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Corbella-Baselga I, Bruix A, Larena R, Julio G, Barraquer RI. Endothelial Involvement in Monocular Mpox Keratitis: In Vivo Confocal Microscopy Approach. Cornea 2024; 43:1058-1061. [PMID: 38692691 DOI: 10.1097/ico.0000000000003558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/19/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE The aim of this study was to describe the clinical features and endothelial involvement in a case of Mpox virus keratitis by in vivo confocal microscopy (IVCM). METHODS This is a case report. RESULTS A 35-year-old man presented with redness, photophobia, pain, tearing, and a low visual acuity of 0.09 (decimal) in the left eye with a 6-week history of Mpox and corneal trauma. Previous testing of blood, interdigital skin lesions, and conjunctival and eyelid margin swabs confirmed the presence of Mpox by polymerase chain reaction. Biomicroscopy displayed superficial stromal infiltrates with a continuous but irregular epithelium. IVCM revealed the presence of pseudoguttata, loss of defined cell boundaries, infiltration of inflammatory cells in the endothelial layer, endothelial ridges, and precipitated pigmented granules, consistent with endotheliitis. After this episode, the patient had 4 reactivations, also treated with topical corticoids and oral tecovirimat 600 mg twice a day for 2 weeks. On the fourth reactivation, this treatment was extended to 4 weeks. On the last visit, the patient presented a visual acuity of 0.5 with disciform keratitis and reduced endotheliitis signs. The endothelial cell density remained normal during the follow-up (2763 ± 376 cell/mm 2 at baseline and 2795 ± 238 cell/mm 2 at the last visit). Polymegathism and pleomorphism showed altered values during the follow-up. CONCLUSIONS Patients with an altered corneal epithelial barrier could suffer Mpox endotheliitis, like other DNA viruses, before disciform keratitis appears. IVCM is a useful tool for the early detection of endotheliitis and for describing its evolution, improving patient care.
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Affiliation(s)
- Inés Corbella-Baselga
- Centro de Oftalmología Barraquer, Barcelona, Spain
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain; and
| | - Anna Bruix
- Centro de Oftalmología Barraquer, Barcelona, Spain
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain; and
| | - Raquel Larena
- Centro de Oftalmología Barraquer, Barcelona, Spain
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain; and
| | - Gemma Julio
- Centro de Oftalmología Barraquer, Barcelona, Spain
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain; and
| | - Rafael I Barraquer
- Centro de Oftalmología Barraquer, Barcelona, Spain
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain; and
- Universitat Internacional de Catalunya, Barcelona, Spain
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2
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Shan K, Montalvo-Toledo LA, Shifera AS, Santiago EA. A Severe and Prolonged Case of Ocular Monkeypox Without Systemic Manifestations. Cornea 2024:00003226-990000000-00573. [PMID: 38870146 DOI: 10.1097/ico.0000000000003574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/16/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE The objective of this study was to present a rare case of prolonged and severe ocular monkeypox virus infection in the absence of systemic manifestations. METHODS This was a single case report. RESULTS A 60-year-old man, having been symptomatic for 9 days, presented with several umbilicated, ulcerated papules on the left cheek, left side of the nose, and left upper eyelid, along with marked follicular conjunctivitis and multiple conjunctival ulcerations. Two weeks after presentation, he developed an irregular, 360° circumferential opacity in the peripheral cornea that progressed to a large epithelial defect with corneal thinning. Although the initial eyelid lesions and conjunctivitis quickly resolved, the patient experienced nonresolving corneal inflammation manifest with peripheral corneal thinning, epithelial defects, and stromal keratitis. Four months after presentation, with the presumptive diagnosis of peripheral ulcerative keratitis, the patient was treated with intravenous steroids and immunosuppressive treatment, after which the ocular surface inflammation improved. However, the inflammation recurred 12 weeks later, and the patient developed severe perilimbal necrotizing conjunctivitis, followed by recurrence of ulcerated nodular eyelid lesions. Eight months after presentation, nucleic acid amplification tests from eyelid lesion swabs returned positive for nonvariola Orthopoxviruses, which led to the diagnosis of mpox. Within 2 weeks of beginning antiviral treatment with systemic tecovirimat and cidofovir and topical trifluridine, the eyelid lesions, conjunctivitis, and corneal inflammation resolved. CONCLUSIONS We present an unusual and challenging case of ocular mpox with severe ocular surface inflammation including peripheral corneal thinning and epithelial defects, without systemic disease. Initiation of antiviral treatment resulted in a quick resolution of the ocular disease.
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Affiliation(s)
- Kevin Shan
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY
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3
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Nguyen M, Doan T, Seitzman GD. Ocular manifestations of mpox. Curr Opin Ophthalmol 2024:00055735-990000000-00175. [PMID: 38847744 DOI: 10.1097/icu.0000000000001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
PURPOSE OF REVIEW To highlight the clinical features of mpox with an emphasis on ocular manifestations and to review treatment options for this re-emerging infectious disease. RECENT FINDINGS Ocular involvement of mpox varies by clade. The most recent 2022 outbreak appears to be associated with fewer conjunctivitis cases compared to previous outbreaks. However, the ocular findings occurring during this newly emerging clade can be visually threatening and include cases of keratitis, rapidly progressing scleritis, and necrotizing periorbital rashes. SUMMARY Ocular mpox is an important clinical feature of systemic mpox virus (MPXV) infection. Heightened clinical suspicion allows for a timely diagnosis and the initiation of antiviral treatment, when appropriate. Randomized clinical trials for mpox systemic and ocular treatment efficacy are lacking. Prior clinical experience with smallpox and in-vitro mpox data support the use of systemic antivirals such as tecovirimat, cidofovir, brincidofovir and topical use of trifluridine in ocular mpox management, though treatment-resistant infection can occur and portend a poor prognosis.
