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Bhalla N, Payam AF. Addressing the Silent Spread of Monkeypox Disease with Advanced Analytical Tools. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023; 19:e2206633. [PMID: 36517107 DOI: 10.1002/smll.202206633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Indexed: 06/17/2023]
Abstract
Monkeypox disease is caused by a virus which belongs to the orthopoxvirus genus of the poxviridae family. This disease has recently spread out to several non-endemic countries. While some cases have been linked to travel from endemic regions, more recent infections are thought to have spread in the community without any travel links, raising the risks of a wider outbreak. This state of public health represents a highly unusual event which requires urgent surveillance. In this context, the opportunities and technological challenges of current bio/chemical sensors, nanomaterials, nanomaterial characterization instruments, and artificially intelligent biosystems collectively called "advanced analytical tools" are reviewed here, which will allow early detection, characterization, and inhibition of the monkeypox virus (MPXV) in the community and limit its expansion from endemic to pandemic. A summary of background information is also provided from biological and epidemiological perspective of monkeypox to support the scientific case for its holistic management using advanced analytical tools.
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Affiliation(s)
- Nikhil Bhalla
- Nanotechnology and Integrated Bioengineering Centre (NIBEC), School of Engineering, Ulster University, York St., BT15 1ED Belfast, Northern Ireland, UK
- Healthcare Technology Hub, Ulster University, York St., BT15 1ED Belfast, Northern Ireland, UK
| | - Amir Farokh Payam
- Nanotechnology and Integrated Bioengineering Centre (NIBEC), School of Engineering, Ulster University, York St., BT15 1ED Belfast, Northern Ireland, UK
- Healthcare Technology Hub, Ulster University, York St., BT15 1ED Belfast, Northern Ireland, UK
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Sanromán Guerrero MA, Sánchez EH, Ruanes BDN, Fernández-González P, Ugalde SA, Leal AG, Fernández MS, Rodríguez JJA, Martinez Garcia L, Escudero R, Méndez MÁF, Zamorano Gómez JL, Llorente BM, Vivancos-Gallego MJ. Case report: From monkeypox pharyngitis to myopericarditis and atypical skin lesions. Front Cardiovasc Med 2023; 9:1046498. [PMID: 36684566 PMCID: PMC9851183 DOI: 10.3389/fcvm.2022.1046498] [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] [Received: 09/16/2022] [Accepted: 12/02/2022] [Indexed: 01/07/2023] Open
Abstract
Background A global outbreak of the human monkeypox virus (HMPXV), first identified in May 2022, was declared a health emergency of international concern on 23 July 2022. Before the global outbreak, monkeypox cases were mostly confined to central and west African countries, where this virus is prevalent. Close contact, mainly sexual contact, is supposed to be the main route of transmission, and it is remarkable that the incidence is higher in men who have sexual relationships with other men. Case summary A 40-year-old Caucasian man arrived at the emergency department complaining of oppressive epigastric pain extending to the chest after a diagnosis of pharyngitis, which was suspected to be caused by the human monkeypox virus. Based on the clinical symptoms, physical examination, serum cardiac biomarkers, and electrocardiographic findings, he was diagnosed with myopericarditis. The real-time PCR for human monkeypox in skin lesions, urine, plasma, and the oropharyngeal swab was positive. The peak of troponin I was 20.6 ng/ml, and the electrocardiogram showed an upward concavity in the ST segment in diffuse leads, which was in agreement with the previous diagnosis. The presence of edema, subepicardial, and myocardial late gadolinium enhancement, and increased values on T1 mapping in the cardiac MRI were in agreement with the diagnosis of myopericarditis. Antiviral treatment with tecovirimat was started with excellent tolerability. After 6 days, the patient recovered and was discharged. Discussion To our knowledge, this is one of the first reported cases of myopericarditis due to human monkeypox infection, which was confirmed by a cardiac MRI following modified Lake Louise criteria. The short span between the onset of the mucocutaneous symptoms and the myocardial damage suggests a pathogenic association. Furthermore, the active viral replication in plasma samples and the negative results on real-time PCR for other viruses support this clinical association.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Laura Martinez Garcia
