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all this is dr mobien say here from doctorbean. com welcome to one more show so uh the discussion today is about the monkey box virus so there are many people who are talking about it you can read about them at many places too what i wanted to do was give us the latest update on the monkey box and then talk about the structure how does this virus infect our cells what does it do within the cell how does it make more viruses and how does it cause the death of the cell the mechanism of the virus itself i think that is also very interesting so let's start and uh thank you very much here we have a new member and we also have cynthia who is a new member who's a member so cynthia your your badge shows that to although once again i thought that i had created new badges i do not know when they will become available but thank you very much for being members okay so let's start so this is dr bean. com in the description there is a link to drbin.

com if you wanted to get access to it here is monkeybox you can read it from a an immunology book as well this is just an easy and free access and here are various links i'm going to start with a detailed discussion of the current status and not let's start with the current status this is europe so from europe's point of view there are now as of 31st may 321 total cases in 17 states or countries most cases are in young men self-identifying as men having sex with men there have been no deaths so that is important no deaths the clinical presentation is mostly mild and they are presenting with and this is why uh it is curious this situation this was not observed like this before so the presenting with lesions on the genitalia and perigenital region so that is the region around the anal canal for example or around the penis and those structures indicating that transmission likely occurred by close physical contact contact during sexual activities and i wanted to talk about this because somebody made a comment when i was speaking with dr heather today uh that this is possibly a transmission through semen so it is not a transmission through semen instead this is a transmission through lesions so if somebody has a rash on their body and that is a monkey pox rash that means there is virus in there and any fluids from that rash when they will come in contact with another part another person's skin and again that skin has to be broken just sitting on the skin is not sufficient so if the skin gets cracked which during the anal intercourse it can happen during many other skin many other functions skin can become cracked dry skin becomes microscopically cracked then injuries are common as well in general in human beings so meaning the skin can be cracked so from those cracks the secretions or the fluids they can enter below the skin layers and infect the cells there that is how the transmission is being observed multiple countries have reported cases with which appear to be linked to events taking place in spain and belgium so i think there were some sex related events and then from there the spread is seen however so this is important many countries also report cases with no known epidemiological link to travel abroad so there is an endemic part as well and here is the list of countries you can see the numbers then case definition this is also an interesting thing how is europe defining a case of monkey pox so a confirmed case is a person with the lab confirmed monkey parks infection and how is that lab confirmation pcr test that is one or orthopox virus specific pcr sa positive result which is then confirmed by nucleotide sequences probable case is a person with an unexplained rash on their skin on any part of their body and one or more other symptoms of monkey pox fever and other symptoms then it may as well be and one of the following has a positive lab test result of ortho box virus infection has an epidemiological link to a confirmed or probable case of monkey pox within the 20 days 21 days reported travel to monkey park's endemic countries within the 21 days or in a person of any sexual orientation who had multiple or anonymous sexual partners in the 21 days before the symptoms is a man who has sex with men or a person with an unexplained generalized a localized maculopapular or vesicular popular rash with centrifugal spread centrifugal spread is away from the center so starting from the head for example or the arms so that is the eu and john snyder i see him being a new member as well so yeah we have one more new member awesome thank you okay so this is europe u. s so in the u. s now we have i believe 10 cases and so here these are the cases california 4 colorado 2.

so these are more than 10. so as of june 2 21 cases and california where i am we have four cases over here colorado florida georgia illinois massachusetts where i used to be pennsylvania utah virginia and washington so these are the cases there again a standard summary similar messages everywhere on all pages a rash that looks like a monkey box rash that is a slightly first there is no elevation just skin redness then it starts becoming elevated and then it becomes filled with the fluids but it is elevated then it becomes more vesicular that means the the roof of that elevated skin becomes thin like a bubble and then it uh crust bursts and then crusts over so rice that looks like a monkey box or some looks like monkey pox or someone who was diagnosed with confirmed or probable monkey box had skin to skin contact with someone in a social network experiencing monkey parks activity this includes men who have sex with men who meet partners through an online website digital application or social event then why the reason it's nothing to do with the with the app itself that hey you meet through grinder and you have a problem it is that they do not know that their partner may have had the rash so if they are living together they would know each other and they would know if there is any issue but if they are meeting someone new and afterwards they develop a rash then it may be that their new partner may have been infected barbara has become a member awesome thank you and then johnny baloney has become a member thank you very much so many members awesome thank you okay so then back here traveled outside of the u. s to country with confirmed cases of monkey parks had contact with dead or live wild animal or exotic pet that exists only in africa or the products that are made from those pets and in the endemic countries where the monkey box is present over there if they are eating the animal meat that may be infected can cause and the meat is not properly cooked then that can cause this infection as well so that is u.