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Affiliation(s)
- Minh Nguyen
- Francis I. Proctor Foundation, Department of Ophthalmology
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Thuy Doan
- Francis I. Proctor Foundation, Department of Ophthalmology
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Gerami D Seitzman
- Francis I. Proctor Foundation, Department of Ophthalmology
- Department of Ophthalmology, University of California, San Francisco, California, USA
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4
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Nakamura H, Yamamoto K. Mpox in people with HIV: A narrative review. HIV Med 2024. [PMID: 38745559 DOI: 10.1111/hiv.13661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The 2022 global mpox outbreak disproportionately impacted people living with HIV. This review explores recent evidence on mpox in this group, focusing on clinical presentation, complications, treatment modalities and vaccine strategies. RECENT FINDINGS Recent studies have suggested that people with HIV diagnosed with mpox have a greater risk of proctitis and hospitalization compared with people without HIV. In addition, those with advanced immunosuppression face an elevated risk of severe mpox infection, which can lead to mortality. Comprehensive and prompt supportive care using antiretrovirals and mpox antivirals is crucial in this group. Although results from randomized clinical trials are still forthcoming, recent studies suggest that early initiation of tecovirimat can prevent disease progression in people with HIV. The non-replicative attenuated smallpox vaccine is well tolerated and effective in preventing monkeypox virus infections in people with HIV. Further studies are needed regarding long-term vaccine effectiveness for this population. CONCLUSION Evaluating the risk of severe mpox in people living with HIV requires assessing the level of immune suppression and viral control. Universal access to vaccination is imperative to prevent the resurgence of future outbreaks.
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Affiliation(s)
- Hideta Nakamura
- First Department of International Medicine, Division of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus Graduate School of Medicine, Nishihara-cho, Japan
| | - Kazuko Yamamoto
- First Department of International Medicine, Division of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus Graduate School of Medicine, Nishihara-cho, Japan
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5
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Finamor LPS, Mendes-Correa MC, Rinkevicius M, Macedo G, Sabino EC, Villas-Boas LS, de Paula AV, de Araujo-Heliodoro RH, da Costa AC, Witkin SS, Santos KLC, Palmeira C, Andrade G, Lucena M, de Freitas Santoro D, da Silva LMP, Muccioli C. Ocular manifestations of Monkeypox virus (MPXV) infection with viral persistence in ocular samples: A case series. Int J Infect Dis 2024; 146:107071. [PMID: 38710273 DOI: 10.1016/j.ijid.2024.107071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/01/2024] [Accepted: 04/22/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVE We describe the clinical presentation and ocular viral dynamics in patients with Monkeypox virus-related ophthalmic disease (MPXROD). METHODS In this case series, we investigated five consecutive patients with confirmed mpox, diagnosed through a positive Monkeypox virus (MPXV) Polymerase Chain Reaction (PCR) test and presenting with ocular symptoms. They were referred from the Reference Center for Sexually Transmitted Infections in São Paulo (CRT) to the Uveitis Sector at the Federal University of São Paulo, between August and December 2022. We performed PCR testing on ocular samples and culture supernatants for MPXV in all patients. Viral sequencing was conducted in one of the cases. RESULTS Replicating MPXV was identified in at least one ocular sample of all patients, between day 31 and day 145 after the onset of skin lesions. All patients presented with keratitis, 3 with uveitis (60%) and two exhibited hypopyon (40%). The onset of ocular symptoms occurred at a mean of 21.2 days after the appearance of the first skin lesion and persisted, on average, for 61,.6 days, with a worsening trend observed until the initiation of tecovirimat treatment. Tecovirimat treatment was administered to all patients, with initiation occurring between 31 and 145 days after the onset of skin lesions. MPXV genome sequencing of an isolate from one patient classified it as belonging to lineage B1 in clade IIb. CONCLUSION This study reveals a late onset and persistence of sight threatening ocular disease, along with potential viral infectivity even after systemic resolution in mpox cases. These findings highlight the risk of ongoing transmission from individuals with prolonged ocular manifestations, particularly through ocular discharge.
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Affiliation(s)
- Luciana P S Finamor
- Department of Ophthalmology & Visual Sciences. Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
| | - Maria Cássia Mendes-Correa
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mônica Rinkevicius
- Department of Ophthalmology & Visual Sciences. Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Guilherme Macedo
- Department of Ophthalmology & Visual Sciences. Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Ester Cerdeira Sabino
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Lucy Santos Villas-Boas
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Raissa Heloisa de Araujo-Heliodoro
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Antonio Charlys da Costa
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Steven S Witkin
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY
| | - Keila Lima Carneiro Santos
- Department of Ophthalmology & Visual Sciences. Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Camila Palmeira
- Department of Ophthalmology & Visual Sciences. Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Gabriel Andrade
- Department of Ophthalmology & Visual Sciences. Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil; Department of Ophthalmology, Santa Casa de São Paulo, São Paulo, Brazil
| | - Maurílio Lucena
- Department of Ophthalmology, Santa Casa de São Paulo, São Paulo, Brazil
| | - Dalton de Freitas Santoro
- Department of Ophthalmology & Visual Sciences. Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Luci Meire Pereira da Silva
- Department of Ophthalmology & Visual Sciences. Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Cristina Muccioli
- Department of Ophthalmology & Visual Sciences. Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
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Pakran J, Alsaberi AM, AlFalasi A, Ibrahim TMKH, Alnuaimi AAEF, Goturu S, Mohamed M, Abraham RM, Sundaramurthi VL, Parambath AK, Jose B, Kamat D, Satish TC, Syeda JT, Gul L, Mathias R, Rasheed Vattiyamveetil S, Backar S, Krishna CV, Al Dhabal L. 'Monkeypox 2.0': Case series on a reconditioned virus causing sexually transmissible disease in urban population. Int J STD AIDS 2024:9564624241244832. [PMID: 38610106 DOI: 10.1177/09564624241244832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
BACKGROUND MPOX (Monkeypox) viral infection, a zoonotic disease previously confined to the African sub-continent, has caught attention worldwide recently due to its resurgence in a new 'avatar' among urban communities. Dermatologists in the U. A. E. started to see patients with fever and a self-limiting pustular necrotic rash that was negative for all other infectious investigations. METHODS We performed a prospective observational multicenter clinical study of the demographics, skin manifestations, and outcomes of patients presenting with necrotic pustular lesions and/or fever. RESULTS 35 cases of PCR confirmed MPOX cases, mostly in the expatriate population, were followed up and found to have high-risk heterosexual contact on an average of 1 week prior to disease onset. We found that they have characteristic annular pustular lesions with necrotic center or "Smoke ring pustules' in all cases. Lesion tenderness and predilection for the lower abdomen, pubic area, and genitalia were observed. Most cases were systemically stable, with fever lasting for an average of 4 days and elevated CRP levels. Genital lesions were prone to secondary bacterial infections. The disease was severe, with larger annular plaques in one of our patients found to be living with HIV. CONCLUSIONS The overall prognosis in healthy individuals is good, with lesions healing within an average of 2 weeks without scarring. 'New world MPOX' should be unclassified from zoonosis to a sexually transmitted infection (STI) capable of transmission in an urban population. Our findings can help in early clinical suspicion and differentiation from other STI's for primary and secondary health care physicians.
