대부분의 원숭이두창 환자들은 경증이고 의학적 개입 없이 회복됩니다. 오심/구토/연하곤란이 있어 탈수에 대한 위험 요인이 있는 사람들은 IV 수액을 위해 단기간 입원이 필요할 수 있습니다. 중증 환자들에게 감염으로부 회복될 때까지 supportive care가 필수적입니다.
대부분의 원숭이두창 환자들은 경증, 저절로 호전됩니다. 그러나 중증 질환과 면역억제 환자, 8세 미만, 임신부, 수유부, 감염 합병증 환자와 같이 중증 질환에 대한 위험 요인이 있는 환자드에서는 항바이러스제가 합리적일 수 있습니다. 또한 입, 눈, 생식기와 같이 전통적으로 비전형적 부위에 원숭이두창 감염이 있는 경우 고려될 수 있습니다.
면역이 억제된 사람들이란 진행된 HIV-1 감염, 백혈병, 림프종, 전신 악성암, 고형장기이식, alkylating/antimetabolite 약제 치료, 방사선, TNF 억제제, 고용량 스테로이드, 24개월 이내 골수이식수여자 또는 24개월 이상이지만 GVHD가 있거나 재발한 경우, 면역결핍이 있는 자가면역질환자입니다.
몇 가지 항바이러스제가 원숭이두창 치료에 유용할 수 있습니다. 이 약제들 중의 일부는 동물 모델과 사람에서 용량 연구에 기반하여 천연두 치료를 위해 승인 받았지만 사람 원숭이두창에 대해서도 같은 활성이 있을 것으로 기대됩니다.
일부 전문가는 중증 질환 환자에서 tecovirimat와 cidofovir 병합 치료를 제안하지만 일반적으로 tecovirimat가 TOC입니다.
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● Tecovirimat — Tecovirimat is a potent inhibitor of an orthopoxvirus protein required for the formation of an infectious virus particle that is essential for dissemination within an infected host. This drug protects nonhuman primates from lethal monkeypox virus infections, and is likely to be efficacious against this infection in humans as well. In the United States, tecovirimat was approved for the treatment of smallpox in July 2018, and is only available through the CDC.
Oral and intravenous preparations are available. The recommended dose of tecovirimat depends upon the patient's weight, as described in manufacturer labeling and the Lexicomp drug information topic within UpToDate. The duration of treatment is 14 days.
Tecovirimat appears to be well tolerated. The most frequently reported side effects are headache, nausea, and abdominal pain. It was administered to approximately 360 human volunteers in an expanded safety trial, which found an adverse effect profile similar to that of placebo. In a small series of seven patients with monkeypox, the one patient treated with tecovirimat experienced no adverse effects, and had a shorter duration of viral shedding and illness compared with the others (including some that received brincidofovir).
● Cidofovir/Brincidofovir — Cidofovir has in vitro activity against monkeypox and has been shown to be effective against lethal monkeypox challenge in animal models. However, there are no clinical data regarding its efficacy against monkeypox infection in humans and its use can be associated with significant adverse events, including nephrotoxicity.
In June 2021, brincidofovir was approved for use in the United States for treatment of smallpox. Brincidofovir is an analog of cidofovir that can be given orally; however, its clinical availability is uncertain at this time.
There are only limited published data with the use of brincidofovir for treatment of monkeypox. Animal models show that it is likely an effective treatment of orthopoxvirus infections. However, in one case series, three patients with monkeypox were treated with brincidofovir (200 mg once a week orally), and all developed elevated liver enzymes resulting in discontinuation of therapy.
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Ref. UpToDate 2022.06.06
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