level (19.6%). There was a significant association between knowledge level and two factors: receiving information on HMPX during their education and seniority (P-value < 0.01 and P-value < 0.05, respectively). Besides, received information on HMPX during their education was a significant predicting factor of good knowledge level (P-value = 0.002).

CONCLUSION

The knowledge level among the medical students was relatively inadequate.

A review on the use of machine learning techniques in monkeypox disease prediction

Infectious diseases have posed a global threat recently, progressing from endemic to pandemic. Early detection and finding a better cure are methods for curbing the disease and its transmission. Machine learning (ML) has demonstrated to be an ideal approach for early disease diagnosis. This review highlights the use of ML algorithms for monkeypox (MP). Various models, such as CNN, DL, NLP, Naïve Bayes, GRA-TLA, HMD, ARIMA, SEL, Regression analysis, and Twitter posts were built to extract useful information from the dataset. These findings show that detection, classification, forecasting, and sentiment analysis are primarily analyzed. Furthermore, this review will assist researchers in understanding the latest implementations of ML in MP and further progress in the field to discover potent therapeutics.

Enhancing Nursing Care in Monkeypox (Mpox) Patients: Differential Diagnoses, Prevention Measures, and Therapeutic Interventions

Monkeypox (Mpox), a rare zoonotic viral infection caused by the monkeypox virus, has been gaining attention due to its potential for human-to-human transmission and its clinical resemblance to other poxvirus infections, such as smallpox and chickenpox. Enhancing nursing care for monkeypox patients is imperative to manage and contain its spread effectively. This review analyzes the key aspects of enhancing nursing care in monkeypox patients, focusing on differential diagnoses, prevention measures, and therapeutic interventions. Differential diagnosis is crucial in terms of the early recognition and management of monkeypox. Given its similarity to other poxvirus infections, a thorough assessment of clinical symptoms, travel history, and exposure to potential reservoir hosts is essential. Nursing professionals play a pivotal role in eliciting comprehensive patient histories and relaying this information to the medical team for accurate diagnosis. Prevention measures constitute a vital component of nursing care in monkeypox management. Implementing stringent infection prevention and control practices, including isolation protocols, personal protective equipment (PPE) usage, and hand hygiene, is imperative to curbing nosocomial transmission. Nurses are at the forefront of enforcing these measures, educating patients, families, and healthcare staff about their significance, and ensuring strict adherence. Therapeutic interventions in monkeypox largely focus on supportive care and symptom management. Nurses occupy a central role in administering antiviral medications, providing wound care for skin lesions, and monitoring patients for potential complications such as secondary bacterial infections. Psychosocial support is equally important, as patients often experience fear and anxiety due to the disease's contagious nature. Nursing professionals offer compassionate care, address patients' emotional needs, and facilitate communication between patients and their families. Enhancing nursing care for monkeypox entails a multifaceted approach involving differential diagnoses, prevention measures, and therapeutic interventions. Nursing professionals serve as frontline caregivers, pivotal in early diagnosis, effective prevention strategies, and comprehensive patient management. As the global healthcare community faces an influx of emerging infectious diseases, the lessons learned from managing monkeypox can contribute to the creation of a more resilient and responsive nursing workforce capable of effectively addressing future health challenges.

Clinical and Epidemiological Interventions for Monkeypox Management in Children: A Systematic Review

This review aims to compile the available literature on monkeypox, identify risk factors for developing the disease, and recommend effective preventative methods to reduce the number of reported cases and fatalities in children and pregnant women. In seeking out pertinent studies on monkeypox virus in children and pregnant women, we searched the literature using the databases Cochrane Library, Google Scholar, PubMed, EMBASE, Web of Science, and Scopus up to 1st February 2023. This study analyzed data from case studies of monkeypox in children and pregnant women. Clinical data and test findings of monkeypox patients less than 18 years old and pregnant women were analyzed. The Newcastle-Ottawa Scale was used to do the quality evaluation. Our record examination spanned the years 1985 to 2023 and found 17 children and five pregnant female patients treated with monkeypox in various hospitals/community centers. Zaire, Gabon, Chicago, Sierra Leone, Central African Republic, Northern DR Congo, Liberia, Cameroon, the Democratic Republic of the Congo, the United Kingdom, the Netherlands, and Florida all contributed to the 14 studies analyzed. There were no studies identified for meta-analysis of selected case studies of hospitalized children and pregnant women who were diagnosed with monkeypox. The incidence, prevalence, clinical characteristics, diagnosis, management, prevention, vaccinations, infant care, and care for expectant mothers are all discussed in this systematic review of monkeypox in children. Our research findings may provide a foundation for further focused research and the development of related recommendations or guidelines.