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Affiliation(s)
- Jaheersha Pakran
- Dermatology and Aesthetic center, Rashid hospital, Dubai Health Authority, Dubai, UAE
| | | | - Amani AlFalasi
- Dermatology and Aesthetic center, Rashid hospital, Dubai Health Authority, Dubai, UAE
| | | | | | | | | | | | | | | | - Beena Jose
- Department of Dermatology, Aster Medical Center, Dubai, UAE
| | - Divya Kamat
- Department of Dermatology, Union Medical Centre, Aster Clinic, Al Karama, Dubai
| | | | | | - Lubna Gul
- Department of Dermatology, Zulekha Hospital, Dubai
| | - Rohini Mathias
- Department of Dermatology, Aster Hospital and Aster Day Surgery Centre, Mankhool, Dubai
| | | | - Shaheela Backar
- Department of Dermatology, NMC Royal Hospital, Abudhabi, UAE
| | - C Vijay Krishna
- Department of Dermatology, Thumbay University Hospital, Ajman, UAE
| | - Laila Al Dhabal
- Department of Infectious disease, Rashid Hospital, Dubai Health Authority, Dubai, UAE
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7
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Lamas-Francis D, Treviño M, Pérez-Freixo H, Martínez-Perez L, Touriño R, Rodríguez-Ares T. Corneal Ulcer due to Monkeypox Infection. Ocul Immunol Inflamm 2024; 32:259-261. [PMID: 36508689 DOI: 10.1080/09273948.2022.2153343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/12/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To report a rare case of keratitis due to monkeypox infection. METHODS A 45-year-old male presented with an epithelial corneal ulcer 20 days following initial diagnosis of monkeypox from genital and perioral lesions. PCR analysis of the epithelium confirmed the presence of human monkeypox virus. RESULTS The patient was hospitalized, and ganciclovir gel, as well as povidone iodine 0.6% and moxifloxacin eyedrops were prescribed. Oral tecovirimat 600 mg was administered during 14 days. A therapeutic contact lens was used. Twenty days after the initial diagnosis of keratitis, the corneal defect closed leaving a faint subepithelial haze, and visual acuity was 0.8. CONCLUSIONS This is an uncommon case report of epithelial keratitis due to human monkeypox. PCR positivity for monkeypox in the corneal epithelium confirmed the presence of viral material in the cornea.
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Affiliation(s)
- David Lamas-Francis
- Ophthalmology, University Hospital of Santiago de Compostela, Santiago, Spain
| | - Mercedes Treviño
- Microbiology, University Hospital of Santiago de Compostela, Santiago, Spain
| | - Hugo Pérez-Freixo
- Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Rosario Touriño
- Ophthalmology, University Hospital of Santiago de Compostela, Santiago, Spain
- Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Teresa Rodríguez-Ares
- Ophthalmology, University Hospital of Santiago de Compostela, Santiago, Spain
- Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
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8
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Smit DP, Tugal-Tutkun I, Thorne JE. Monkeypox. Ocul Immunol Inflamm 2024; 32:251-252. [PMID: 38527231 DOI: 10.1080/09273948.2023.2298177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- Derrick P Smit
- The Division of Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ilknur Tugal-Tutkun
- The Department of Ophthalmology, Istanbul University, Istanbul, Turkey
- Eye Protection Foundation Bayrampasa Eye Hospital, Istanbul, Turkey
| | - Jennifer E Thorne
- The Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- The Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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9
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Androudi S, Kaufman AR, Kouvalakis A, Mitsios A, Sapounas S, Al-Khatib D, Schibler M, Pineda R, Baglivo E. Non-Healing Corneal Ulcer and Uveitis Following Monkeypox Disease: Diagnostic and Therapeutic Challenges. Ocul Immunol Inflamm 2024; 32:253-258. [PMID: 37140328 DOI: 10.1080/09273948.2023.2202746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/10/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE The ocular manifestations of Monkeypox virus (Mpox) infection remain incompletely characterized. Our goal is to present a case series of non-healing corneal ulcers with associated uveitis caused by Mpox infection as well as management recommendations for Mpox-related ophthalmic disease (MPXROD). METHODS Retrospective case series. RESULTS Two male patients with recent hospitalization for systemic Mpox infection presented with non-healing corneal ulcer associated with anterior uveitis and severe IOP elevation. Despite initiation of conservative medical treatment including corticosteroid treatment for uveitis, in both cases, there was clinical progression with enlarging cornea lesions. Both cases received oral tecovirimat with complete healing of the corneal lesion. CONCLUSIONS Corneal ulcer and anterior uveitis are rare complications of Mpox infection. Although Mpox disease is generally anticipated to be self-limited, tecovirimat may be an effective intervention in poorly healing Mpox keratitis. Corticosteroids should be used with caution in Mpox uveitis, as they might lead to worsening infection.
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Affiliation(s)
- Sofia Androudi
- Department of Ophthalmology, University Hospital of Larissa, Larissa, Greece
- Department of Medicine, University of Thessaly, Volos, Greece
| | - Aaron R Kaufman
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Andreas Mitsios
- Department of Medicine, University of Thessaly, Volos, Greece
| | - Spyros Sapounas
- Department of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization of Greece, Athens, Greece
| | - Danial Al-Khatib
- Department of Ophthalmology, Clinique de L'Oeil, Geneva, Switzerland
| | - Manuel Schibler
- Infectious Disease Department, Geneva University Hospital, Geneva, Switzerland
| | - Roberto Pineda
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Edoardo Baglivo
- Department of Ophthalmology, Clinique de L'Oeil, Geneva, Switzerland
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10
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Sun Y, Nie W, Tian D, Ye Q. Human monkeypox virus: Epidemiologic review and research progress in diagnosis and treatment. J Clin Virol 2024; 171:105662. [PMID: 38432097 DOI: 10.1016/j.jcv.2024.105662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/22/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
Monkeypox virus (MPXV) is responsible for causing a zoonotic disease called monkeypox (mpox), which sporadically infects humans in West and Central Africa. It first infected humans in 1970 and, along with the variola virus, belongs to the genus Orthopoxvirus in the poxvirus family. Since the World Health Organization declared the MPXV outbreak a "Public Health Emergency of International Concern" on July 23, 2022, the number of infected patients has increased dramatically. To control this epidemic and address this previously neglected disease, MPXV needs to be better understood and reevaluated. In this review, we cover recent research on MPXV, including its genomic and pathogenic characteristics, transmission, mutations and mechanisms, clinical characteristics, epidemiology, laboratory diagnosis, and treatment measures, as well as prevention of MPXV infection in light of the 2022 and 2023 global outbreaks. The 2022 MPXV outbreak has been primarily associated with close intimate contact, including sexual activity, with most cases diagnosed among men who have sex with men. The incubation period of MPXV infection usually lasts from 6 to 13 days, and symptoms include fever, muscle pains, headache, swollen lymph nodes, and a characteristic painful rash, including several stages, such as macules, papules, blisters, pustules, scabs, and scab shedding involving the genitals and anus. Polymerase chain reaction (PCR) is usually used to detect MPXV in skin lesion material. Treatment includes supportive care, antivirals, and intravenous vaccinia immune globulin. Smallpox vaccines have been designed with four givens emergency approval for use against MPXV infection.
