Monkeypox
It was another day in the office in the small town where I work as an Infectious Disease Physician. The phone rang. It was one of the nurses in the Emergency Room. She said to me that they needed me to see a patient immediately as the patient had been exposed to Monkeypox.
Monkeypox? I struggled to recall this disease. I asked the nurse for details. She told me that the patient had been on a flight from Lagos in Nigeria to the United States. One of the passengers on that flight got sick and developed sores on his face. He was admitted to a local hospital in Dallas. A biopsy of one of those lesions came back as 'Monkeypox'. All the other passengers on that flight were considered to have been exposed.
Monkeypox is a pox virus of the same family as Smallpox. It is called Monkeypox because the first outbreak occurred in some research monkeys in 1958. The first human case was described in 1970. It is thought to spread from rodents. It still occurs rarely in parts of Africa. There are two variants. The less lethal one is found in West Africa and has a 1% mortality, but transmission is rare. A central African variant is more easily transmissible and has a higher mortality of 10%.
There have been sporadic cases. There were a few cases in the United States in 2013, acquired from infected pet mice imported from Ghana. There have been none since then until this case in 2021. There was an outbreak in Nigeria from 2017 to 2019. Treatment is mostly supportive. The incubation period is 7 to 14 days. Luckily on this flight everyone was wearing masks because of the Covid outbreak, so risk of exposure was low.
Once the first passenger was diagnosed, the CDC aggressively traced every other passenger on that flight and put them under surveillance. They could not find two of those passengers, one of whom was our patient. The CDC then put out an alert to all the hospitals with the names of the missing passengers. Our patient had come to visit family near our hospital. She had forgotten her regular medications and came to our Emergency Room to get these prescribed. Once she got there, the system flagged her and she was put in isolation. She could not understand what was being told to her and I was told she could not speak English.
I saw her through telemedicine. She appeared very frightened. I had been born in Pakistan, but grew up in Nigeria. I was familiar with a form of English spoken in Nigeria called 'Pidgin English'. So, I decide to try that and said to her "Madam, how you de", Wetin happen? (How are you, what happened)?
She was taken aback to see a South Asian man speaking pidgin but instantly understood me. “I de fine” (I am fine) she said. Make una help me (please help me). I talked to her for some time and calmed her down. She asked for some food and I told her that I will ask for dinner for her, but could not arrange pounded yam and egusi (typical Nigerian dishes). She laughed. We got friendly and she told me that she worked in a market in Lagos. I also told her about growing up in Nigeria.
She had no symptoms and it was a month after the flight (well beyond the typical 14-day incubation period). I recommended that no further monitoring was needed and she was subsequently discharged from the hospital. I had never imagined that my knowledge of pidgin English will come in use in this way. I hope my patient is continuing to do well.