s then this is who and who's report this one i would like to go over this it is bit long so before this report i want to go over what is this virus so so there are so many people talking about what happens and so i wanted to go over i wanted to mobilize this the only request is to please forgive me i did not do the diagrams beforehand as i was with dr heather all is his fault today so as i was with dr heather and then just didn't have enough time so i'm gonna i'm going to present it to you by drawing and it might take a little more time so here is what we have monkey box virus is a pox infection virus that means the infection it causes is like parks those little vesicles or bubbles on the skin the virus itself is either oval or brick shaped it looks like a brick or it looks like oval or it looks like an oval brick so that is how the virus looks like virus is enveloped this is really really important it is an enveloped virus so that is very similar envelope to starscope 2. sarskoff 2 is enveloped virus as well and now for the enveloped viruses please keep in mind that the envelope on them that they are they that they have is actually part of our cell membrane and i'll not cell membrane cell cell vesicles part i'll explain what it is meaning it is ours so it is a brick-shaped enveloped virus there is another problem if if it is enveloped and we ingest it with food in theory the stomach acids will burst the envelope causing destruction of the virus but sarskoff too is not destroyed that way because saskof2 for example has the spikes on it that protect them similarly this virus can escape these stomach acids as well oh and we'll and sky frog is here yeah sky frog i left you a message on discord so here enveloped virus inside the virus of course there are certain enzymes which will say non-structural proteins these enzymes are necessary for this virus to function or this virus to replicate in our cells so that is its machinery to make more viruses or the machinery to make more machinery to make more viruses so that is non-structural proteins then it has a long linear if i can make it like this it has a long linear double-stranded dna segment that is its genome so this is a dna virus not an rna virus as we saw with the source of two cysts ii was a positive sense rna virus this one is a single stranded sorry double-stranded dna but a single long strand why do i keep saying single long strand in many viruses the dna may be in a circular structure it may be double-stranded but circular here it is one long segment that is a genome this is the virus now this virus it arrives near our cells what it does is and can you imagine we actually do not know exactly how it enters our cells but what we suspect and i hope my audio is working um this camera scares me every single day so you may have seen that the lens is now actually a little better so my picture profile this is still the same camera sony a7c with the sony's grandmaster lens but i changed the picture profile so tell me how does this look now okay so back here you can hear me right okay excellent ddr says we can hear you so on the surface of our cells there are glycosaminoglycans or something that we say gag glycose amino glycans these are carbohydrates which are connected to little bit of a protein imagine if my hand my finger is a protein tiny protein and if i bind a long thread with it and that thread is made up of candies then that is glycans so a little bit of protein tiny bit of a root of a protein with which a lot of amino acid long chain of amino acids oh i'm saying amino acids glucoses are attached or glycans this is a long carbohydrate engine and the cells have many of these like hair on them this actually gives them the ability to become slippery and slip past each other and there are many functions of these it is thought that the monkey box virus connects or binds with these glycosaminoglycans gags and then it enters the cell now cell entry is also not very clear so it is thought that what happens is the virus unquotes so unquoting all enveloped viruses will have to uncode meaning their envelope has to be broken down and their genome and the enzymes that are inside the virus they have to come out in our cell they have to be liberated from this little pocket so what happens is the virus unquotes they say unquotes in two stages first it binds with the glycans then it kind of comes near the cell membrane and then it fuses the viruses coat or the envelope fuses with our cell membrane and then as it fuses and opens up in two stages this would be called uncoating once it is unquoted the genome of the virus that dna will enter our cytoplasm our cells cytoplasm plus those little non-structural proteins or those tiny builders that it has brought with it they all the whole crew with their brain the genome has entered our cell good so far now generally double-stranded dna viruses replicate their genome that means their dna inside a nucleus why because a nucleus if i make another cell over here this is our cell this is the nucleus now i made it a little bigger this is a nucleus within the nucleus of our cell we have our dna correct i'm just going to make tiny bit of dna just to give an example this is our dna and now in the nucleus we have our own builders these are called dna dependent rna polymerases dna dependent rna rna polymerases what does that mean polymerases are the enzymes that can create polymers so here we are talking about dna so these enzymes can make dna polymers they can make dna that's one second they are dna dependent rna that means that they need a dna structure to copy into an rna so in case of sask of 2 for example we said rna dependent rna polymerase that polymerase that builder