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Affiliation(s)
- Yanhong Sun
- Department of Clinical Laboratory, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Wenjian Nie
- Department of Clinical Laboratory, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Dandan Tian
- Department of Clinical Laboratory, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Qing Ye
- Department of Clinical Laboratory, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China.
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11
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Cinatl J, Bechtel M, Reus P, Ott M, Rothweiler F, Michaelis M, Ciesek S, Bojkova D. Trifluridine for treatment of mpox infection in drug combinations in ophthalmic cell models. J Med Virol 2024; 96:e29354. [PMID: 38180134 DOI: 10.1002/jmv.29354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/23/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024]
Abstract
The Mpox virus can cause severe disease in the susceptible population with dermatologic and systemic manifestations. Furthermore, ophthalmic manifestations of mpox infection are well documented. Topical trifluridine (TFT) eye drops have been used for therapy of ophthalmic mpox infection in patients, however, its efficacy against mpox virus infection in this scenario has not been previously shown. In the present study, we have established ophthalmic cell models suitable for the infection with mpox virus. We show, that TFT is effective against a broad range of mpox isolates in conjunctival epithelial cells and keratocytes. Further, TFT remained effective against a tecovirimat-resistant virus strain. In the context of drug combinations, a nearly additive effect was observed for TFT combinations with brincidofovir and tecovirimat in conjunctival epithelial cells, while a slight antagonism was observed for both combinations in keratocytes. Altogether, our findings demonstrate TFT as a promising drug for treatment of ophthalmic mpox infection able to overcome tecovirimat resistance. However, conflicting results regarding the effect of drug combinations with approved compounds warrant close monitoring of such use in patients.
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Affiliation(s)
- Jindrich Cinatl
- Institute of Medical Virology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
- Dr. Petra Joh-Forschungshaus, Frankfurt am Main, Germany
| | - Marco Bechtel
- Institute of Medical Virology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Philipp Reus
- Institute of Medical Virology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
- Discovery Research ScreeningPort, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Hamburg, Germany
| | - Melanie Ott
- Dr. Petra Joh-Forschungshaus, Frankfurt am Main, Germany
| | | | - Martin Michaelis
- Dr. Petra Joh-Forschungshaus, Frankfurt am Main, Germany
- School of Biosciences, University of Kent, Canterbury, UK
| | - Sandra Ciesek
- Institute of Medical Virology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
- German Center for Infection Research, DZIF, External Partner Site, Frankfurt am Main, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany
| | - Denisa Bojkova
- Institute of Medical Virology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
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Lucena-Neto FD, Falcão LFM, Vieira-Junior AS, Moraes ECS, David JPF, Silva CC, Sousa JR, Duarte MIS, Vasconcelos PFC, Quaresma JAS. Monkeypox Virus Immune Evasion and Eye Manifestation: Beyond Eyelid Implications. Viruses 2023; 15:2301. [PMID: 38140542 PMCID: PMC10747317 DOI: 10.3390/v15122301] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Monkeypox virus (MPXV), belonging to the Poxviridae family and Orthopoxvirus genus, is closely related to the smallpox virus. Initial prodromal symptoms typically include headache, fever, and lymphadenopathy. This review aims to detail various ocular manifestations and immune evasion associated with the monkeypox viral infection and its complications, making it appropriate as a narrative review. Common external ocular manifestations of MPXV typically involve a generalized pustular rash, keratitis, discharges, and dried secretions related to conjunctival pustules, photophobia, and lacrimation. Orthopoxviruses can evade host immune responses by secreting proteins that antagonize the functions of host IFNγ, CC and CXC chemokines, IL-1β, and the complement system. One of the most important transcription factors downstream of pattern recognition receptors binding is IRF3, which controls the expression of the crucial antiviral molecules IFNα and IFNβ. We strongly recommend that ophthalmologists include MPXV as part of their differential diagnosis when they encounter similar cases presenting with ophthalmic manifestations such as conjunctivitis, blepharitis, or corneal lesions. Furthermore, because non-vaccinated individuals are more likely to exhibit these symptoms, it is recommended that healthcare administrators prioritize smallpox vaccination for at-risk groups, including very young children, pregnant women, older adults, and immunocompromised individuals, especially those in close contact with MPXV cases.
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Affiliation(s)
- Francisco D. Lucena-Neto
- Department of Infectious Disease, School of Medicine, State University of Pará, Belém 66087-670, PA, Brazil; (F.D.L.-N.); (L.F.M.F.); (A.S.V.-J.); (C.C.S.); (J.R.S.); (P.F.C.V.)
| | - Luiz F. M. Falcão
- Department of Infectious Disease, School of Medicine, State University of Pará, Belém 66087-670, PA, Brazil; (F.D.L.-N.); (L.F.M.F.); (A.S.V.-J.); (C.C.S.); (J.R.S.); (P.F.C.V.)
| | - Adolfo S. Vieira-Junior
- Department of Infectious Disease, School of Medicine, State University of Pará, Belém 66087-670, PA, Brazil; (F.D.L.-N.); (L.F.M.F.); (A.S.V.-J.); (C.C.S.); (J.R.S.); (P.F.C.V.)
| | - Evelly C. S. Moraes
- Department of Infectious Disease, School of Medicine, Federal University of Pará, Belém 66075-110, PA, Brazil; (E.C.S.M.); (J.P.F.D.)
