SUDANESE JOURNAL OF PAEDIATRICS

2023; Vol 23, Issue No. 2

LETTER TO THE EDITOR

Diagnostic dilemma of viral outbreaks in India in children: monkeypox or tomato flu?

Rachna Pasi (1), Kumar Satish Ravi (2)

(1) Assistant Professor, Department of Pediatrics, AIIMS Delhi, New Delhi, India

(2) Professor & Head, Department of Anatomy, AIIMS Gorakhpur, Uttar Pradesh, India

Correspondence to:

Rachna Pasi

Assistant Professor, Department of Pediatrics, AIIMS Delhi, New Delhi, India.

Email: rachna.pasi [at] gmail.com

Received: 10 November 2022 | Accepted: 26 March 2023

How to cite this article:

Pasi R, Ravi KS. Diagnostic dilemma of viral outbreaks in India in children: monkeypox or tomato flu? Sudan J Paediatr. 2023;23(2):257–258.

https://doi.org/10.24911/SJP.106-1668105229

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Dear Editor,

We have not emerged from the COVID-19 pandemic around the world, while two new popular contaminations have now been reported in India. Monkeypox and tomato influenza are viral diseases with arising dangerous to general wellbeing around the world [1,2]. We need to know about the diagnostic clues of look-alike clinical manifestations of these two endemic infections prevalent in children in India.

Monkeypox is definitely not a new infection; the first case was accounted for in 1970 in a child in the Democratic Republic of Congo. Various flare-ups have been accounted for in the USA, in the endemic areas of Africa, Nigeria, the United Kingdom and Singapore in 2018, 2019 and 2021. As of late, it has been believed to spread to nonendemic nations since May 2022, including India [3]. However, it has changed the pattern of infectivity by including up to nine people in the chain. Conversely, beforehand, contaminating just 2–3 people from a solitary wellspring of exposure was accounted for. The rising infectivity might be because of changes in the genomic construction of the infection, changing the populace’s ailment, or the long hole to smallpox immunization because of its destruction in 1980, causing vanning resistance [4]. Monkeypox is a zoonotic viral contamination of the variety orthopoxviral and family poxviridae, an encompassed dsDNA infection. High-risk bunches are medical care personnel, close family contacts, or inhabitants of neighbouring regions. The disease has two phases set apart by fundamental side effects, fever, headache, lymphadenopathy, back pain, lethargy or generalized weakness, followed by skin rashes after 1 to 3 days of the beginning of fever. Skin rash fundamentally influences the face (95%), trailed by palm and soles (75%), oral mucosa (70%), genital injuries (30%), and eye sores (20%) [2]. It is normally a self-restricted sickness except in people with immunodeficiency, HIV disease, and small kids, where it can give extreme side effects. Congenital and neonatal monkeypox have additionally been found in an endemic locale previously. In outrageous cases, there are difficulties of extreme sepsis, encephalitis, bronchopneumonia, auxiliary bacterial contamination to sores, corneal sickness, loss of vision, or skin sloughing [2]. Tomato influenza is one more arising disease detailed in India on the sixth May 2022, with the primary case in the Kollam region of Kerala [1]. The patient had exposure to a patient with similar complaints, and that contact has a history of travel to the UK. Till now, tomato flu cases have been reported in three territories of India, Kerala, Tamil Nadu and Orrisa. It is caused by the coxsackie virus, a type of enterovirus. This is a variable presentation of hand-foot and mouth disease (HMFD). The sort of coxsackie infection separated by pytogenetic examination is CA16 which likewise caused flare-ups of HMFD before. It has been tracked down in five WHO districts since May 2022 [1].

Clinical signs such as rashes are normal in this multitude of two viral diseases common in India. The incubation period is 6–13 days for monkeypox and 7–10 days for tomato influenza [1,5]. Monkeypox is somewhat less infectious, though tomato influenza has been announced as exceptionally infectious. Monkeypox can contaminate any age group, yet kids are impacted more, though tomato influenza is generally an infection of under five children. Monkeypox typically presents with lymphadenopathy, which is not accounted for in tomato flu [2]. Polymerase chain reaction testing of fluids or skin sloughed from blisters in monkeypox can affirm the illness. However, tomato flu is a clinical diagnosis due to the presence of characteristic rashes that appear over the body filled with fluid distributed on the hands and foot; round in shape which mimics tomato in appearance, hence the name of the disease and a diagnosis of exclusion. Treatment is primarily symptomatic with isolation in both cases, 2–4 weeks in monkeypox and 5–7 days in tomato flu. Anti-viral approved treatment modalities in monkeypox are tecovirimat and cidofovir. Tomato flu treatment is mainly supportive with no definitive therapy till now. Smallpox immunization (Ankara strain) was endorsed in 2019 with two dosages, giving 85% resistance against monkeypox [4]. Both contaminations mend without scarring and case casualty is more with monkeypox (0%–11%) [4].

Containment of these forthcoming endemic viral diseases ought to be the need of our health system upgradation through education of health care workers, limiting its additionally spread through isolation, case reconnaissance, dynamic case detailing and treatment of the cases [1,6].

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CONFLICTS OF INTEREST

The authors declare no conflict of interest.

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FUNDING

None.

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ETHICAL APPROVAL

Not applicable.

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REFERENCES

1. Chavda VP, Patel K, Apostolopoulos V. Tomato flu outbreak in India. Lancet Respir Med. 2023 Jan;11(1):e1–2. https://doi.org/10.1016/S2213-2600(22)00300-9
2. World Health Organization. Multi-country monkeypox outbreak: situation update. Geneva, Switzerland: World Health Organization; 2022 [cited 2022 Jun 17]. Available from: https://www.who.int/emergencies/disease-outbreak-news/item/ 2022-DON393
3. World Health Organization. Monkeypox 2022. Geneva, Switzerland: WHO; 2022 [cited 2022 Aug 20]. Available from:https://www.who.int/ news-room/fact-sheets/detail/monkeypox
4. Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, et al. The changing epidemiology of human monkeypox-A potential threat? A systematic review. PLoS Negl Trop Dis. 2022;16:e0010141.
5. Lahariya C, Thakur A, Dudeja N. Monkeypox disease outbreak: epidemiology, challenges, and the way forward. Indian Pediatr. 2022;59(8):636–42.
6. Oliveira CBS, Andrade JMA, Oliveira JIN. Monkeypox: a looming concern for children? Asian Pac J Trop Med. 2022;15(8):335–6.