makes rna by looking at an example rna so imagine if you are going to cook something and we give you a book and you look at the recipe there and looking at that recipe you cook something now if that recipe recipe book or that sample to make is a dna and then you look at that and make an rna then it would be called dna dependent rna polymerase looks at a dna makes an rna if it is an rna dependent rna polymerase looks at an rna makes an rna so normally these enzymes are present inside the nucleus however this smart depends virus brings in its own dna dependent rna polymerase its own dna dependent rna polymerase why because it does not want to go in our nucleus at all it wants to do everything in our cytoplasm so imagine if this is a nucleus all the nucleus is not normally eccentric can you imagine this that people are this guy sultanji is sending uh what is that spam here man what is wrong with you so i'm gonna block him hold on okay blocked i can't imagine people do this okay so here is a nucleus this virus and its crew do not want to go in a nucleus and use our enzyme instead they bring in their own enzyme stay inside our cells cytoplasm use their dna to make rna from it so their own builders make rna this rna template is then used by our ribosomes ribosomes remember this is the same thing like saskov2 our ribosomes then engage with this rna and then they start making more builders proteins of this virus these newly formed builder proteins would then help make more non-structural proteins plus they would help make copies of this genome so now we'll have the virus genome more brains and the viral structural proteins and non-structural proteins formed then what happens then i want to go here and make one more cell so let's say this is our cell this is our nucleus our nucleus i just made the nucleus smaller around the nucleus we have things called ribosomes endoplasmic reticulum sorry i'm calling them ribosomes endoplasmic reticulums which are small chambers in which various things happen on these endoplasmic reticulums some of them have ribosome attached with them these ribosomes are these parts that are using rna to make more genome or make virus proteins so these rnas sorry what is that ribosomes are here they attach with the rna of the virus they make our viral structures that go inside let me change the color they go inside the endoplasmic reticulum or er now here is the interesting part we actually do not know so many things we don't know about this virus we actually do not know how this virus now assembles but it assembles and on the assembly the membrane remember it doesn't have a membrane yet the original parent viruses membrane got fused with our membrane these little child viruses the virions that are being formed they don't have a membrane yet so what they do is they steal the membrane of the endoplasmic reticulum while they bud out of it i used to in the beginning of sask of two i used to keep a little shawl here and i used to put that shawl on my head if some of you remember and i used to say that as the virus comes out of it it would pinch out that part of the shawl with it so that's the same thing as the virus buds out of the endoplasmic reticulum it would then then steal a part of the membrane of that vesicle now then the other structural non-structural proteins those things become part of it how do they all assemble in the form of this little new virus we don't know exactly but eventually there are these brick-shaped new viruses with their own dna and their own new builders they are all formed when they are formed here is where it becomes bad this virus when it comes out of the cell it kills the cell on its way this is different from other enveloped viruses many enveloped viruses do not kill the cell when they are exiting they simply just bubble out of the cell but this one on the way out kills the cell that is why the destruction and that is why the skin damage there is another part of that skin damage i'll explain that in a second that is a cytotoxic immune system response which also causes plays a part in the damage but this is how this virus now works virus attaches to the glycans ends up with the genome and the non-structural proteins in the cytoplasm in the cytoplasm it comes in with its own dna dependent rna polymerases that start making the rnas or the genome that rna attaches with the ribosome and makes more rnas and dna pieces would start becoming assembled afterwards then non-structural protein structural proteins and the genome they all are collected together then they they steal an envelope from the endoplasmic reticulum and that is a virus then these little virions get out of the cell killing the cell on the way out now how about immune systems response immune systems response is cytotoxic this is why patients of hiv have more severe case of this virus because hiv patients cytotoxic t lymphocytes are impacted so here is what happens so let's say there is the cell with the virus in it and there are viruses coming out and there are virus proteins being presented we know all of this so when this happens we also know that the naive t cell will appear and connect here naive t cell and then this naive t cell will predominantly move towards the helper one pathway and that would then cause cytotoxic t lymphocyte to be activated these cytotoxic t lymphocytes in turn would start killing the cells so when the skin cells are killed that is when those parks like elevations would start forming because now there is dead tissue and debris and the fluids and the pus forming and then as more and more skin tissue is killed more and more cells are dying and the more and more skin would raise and it would become thin layered