| | - Joacy P. F. David
- Department of Infectious Disease, School of Medicine, Federal University of Pará, Belém 66075-110, PA, Brazil; (E.C.S.M.); (J.P.F.D.)
| | - Camilla C. Silva
- Department of Infectious Disease, School of Medicine, State University of Pará, Belém 66087-670, PA, Brazil; (F.D.L.-N.); (L.F.M.F.); (A.S.V.-J.); (C.C.S.); (J.R.S.); (P.F.C.V.)
| | - Jorge R. Sousa
- Department of Infectious Disease, School of Medicine, State University of Pará, Belém 66087-670, PA, Brazil; (F.D.L.-N.); (L.F.M.F.); (A.S.V.-J.); (C.C.S.); (J.R.S.); (P.F.C.V.)
| | - Maria I. S. Duarte
- Department of Infectious Disease, School of Medicine, São Paulo University, São Paulo 01246-904, SP, Brazil;
| | - Pedro F. C. Vasconcelos
- Department of Infectious Disease, School of Medicine, State University of Pará, Belém 66087-670, PA, Brazil; (F.D.L.-N.); (L.F.M.F.); (A.S.V.-J.); (C.C.S.); (J.R.S.); (P.F.C.V.)
| | - Juarez A. S. Quaresma
- Department of Infectious Disease, School of Medicine, State University of Pará, Belém 66087-670, PA, Brazil; (F.D.L.-N.); (L.F.M.F.); (A.S.V.-J.); (C.C.S.); (J.R.S.); (P.F.C.V.)
- Department of Infectious Disease, School of Medicine, Federal University of Pará, Belém 66075-110, PA, Brazil; (E.C.S.M.); (J.P.F.D.)
- Department of Infectious Disease, School of Medicine, São Paulo University, São Paulo 01246-904, SP, Brazil;
- Virology Section, Evandro Chagas Institute, Ananindeua 67030-000, PA, Brazil
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13
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Malciolu-Nica MA, Costescu C, Popescu CP, Florescu SA, Oprea C. Mpox-Related Ophthalmic Disease: A Rare Case Report. AIDS Res Hum Retroviruses 2023; 39:616-620. [PMID: 37756367 DOI: 10.1089/aid.2023.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
Monkeypox virus (mpox), a double-stranded DNA virus belonging to the Orthopox genus, can affect vulnerable anatomic sites, including the eyes, causing a monkeypox-related ophthalmic disease. The mpox virus may enter the eye via autoinoculation and cause multiple problems from mild lesions including conjunctivitis, blepharitis, keratitis, to severe ones such as corneal ulcers, corneal scarring, and rarely loss of vision. The aim of this article is to aggregate from an ophthalmologic point of view what is presently known about mpox-related ophthalmic disease (mpoxROD) and to present a particular case of a 41-year-old, white, bisexual, HIV positive male, with severe ocular complications. This article presents the first reported case in Romania, of severe mpoxROD, with clinically relevant information for infectious disease doctors and especially for ophthalmologists.
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Affiliation(s)
| | - Cristiana Costescu
- Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
| | - Corneliu Petru Popescu
- Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Simin Aysel Florescu
- Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristiana Oprea
- Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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14
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Bacorn C, Majidi S, Schultz H, Sulewski ME, Eberhart CG, Mahoney NR. Severe Mpox Infection of the Eye and Periocular Region. Ophthalmic Plast Reconstr Surg 2023; 39:e176-e179. [PMID: 37405735 DOI: 10.1097/iop.0000000000002425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Mpox is an emerging zoonotic infection with potentially severe ocular and periocular consequences, particularly in immunocompromised patients. This report summarizes 2 cases of fulminant mpox presenting in patients with AIDS. In the first case, confluent lesions resulted in orbital compartment syndrome and total eyelid necrosis. In the second case, eyelid involvement was accompanied by corneal melt and perforation. Despite aggressive medical and surgical treatment, both patients developed permanent loss of vision and ultimately expired.
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Affiliation(s)
- Colin Bacorn
- Department of Ophthalmology, Division of Oculoplastic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Shahriyar Majidi
- Department of Ophthalmology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Hannah Schultz
- Department of Ophthalmology, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Charles G Eberhart
- Departments of Pathology, Oncology and Ophthalmology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nicholas R Mahoney
- Department of Ophthalmology, Division of Oculoplastic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
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15
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Barshak MB, Dugdale CM, Pineda R. Case 14-2023: A 31-Year-Old Man with Redness of the Right Eye. N Engl J Med 2023; 388:1800-1810. [PMID: 37163627 DOI: 10.1056/nejmcpc2211511] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Miriam B Barshak
- From the Department of Medicine, Massachusetts General Hospital (M.B.B., C.M.D.), the Departments of Medicine (M.B.B., C.M.D.) and Ophthalmology (R.P.), Harvard Medical School, and the Department of Ophthalmology, Massachusetts Eye and Ear (R.P.) - all in Boston
| | - Caitlin M Dugdale
- From the Department of Medicine, Massachusetts General Hospital (M.B.B., C.M.D.), the Departments of Medicine (M.B.B., C.M.D.) and Ophthalmology (R.P.), Harvard Medical School, and the Department of Ophthalmology, Massachusetts Eye and Ear (R.P.) - all in Boston
| | - Roberto Pineda
- From the Department of Medicine, Massachusetts General Hospital (M.B.B., C.M.D.), the Departments of Medicine (M.B.B., C.M.D.) and Ophthalmology (R.P.), Harvard Medical School, and the Department of Ophthalmology, Massachusetts Eye and Ear (R.P.) - all in Boston
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16
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Gurnani B, Kaur K, Chaudhary S, Balakrishnan H. Ophthalmic manifestations of monkeypox infection. Indian J Ophthalmol 2023; 71:1687-1697. [PMID: 37203020 PMCID: PMC10391517 DOI: 10.4103/ijo.ijo_2032_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
After the global COVID-19 pandemic, there has been an alarming concern with the monkeypox (mpox) outbreak, which has affected more than 110 countries worldwide. Monkeypox virus is a doublestranded DNA virus of the genus Orthopox of the Poxviridae family, which causes this zoonotic disease. Recently, the mpox outbreak was declared by the World Health Organization (WHO) as a public health emergency of international concern (PHEIC). Monkeypox patients can present with ophthalmic manifestation and ophthalmologists have a role to play in managing this rare entity. Apart from causing systemic involvement such as skin lesions, respiratory infection and involvement of body fluids, Monkeypox related ophthalmic disease (MPXROD) causes varied ocular manifestations such as lid and adnexal involvement, periorbital and lid lesion, periorbital rash, conjunctivitis, blepharocounctivitis and keratitis. A detailed literature review shows few reports on MPXROD infections with limited overview on management strategies. The current review article is aimed to provide the ophthalmologist with an overview of the disease with a spotlight on ophthalmic features. We briefly discuss the morphology of the MPX, various modes of transmission, an infectious pathway of the virus, and the host immune response. A brief overview of the systemic manifestations and complications has also been elucidated. We especially highlight the detailed ophthalmic manifestations of mpox, their management, and prevention of vision threatening sequelae.