- Department of Microbiology, University Hospital Ramón y Cajal and IRYCIS, Universidad de Alcalá, CIBERESP, Madrid, Spain
| | - Rosa Escudero
- Department of Infectious Diseases, University Hospital Ramón y Cajal and IRYCIS, Universidad de Alcalá, CIBERINFEC, Madrid, Spain
| | | | | | | | - Maria Jesús Vivancos-Gallego
- Department of Infectious Diseases, University Hospital Ramón y Cajal and IRYCIS, Universidad de Alcalá, CIBERINFEC, Madrid, Spain
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Michel J, Targosz A, Rinner T, Bourquain D, Brinkmann A, Sacks JA, Schaade L, Nitsche A. Evaluation of 11 commercially available PCR kits for the detection of monkeypox virus DNA, Berlin, July to September 2022. Euro Surveill 2022; 27:2200816. [PMID: 36367010 PMCID: PMC9650706 DOI: 10.2807/1560-7917.es.2022.27.45.2200816] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Before the international spread of monkeypox in May 2022, PCR kits for the detection of orthopoxviruses, and specifically monkeypox virus, were rarely available. Here we describe the evaluation of 11 recently developed commercially available PCR kits for the detection of monkeypox virus DNA. All tested kits are currently intended for research use only and clinical performance still needs to be assessed in more detail, but all were suitable for diagnostics of monkeypox virus, with variations in specificity rather than sensitivity.
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Affiliation(s)
- Janine Michel
- Robert Koch Institute (RKI), Center for Biological Threats and Special Pathogens, German Reference Laboratory for Poxviruses, Berlin, Germany
| | - Angelina Targosz
- Robert Koch Institute (RKI), Center for Biological Threats and Special Pathogens, German Reference Laboratory for Poxviruses, Berlin, Germany
| | - Thomas Rinner
- Robert Koch Institute (RKI), Center for Biological Threats and Special Pathogens, German Reference Laboratory for Poxviruses, Berlin, Germany
| | - Daniel Bourquain
- Robert Koch Institute (RKI), Center for Biological Threats and Special Pathogens, German Reference Laboratory for Poxviruses, Berlin, Germany
| | - Annika Brinkmann
- Robert Koch Institute (RKI), Center for Biological Threats and Special Pathogens, German Reference Laboratory for Poxviruses, Berlin, Germany
| | - Jilian Amber Sacks
- World Health Organization (WHO), Department of Epidemic and Pandemic Preparedness and Prevention, Geneva, Switzerland
| | - Lars Schaade
- Robert Koch Institute (RKI), Center for Biological Threats and Special Pathogens, German Reference Laboratory for Poxviruses, Berlin, Germany
| | - Andreas Nitsche
- Robert Koch Institute (RKI), Center for Biological Threats and Special Pathogens, German Reference Laboratory for Poxviruses, Berlin, Germany
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Vivancos-Gallego MJ, Sánchez-Conde M, Rodríguez-Domínguez M, Fernandez-Gonzalez P, Martínez-García L, Garcia-Mouronte E, Martínez-Sanz J, Moreno-Zamora AM, Casado JL, Ron R, Galán JC, Pérez-Elías MJ, Moreno S. Human Monkeypox in People With HIV: Transmission, Clinical Features, and Outcome. Open Forum Infect Dis 2022; 9:ofac557. [PMID: 36381620 PMCID: PMC9664972 DOI: 10.1093/ofid/ofac557] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/18/2022] [Indexed: 07/30/2023] Open
Abstract
We describe the first 25 persons with HIV diagnosed with human monkeypox virus (MPXV) in our hospital in an ongoing outbreak in Spain. Proctitis was the predominant finding in 52%, and MPXV DNA was detected in rectal swabs from 90%. Proctitis and demonstration of MPXV in rectal swabs support the sexual transmission of MPXV.