because cells are being removed and killed and destroyed eventually that parks will break and then there will be a crust that would appear and then ideally a healing but a scar can be formed forever and i had this discussion in the past then when smallpox was more common in the societies then milkmaids used to be appreciated or loved because milkmaids used to get cowpox which will give them immunity from the smallpox and cowpox did not create those lesions with such scarring so milkmaids used to have very clean neat skin while a lot of society members used to have small pork skin and because of that they used to likes milkmaid's skins so here is the mechanism how the skin lesion is produced number one because of the skin cell dying and number two because of the cytotoxic attack in cells which in turn cause intensity so this is the mechanism so let me just now very quickly mechanism is done um so here this is monkey box you can read all about it here and then this is the pox vdi in general so this is a a family of viruses not just a small park so if you see here there are ortho pox viruses parapox viruses yet epochs viruses and so on small parks then you see cow pox will be here monkey pox will be here and then there are structures for how does it replicate and if you see most of the replication stages are actually then tagged as hey citation needed more information needed so anyways that is what happens with this virus now and this is the glycoaminoglycan which are really just these disaccharides or two glucose two candies connected in two candy series and now then going to the final part of the who and then we are done for the today's discussion this is the multi-country monkey pass outbreak in non-endemic countries update and this is 29th may i thought for the first time from who i saw some descent out update so here since 13 may 2022 has been reported in 23 member states have presented through primary care or sexual health services so it is occurring in people who are either coming to the normal clinics or sexual health clinics one case of monkey box in a non-endemic country is considered an outbreak so if a country is non-endemic from monkey pox so let's say u. s is not endemic even one case will mean there is an outbreak in this country the sudden appearance of monkey park simultaneously in several non-endemic countries suggest that there may have been undetected transmission of some time as well as recent amplifying event and we have one more i am celebrating the members by myself adi been is a member as well thank you very much so continuing description of the outbreak 26 may cumulative 257 lab confirmed cases 120 to 120 suspected fortunately no deaths and this is how various countries so this is world level so i was selfish and i looked at u.

s confirmed cases 10 although you just saw the u. s data and that is 21 now so they're a little behind there and same is for europe these are the endemic countries so check this out the difference between them so this is confirmed suspected here endemic countries have deaths as well so for example cameroon 15 december 2021 to may 2022 accumulated cumulative cases 25 nine deaths central african republic for march to 17 may 2022 eight cases two deaths so uh doug had corrected me on dr heather's show one percent fatality rate or 10 percent fertility rate two uh variants i was saying 10 to 30. democratic republic of the congo first january to 8 may 2022 1285 cases 58 deaths nigeria 1 1st january 2 30 april 46 cases no death republic of congo two cases no deaths then it is a zoonotic virus that means it is present in the in the animals then jumps on us fine we know that the name monkey parks originated from the initial discovery of the virus in monkeys in statins serum institute copenhagen denmark in 1958 the first human case was identified in democratic republic of the congo in a young child in 1970 is transmitted from one person to another by close contact with lesions body fluids respiratory droplets contaminated materials such as bedding it has to be fluids in which the infection is present this is why it is not easy to have it in semen because semen is not a fluid that is produced in a easily infectible area so it is being produced in the prostate and the ejaculatory ducts and prostate and the is and so ducts are really more ductile system and so they are less easy to infect with monkey pox but who knows as this is happening maybe that is the next step the incubation period is 6 to 13 days but can range from 5 to 21 days monkey box is usually self-limiting but is there likely to be a little immunity to monkeybox so there is no immunity in us so understood the the two clades the congo basin clade the one percent and 10 fatality clades the congo basin clade and the west african clade the congo basin clade appears to cause severe disease more frequently with case fatality ratio previously reported up to 10 currently the democratic republic of the congo is reporting a cfr among suspected cases of around three percent and we have alexander who is a member as well yay one more member thank you alicia says there's a long incubation time yes correct so doug is semiline vesicles producer largest correct so doug here is helping us with that part as well doug says i caught up thank you very much for being here and i saw you there as well okay so back here since 2017 so the west african clade has in the past been associated with an overall lower cfr of around one percent in generally younger population in south africa since 2017 a few deaths of persons with monkey pox in west africa have been associated with young age or untreated hiv so there is a vaccine a smallpox vaccine helps with this as well in the u.