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Affiliation(s)
- Bharat Gurnani
- Cornea and Refractive Services, Dr. Om Parkash Eye Institute, Mall Road, Amritsar, Punjab, India
| | - Kirandeep Kaur
- Pediatric Ophthalmology and Strabismus, Dr. Om Parkash Eye Institute, Mall Road, Amritsar, Punjab, India
| | - Sameer Chaudhary
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
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17
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Mukit FA, Louie EM, Cape HT, Bohn SN. A Suspected Case of a Neonatal Monkeypox Infection With Ocular Involvement. Cureus 2023; 15:e38819. [PMID: 37303431 PMCID: PMC10251443 DOI: 10.7759/cureus.38819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Mpox (initially reported as monkeypox virus Clade IIb) ravaged the non-endemic world in 2022 with dermatological and systemic manifestations. The rapid propagation of this virus shed light on the scarcity of information for a virus that was first reported in 1958. We present the first probable neonatal case of mpox with ocular involvement. Ophthalmologists may be the first to diagnose mpox or be a part of the multidisciplinary team required for adequate work-up and treatment to prevent life-long sequelae in the neonatal population.
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Affiliation(s)
- Fabliha A Mukit
- Ophthalmology, University of Tennessee Health Science Center (UTHSC) Hamilton Eye Institute, Memphis, USA
| | - Emily M Louie
- Ophthalmology, University of Tennessee Health Science Center (UTHSC) College of Medicine, Memphis, USA
| | - Hays T Cape
- Ophthalmology, University of Tennessee Health Science Center (UTHSC) College of Medicine, Memphis, USA
| | - Shiva N Bohn
- Ophthalmology, University of Tennessee Health Science Center (UTHSC) Hamilton Eye Institute, Memphis, USA
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18
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Zhu A, Mahajan J, Oydanich MK, Luo MC, Khouri AS. Analysis of google trends and search results for ophthalmic symptoms of monkeypox. Int Ophthalmol 2023:10.1007/s10792-023-02714-1. [PMID: 37071346 PMCID: PMC10112309 DOI: 10.1007/s10792-023-02714-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/09/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE In July 2022, the World Health Organization (WHO) declared monkeypox virus's global spread a "public health emergency of international concern." About a quarter of monkeypox cases feature ophthalmic symptoms. We assessed trends in worldwide search interest in monkeypox ophthalmic involvement and inclusion in online search engine queries. METHODS The following keywords were searched on Google Trends from April 1, 2022, to August 12, 2022: monkeypox + eye, pink eye, eye infection, eyelid, vision, blurry vision, vision loss, blindness, eye symptoms, eye problems, eye pain, eye redness, conjunctivitis, conjunctiva, cornea, keratitis, corneal ulcer, and blepharitis. We analyzed trends, correlated search interest with case count data, and compared popularity of search terms via nonparametric Mann-Whitney-U analysis. Inclusion of ophthalmic symptoms in Google search results for "monkeypox symptoms" was assessed. RESULTS "Monkeypox eye" had the highest average search interest worldwide and in the United States. Search interest peaked between mid-May and late July 2022. When compared to interest in "monkeypox rash," the most searched monkeypox symptom, the average interest in "monkeypox eye" was lower (p < 0.01). Of the first 50 results from the Google search of "monkeypox symptoms," 10/50 (20%) mentioned ophthalmic symptoms. 6/50 (12%) mentioned the eye as a route of virus transmission. CONCLUSION Search interest in monkeypox ophthalmic symptoms corresponds with geographic and temporal trends, i.e., timing and location of the first reported non-endemic cases and WHO announcement. Although ophthalmic symptoms are not as widely searched currently, inclusion in public health messaging is key for diagnosis, appropriate management, and reduction of further transmission.
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Affiliation(s)
- Aretha Zhu
- Rutgers New Jersey Medical School, Institute of Ophthalmology & Visual Science, 90 Bergen Street, Suite 6100, Newark, NJ, USA
| | - Jasmine Mahajan
- Rutgers New Jersey Medical School, Institute of Ophthalmology & Visual Science, 90 Bergen Street, Suite 6100, Newark, NJ, USA
| | - Marko K Oydanich
- Rutgers New Jersey Medical School, Institute of Ophthalmology & Visual Science, 90 Bergen Street, Suite 6100, Newark, NJ, USA
| | - Michael C Luo
- Department of Mathematical Sciences, New Jersey Institute of Technology, 323 Dr Martin Luther King Jr Blvd, Newark, NJ, USA
| | - Albert S Khouri
- Rutgers New Jersey Medical School, Institute of Ophthalmology & Visual Science, 90 Bergen Street, Suite 6100, Newark, NJ, USA.
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19
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Alam MS, Shakeel L, Hussain HU, Rehan ST, Mumtaz H. Ocular manifestations: A novel association of Monkeypox virus outbreak in 2022. J Infect Public Health 2023; 16:640-643. [PMID: 36871460 PMCID: PMC9908763 DOI: 10.1016/j.jiph.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023] Open
Abstract
Monkeypox virus (MPXV) is a double-stranded DNA zoonotic virus of the Poxviridae family. Infected persons, animals, or inanimate items can all spread the virus to humans when they come into close contact. The first human-to-human transmission was reported in 1970 in the Democratic Republic of Congo. The outbreak emerged in May 2022 involved mostly men who had sex with men (MSM). Patients usually present with symptoms of rash along with fever, flu-like symptoms, and lesions in the genital and perineal region. A rising concern is ocular manifestations seen with MPVX like conjunctivitis, blepharitis, keratitis, and corneal lesions, especially in unvaccinated patients which might lead to blindness. Although it is self-limiting with supportive care, many patients benefited from tecovirimat. Combination therapy of brincidofovir and tecovirimat was also used for severe disease. Smallpox vaccinations will also play a vital role as unvaccinated patients had serious complications. Risk counseling should be carried out to prevent further spread amongst high-risk populations. Ophthalmologists should also remain aware of these ocular manifestations during the current outbreak and keep it as a differential diagnosis whenever they come across with aforementioned complaints that can be seen in MPVX illness.