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Affiliation(s)
- María Jesús Vivancos-Gallego
- Correspondence: Maria J. Vivancos-Gallego, MD, PhD, Department of Infectious Diseases, Hospital U. Ramón y Cajal, Carretera de Colmenar, Km, 9,100, 28034 Madrid, Spain ()
| | | | - Mario Rodríguez-Domínguez
- Department of Microbiology, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
- CIBERESP, Madrid, Spain
| | | | - Laura Martínez-García
- Department of Microbiology, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
- CIBERESP, Madrid, Spain
| | | | - Javier Martínez-Sanz
- Department of Infectious Diseases, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
- CIBERINFEC, Madrid, Spain
| | - Ana María Moreno-Zamora
- Department of Infectious Diseases, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
- CIBERINFEC, Madrid, Spain
| | - Jose Luis Casado
- Department of Infectious Diseases, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
- CIBERINFEC, Madrid, Spain
| | - Raquel Ron
- Department of Infectious Diseases, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
- CIBERINFEC, Madrid, Spain
| | - Juan Carlos Galán
- Department of Microbiology, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
- CIBERESP, Madrid, Spain
| | - María Jesús Pérez-Elías
- Department of Infectious Diseases, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
- CIBERINFEC, Madrid, Spain
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Wibbelt G, Tausch SH, Dabrowski PW, Kershaw O, Nitsche A, Schrick L. Berlin Squirrelpox Virus, a New Poxvirus in Red Squirrels, Berlin, Germany. Emerg Infect Dis 2018; 23:1726-1729. [PMID: 28930029 PMCID: PMC5621524 DOI: 10.3201/eid2310.171008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Near Berlin, Germany, several juvenile red squirrels (Sciurus vulgaris) were found with moist, crusty skin lesions. Histology, electron microscopy, and cell culture isolation revealed an orthopoxvirus-like infection. Subsequent PCR and genome analysis identified a new poxvirus (Berlin squirrelpox virus) that could not be assigned to any known poxvirus genera.
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Gelderblom HR, Madeley D. Rapid Viral Diagnosis of Orthopoxviruses by Electron Microscopy: Optional or a Must? Viruses 2018; 10:E142. [PMID: 29565285 PMCID: PMC5923436 DOI: 10.3390/v10040142] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/22/2018] [Accepted: 02/22/2018] [Indexed: 12/20/2022] Open
Abstract
Diagnostic electron microscopy (DEM) was an essential component of viral diagnosis until the development of highly sensitive nucleic acid amplification techniques (NAT). The simple negative staining technique of DEM was applied widely to smallpox diagnosis until the world-wide eradication of the human-specific pathogen in 1980. Since then, the threat of smallpox re-emerging through laboratory escape, molecular manipulation, synthetic biology or bioterrorism has not totally disappeared and would be a major problem in an unvaccinated population. Other animal poxviruses may also emerge as human pathogens. With its rapid results (only a few minutes after arrival of the specimen), no requirement for specific reagents and its "open view", DEM remains an important component of virus diagnosis, particularly because it can easily and reliably distinguish smallpox virus or any other member of the orthopoxvirus (OPV) genus from parapoxviruses (PPV) and the far more common and less serious herpesviruses (herpes simplex and varicella zoster). Preparation, enrichment, examination, internal standards and suitable organisations are discussed to make clear its continuing value as a diagnostic technique.
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Affiliation(s)
- Hans R Gelderblom
- (ret) Robert Koch Institute, Centre for Biological Threats and Special Pathogens, ZBS 4: Advanced Light and Electron Microscopy, Seestrasse 10, D-13353 Berlin, Germany.
| | - Dick Madeley
- (ret) University of Newcastle upon Tyne, Burnfoot, Stocksfield, Northumberland, NE43 7TN, UK.