s we talked about it september 2019 we approved a couple of vaccines or one more vaccine although the supply is limited then the risk assessment so who's racist assessment i do not know how much we can now bank on that considering the source of two but anyways currently the overall public health risk at global level is assessed as moderate considering this is the first time that monkey parks cases and clusters are reported concurrently in widely desperate who geographical areas and without known epidemiological links to endemic countries in west africa so they're saying it is moderate it is kind of a little concerning because why did this just happen the relatively mild symptoms in many cases with localized rash and lymphadenopathy such that my person that many persons may not present to healthcare services so lymphadenopathy lack of so why does it keep increasing or spreading there is the potential for greater health impact with wider spread to vulnerable population groups as deaths among cases in previous outbreaks have been reported to occur more often among children immunocompromised individuals including persons with poorly controlled hiv infection who may be especially at risk of the severe disease and the reason is because the cytotoxic t cell and the helper cells are not as many and as aggressive so i believe this is the discussion they continue and it's a nice uh decent the treatment clinical case of patient occupies is supportive so really no treatment but supportive all symptoms should be attended to including fever painful sores and skin lesions discomfort related to swollen lymph nodes or any other concerns patients should have plenty of rest and fluids as systemic symptoms for example fever may lead to dehydration and localized symptoms like sores in mouth or swollen lymph nodes may result in difficulty eating or drinking enough liquids care should be taken to avoid touching mucous membranes such as the eyes and secondary infections of lesions must be prevented or treated according to local medical protocols the patient can actually become blind if the park's virus starts infecting conjunctiva and the eye structures proper eye and skin care will help to reduce complications and sequelae such as scarring patients should also be monitored to ensure that swelling of lymph nodes or abscesses in the mouth or throat do not compromise the ability to breathe leading to respiratory obstruction so that is the discussion for today i wanted to i wanted to make sure that we can look at this virus a little more in depth in depth not death in little more in depth so with this how about this if i now hang up john 653 says we need a tutorial to how to become a member let me show it to you right now so if you go to let me first bring up my channel okay so here is the tutorial so gazer gazer says open source are not good these days as more pathogens seem to be around in yes i think that one important thing that we have been in in the lockdowns for two years our immune system and the the pathogen structures seem to be totally not in sync anymore okay so paul i hope you can see that i have started sharing [Laughter] granny says till death as part yes barbara says where can we find your interview with dr heather today i have to actually ask him where is the link for that he said it will be on youtube and rumble i don't know if i said things that may have rubbed negatively for youtube and if it is only on rumble i have to ask him for the for the link but i saw doug was there jody denise tg um i saw more people there more cool beans there luffy was being mentioned too so there was a good representation of cool beans there so uh if you go here to doctorbean. com sorry on the on youtube dr bean here there is this join button this is a new thing so if you click on the join button there are three possibilities you can become luffy enters the first uh level or luffy has catnip that is the second level and then luffy zooms that is the third level every second level contains every advanced level contains the level below the features from there so for example luffy enters has when you join that it is 299 per month and there are these little what are these badges and emoticons that you can use i don't know why they are not yet prevalent or maybe they are if you then become let's say luffy has catnip then you get the level one plus this levels um benefits and this level has early access to new videos so this this is for those videos that i would record and put them up you can actually watch them first and then they would be open to public then there can be photos and statuses that are only for these members then if you are zoom member then it is 24. 99 so it has level one or two included in it plus a zoom call i believe every month with you so that is the this is how then you click join and you join so hopefully that helps and i just saw alicia becoming a member thank you very much so alexander says cool angry shocked awesome so i think these are all the badges i cannot see those here in this chat but hopefully in the live chat these can be seen so texas i see that you're here i hope you're doing well i hope sky frog is doing well i hope lisu and her family are doing well and so what was i going to say what i was going to say was how about if we so tomorrow i have a 10 o'clock with dr mark levitt on this channel so how about if we skip the chat chat today as well so i would hang up this call and wait for your comments if you say it's okay then we'll continue tomorrow now please also remember tomorrow evening this time we will have we'll have dr denise hertz she is a doctor who was also participant in nih study and she wants to also present her situation so with this please like subscribe and share if you like it i think these are good interesting talks if you like them like subscribe and share and become member and in the in the description there is a link to dr bean.