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Affiliation(s)
| | - Laiba Shakeel
- Dow University of Health Sciences, 74200, Karachi, Pakistan.
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Hatami H, Jamshidi P, Arbabi M, Safavi-Naini SAA, Farokh P, Izadi-Jorshari G, Mohammadzadeh B, Nasiri MJ, Zandi M, Nayebzade A, Sechi LA. Demographic, Epidemiologic, and Clinical Characteristics of Human Monkeypox Disease Pre- and Post-2022 Outbreaks: A Systematic Review and Meta-Analysis. Biomedicines 2023; 11:957. [PMID: 36979936 PMCID: PMC10045775 DOI: 10.3390/biomedicines11030957] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/28/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
(1) Background: In early May 2022, an increasing number of human monkeypox (mpox) cases were reported in non-endemic disparate regions of the world, which raised concerns. Here, we provide a systematic review and meta-analysis of mpox-confirmed patients presented in peer-reviewed publications over the 10 years before and during the 2022 outbreak from demographic, epidemiological, and clinical perspectives. (2) Methods: A systematic search was performed for relevant studies published in Pubmed/Medline, Embase, Scopus, and Google Scholar from 1 January 2012 up to 15 February 2023. Pooled frequencies with 95% confidence intervals (CIs) were assessed using the random or fixed effect model due to the estimated heterogeneity of the true effect sizes. (3) Results: Out of 10,163 articles, 67 met the inclusion criteria, and 31 cross-sectional studies were included for meta-analysis. Animal-to-human transmission was dominant in pre-2022 cases (61.64%), but almost all post-2022 reported cases had a history of human contact, especially sexual contact. The pooled frequency of MSM individuals was 93.5% (95% CI 91.0-95.4, I2: 86.60%) and was reported only in post-2022 included studies. The male gender was predominant in both pre- and post-2022 outbreaks, and the mean age of confirmed cases was 29.92 years (5.77-41, SD: 9.38). The most common clinical manifestations were rash, fever, lymphadenopathy, and malaise/fatigue. Proctalgia/proctitis (16.6%, 95% CI 10.3-25.6, I2: 97.76) and anal/perianal lesions (39.8%, 95% CI 30.4-49.9, I2: 98.10) were the unprecedented clinical manifestations during the 2022 outbreak, which were not described before. Genitalia involvement was more common in post-2022 mpox patients (55.6%, 95% CI 51.7-59.4, I2: 88.11). (4) Conclusions: There are speculations about the possibility of changes in the pathogenic properties of the virus. It seems that post-2022 mpox cases experience a milder disease with fewer rashes and lower mortality rates. Moreover, the vast majority of post-2022 cases are managed on an outpatient basis. Our study could serve as a basis for ongoing investigations to identify the different aspects of previous mpox outbreaks and compare them with the current ones.
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Affiliation(s)
- Hossein Hatami
- Department of Public Health, School of Public Health and Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran;
| | - Parnian Jamshidi
- Department of Public Health, School of Public Health and Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran;
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran; (M.A.); (P.F.); (B.M.); (M.J.N.)
| | - Mahta Arbabi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran; (M.A.); (P.F.); (B.M.); (M.J.N.)
| | - Seyed Amir Ahmad Safavi-Naini
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran;
| | - Parisa Farokh
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran; (M.A.); (P.F.); (B.M.); (M.J.N.)
| | - Ghazal Izadi-Jorshari
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran;
| | - Benyamin Mohammadzadeh
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran; (M.A.); (P.F.); (B.M.); (M.J.N.)
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran; (M.A.); (P.F.); (B.M.); (M.J.N.)
| | - Milad Zandi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran 1417613151, Iran;
| | - Amirhossein Nayebzade
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran;
| | - Leonardo A. Sechi
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
- SC Microbiologia e Virologia, Azienda Ospedaliera Universitaria, 07100 Sassari, Italy
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21
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Ayala-Rivera VD, Padilla-Pantoja FD. Late ophthalmologic manifestations of monkeypox in a Latin American immunosuppressed patient. Int J STD AIDS 2023:9564624231162180. [PMID: 36922742 DOI: 10.1177/09564624231162180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND The re-emergence of Monkeypox (MPX) and its related ophthalmic disease represent a clinical challenge in the initial stages because of the presence of lesions like those caused by varicella zoster, syphilis, and other infections due to other poxviruses. Human Immunodeficiency Virus (HIV) infection and secondary immunodepression raise the risk of severe and prolonged disease. PURPOSE We present the case of a young immunosuppressed male patient with MPX, who presented with multiple skin lesions, also including risky ophthalmological manifestations due to extensive eyelid involvement. CONCLUSIONS We describe a novel form of late-onset conjunctivitis and eyelid lesions, without active extraocular disease, highlighting the heterogeneous behavior of the new clinical form of MPX, that exhibits a wide spectrum of lesions in different stages of evolution.
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Affiliation(s)
- Victor David Ayala-Rivera
- Visual Neurophysiology Laboratory, Department of Systems Biology, Physiology Unit, Faculty of Medicine and Health Sciences, 16720Universidad de Alcalá, Madrid, Madrid, Spain
| | - Fabio Daniel Padilla-Pantoja
- Ophthalmologist, Department of Surgery, Ophthalmology Unit, Faculty of Medicine, 28021Universidad Nacional de Colombia, Bogotá, Colombia
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22
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Doan S, Houry R, Cristea I, Boughar B, Cochereau I, Gabison EE, Guindolet D. Severe Corneal Involvement Associated With Mpox Infection. JAMA Ophthalmol 2023; 141:402-403. [PMID: 36892826 DOI: 10.1001/jamaophthalmol.2023.0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
This article discusses 2 cases of severe corneal involvement during mpox.