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Reynolds MG, Guagliardo SAJ, Nakazawa YJ, Doty JB, Mauldin MR. Understanding orthopoxvirus host range and evolution: from the enigmatic to the usual suspects. Curr Opin Virol 2018; 28:108-115. [PMID: 29288901 DOI: 10.1016/j.coviro.2017.11.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 11/16/2022]
Abstract
In general, orthopoxviruses can be considered as falling into one of three host-utilization categories: highly specialized, single-host; broad host range; or 'cryptic', the last encompassing those viruses about which very little is known. Single-host viruses tend to exploit abundant hosts that have consistent patterns of interaction. For these viruses, observed genome reduction and loss of presumptive host-range genes is thought to be a consequence of relaxed selection. In contrast, the large genome size retained among broad host range orthopoxviruses suggests these viruses may depend on multiple host species for persistence in nature. Our understanding of the ecologic requirements of orthopoxviruses is strongly influenced by geographic biases in data collection. This hinders our ability to predict potential sources for emergence of orthopoxvirus-associated infections.
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Affiliation(s)
- Mary G Reynolds
- United States Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, 1600 Clifton Rd., NE Atlanta, GA 30333, USA.
| | - Sarah Anne J Guagliardo
- United States Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, 1600 Clifton Rd., NE Atlanta, GA 30333, USA; United States Centers for Disease Control and Prevention, Epidemic Intelligence Service, 1600 Clifton Rd., NE Atlanta, GA 30333, USA
| | - Yoshinori J Nakazawa
- United States Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, 1600 Clifton Rd., NE Atlanta, GA 30333, USA
| | - Jeffrey B Doty
- United States Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, 1600 Clifton Rd., NE Atlanta, GA 30333, USA
| | - Matthew R Mauldin
- United States Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, 1600 Clifton Rd., NE Atlanta, GA 30333, USA
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Stagegaard J, Kurth A, Stern D, Dabrowski PW, Pocknell A, Nitsche A, Schrick L. Seasonal recurrence of cowpox virus outbreaks in captive cheetahs (Acinonyx jubatus). PLoS One 2017; 12:e0187089. [PMID: 29121668 PMCID: PMC5679633 DOI: 10.1371/journal.pone.0187089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 10/15/2017] [Indexed: 11/18/2022] Open
Abstract
Cowpox virus infections in captive cheetahs (Acinonyx jubatus) with high morbidity and mortality have already been reported in the UK and Russia in the 1970s. However, most of the reported cases have been singular events. Here, we report a total of five cowpox virus outbreaks in cheetahs in the same safari park in Denmark between 2010 and 2014. Nine cheetahs showed varying severity of clinical disease; two of them died (22%). All episodes occurred between August and October of the respective year. No other carnivores kept at the same institution nor the keepers taking care of the animals were clinically affected. The clinical picture of cowpox was confirmed by extensive laboratory investigations including histopathological and molecular analyses as well as cell culture isolation of a cowpox virus. High anti-orthopoxvirus antibody titers were detected in all 9 diseased cheetahs compared to seven contact cheetahs without clinical signs and 13 cheetahs not in direct contact. Additionally, whole genome sequencing from one sample of each cluster with subsequent phylogenetic analysis showed that the viruses from different outbreaks have individual sequences but clearly form a clade distinct from other cowpox viruses. However, the intra-clade distances are still larger than those usually observed within clades of one event. These findings indicate multiple and separate introductions of cowpox virus, probably from wild rodent populations, where the virus keeps circulating naturally and is only sporadically introduced into the cheetahs. Sero-positivity of voles (Arvicola amphibious) caught in zoo grounds strengthens this hypothesis. As a consequence, recommendations are given for medical and physical management of diseased cheetahs, for hygienic measures as well as for pre-shipment isolation before cheetah export from zoo grounds.
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Affiliation(s)
| | - Andreas Kurth
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
- German Consultant Laboratory for Poxviruses, Robert Koch Institute, Berlin, Germany
| | - Daniel Stern
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | | | | | - Andreas Nitsche
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
- German Consultant Laboratory for Poxviruses, Robert Koch Institute, Berlin, Germany
- * E-mail:
| | - Livia Schrick
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
- German Consultant Laboratory for Poxviruses, Robert Koch Institute, Berlin, Germany
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