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Affiliation(s)
- Serge Doan
- Ophthalmology Department, Bichat Claude-Bernard Hospital, Paris, France.,Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
| | - Renan Houry
- Ophthalmology Department, Bichat Claude-Bernard Hospital, Paris, France.,Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
| | - Ioana Cristea
- Infectious Diseases Department, Bichat Claude-Bernard Hospital, Paris, France
| | - Boualem Boughar
- Ophthalmology Department, Bichat Claude-Bernard Hospital, Paris, France
| | - Isabelle Cochereau
- Ophthalmology Department, Bichat Claude-Bernard Hospital, Paris, France.,Ophthalmology Department, Rothschild Foundation Hospital, Paris, France.,Université de Paris, Paris, France
| | - Eric E Gabison
- Ophthalmology Department, Bichat Claude-Bernard Hospital, Paris, France.,Ophthalmology Department, Rothschild Foundation Hospital, Paris, France.,Université de Paris, Paris, France
| | - Damien Guindolet
- Ophthalmology Department, Bichat Claude-Bernard Hospital, Paris, France.,Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
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23
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Vasquez-Perez A, Magan T, Volpe G, Osborne SF, McFaul K, Vahdani K. Necrotizing Blepharoconjunctivitis and Keratitis in Human Monkeypox. JAMA Ophthalmol 2023; 141:285-288. [PMID: 36757718 PMCID: PMC9912162 DOI: 10.1001/jamaophthalmol.2022.6253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/13/2022] [Indexed: 02/10/2023]
Abstract
Importance Ophthalmic manifestations occur in less than 5% of patients with human mpox (monkeypox), most commonly presenting with self-limiting conjunctivitis and keratitis. Cases with severe ophthalmic complication are uncommon. Objective To present a case of human mpox with sight-threatening necrotizing blepharoconjunctivitis. Design, Setting, and Participants This is a report of a patient who developed necrotizing conjunctivitis due to the monkepox virus at a large university hospital. Data were collected from July to October 2022. Main Outcomes and Measures Description of the progression and clinical evaluation of the ocular condition and the management. Results A 63-year-old HIV-positive man presented initially with conjunctivitis and eyelid swelling and developed skin lesions from monkeypox virus 2 days later. Despite remaining stable systemically, after 4 days, his ophthalmic condition evolved to necrotizing blepharoconjunctivitis for which systemic antiviral treatment with tecovirimat was given along with topical trifluoridine, 1%, eye drops. In addition, he required repeated tissue debridement with amniotic membrane grafting to preserve the eye integrity. Conclusions and Relevance The severity of this observation was associated with a coexisting immunocompromised state and appeared similar to findings associated with other orthopoxviruses. Ophthalmic manifestations could be the initial presentation of human mpox and could also be severe. Early recognition and intervention may limit the likelihood of substantial ocular morbidity.
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Affiliation(s)
| | - Tejal Magan
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Giulio Volpe
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Sarah F. Osborne
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Katie McFaul
- St George’s Hospital NHS Foundation Trust, London, United Kingdom
| | - Kaveh Vahdani
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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24
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Shamim MA, Padhi BK, Satapathy P, Veeramachaneni SD, Chatterjee C, Tripathy S, Akhtar N, Pradhan A, Dwivedi P, Mohanty A, Rodriguez-Morales AJ, Sah R, Al-Tammemi AB, Al-Tawfiq JA, Nowrouzi-Kia B, Chattu VK. The use of antivirals in the treatment of human monkeypox outbreaks: a systematic review. Int J Infect Dis 2023; 127:150-161. [PMID: 36470502 PMCID: PMC9719850 DOI: 10.1016/j.ijid.2022.11.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Human monkeypox virus (MPXV) infection is a recently declared public health emergency of international concern by the World Health Organization. Besides, there is scant literature available on the use of antivirals in MPXV infection. This systematic review compiles all evidence of various antivirals used on their efficacy and safety and summarizes their mechanisms of action. METHODS A review was done of all original studies mentioning individual patient data on the use of antivirals in patients with MPXV infection. RESULTS Of the total 487 non-duplicate studies, 18 studies with 71 individuals were included. Tecovirimat was used in 61 individuals, followed by cidofovir in seven and brincidofovir (BCV) in three individuals. Topical trifluridine was used in four ophthalmic cases in addition to tecovirimat. Of the total, 59 (83.1%) were reported to have complete resolution of symptoms; one was experiencing waxing and waning of symptoms, only one (1.8%) had died, and the others were having a resolution of symptoms. The death was thought unrelated to tecovirimat. Elevated hepatic panels were reported among all individuals treated with BCV (leading to treatment discontinuation) and five treated with tecovirimat. CONCLUSION Tecovirimat is the most used and has proven beneficial in several aggravating cases. No major safety concerns were detected upon its use. Topical trifluridine was used as an adjuvant treatment option along with tecovirimat. BCV and cidofovir were seldom used, with the latter often being used due to the unavailability of tecovirimat. BCV was associated with treatment discontinuation due to adverse events.
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Affiliation(s)
| | - Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India,Corresponding authors
| | - Prakasini Satapathy
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Snehasish Tripathy
- Department of Preventive Oncology, Homi Bhabha Cancer Hospital and Research Centre, Muzaffarpur, India
| | - Naushaba Akhtar
- Indian Council of Medical Research - Regional Medical Research Centre, Bhubaneswar, India
| | - Anindita Pradhan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Pradeep Dwivedi
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India,Centre of Excellence for Tribal Health, All India Institute of Medical Sciences, Jodhpur, India
| | - Aroop Mohanty
- All India Institute of Medical Sciences, Gorakhpur, India
| | - Alfonso J. Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia,Institución Universitaria Visión de las Américas, Pereira, Colombia,Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur, Lima, Peru
| | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal,Harvard Medical School, Boston, USA,Dr. D.Y. Patil Medical College, Hospital and Research Center, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India,Corresponding authors
| | - Ala'a B. Al-Tammemi
- Migration Health Division, International Organization for Migration (IOM), Amman, Jordan
| | - Jaffar A. Al-Tawfiq
- Infectious Diseases Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA,Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA,Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Behdin Nowrouzi-Kia
- ReSTORE Lab, Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Vijay Kumar Chattu
- ReSTORE Lab, Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada,Center for Transdisciplinary Research, Saveetha Institute of Medical and Technological Sciences, Saveetha University, Chennai, India,Department of Community Medicine, Faculty of Medicine, Datta Meghe Institute of Medical Sciences, Wardha, India,Corresponding authors
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25
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Updated Information on Monkeypox Virus (MPXV) Ophthalmic Disease. JAMA Ophthalmol 2023; 141:104. [PMID: 36656296 PMCID: PMC9857357 DOI: 10.1001/jamaophthalmol.2022.6121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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