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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; 43:1176-1180. [PMID: 38870146 DOI: 10.1097/ico.0000000000003574] [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: 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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2
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Chakravarty N, Hemani D, Paravastu R, Ahmad Z, Palani SN, Arumugaswami V, Kumar A. Mpox Virus and its ocular surface manifestations. Ocul Surf 2024; 34:108-121. [PMID: 38972544 DOI: 10.1016/j.jtos.2024.07.001] [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: 04/16/2024] [Revised: 06/28/2024] [Accepted: 07/04/2024] [Indexed: 07/09/2024]
Abstract
The Mpox virus (MPXV) is the causative agent of human Mpox disease - a debilitating rash illness similar to smallpox. Although Clade I MPXV has remained endemic to West and Central Africa, Clade II MPXV has been responsible for many outbreaks worldwide. The most recent outbreak in 2022 resulted from the rapid spread of a new clade of MPXV, classified into Clade IIb - a distinct lineage from the previously circulating viral strains. The rapid spread and increased severity of Mpox disease by the Clade IIb strain have raised the serious public health imperative of better understanding the host and viral determinants during MPXV infection. In addition to typical skin rashes, including in the periorbital area, MPXV causes moderate to severe ophthalmic manifestations - most commonly, ocular surface complications (e.g., keratitis, conjunctivitis, blepharitis). While ocular manifestations of Clade I Mpox within the Congo basin have been well-reported, global incidence trends of ocular Mpox cases by Clade IIb are still emerging. Given the demonstrated ability of all MPXV strains to auto-inoculate ocular tissue, alongside the enhanced transmissibility of the Clade IIb virus, there is an urgent need to elucidate the mechanisms by which MPXV causes ocular anomalies. In this review, we discuss the viral and genomic structures of MPXV, the epidemiology, and pathology of systemic and ocular Mpox, as well as potential prophylactic and therapeutic interventions.
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Affiliation(s)
- Nikhil Chakravarty
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA, USA; School of Medicine, California University of Science and Medicine, Colton, CA, USA
| | - Darshi Hemani
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, Detroit, MI, USA
| | - Ramya Paravastu
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Zeeshan Ahmad
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, Detroit, MI, USA
| | - Sankara Naynar Palani
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Vaithilingaraja Arumugaswami
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA, USA; Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, Los Angeles, CA, USA; California NanoSystems Institute, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Ashok Kumar
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, Detroit, MI, USA.
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3
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Yi-Ting L, Chien-Hsien H, Hwa-Hsin F, Cheng-Kuo C, Pai-Huei P. Monkeypox-related ophthalmic disease. Taiwan J Ophthalmol 2024; 14:279-283. [PMID: 39027066 PMCID: PMC11254000 DOI: 10.4103/tjo.tjo-d-23-00141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/19/2024] [Indexed: 07/20/2024] Open
Abstract
Monkeypox (Mpox) is an acute febrile rash illness caused by the Mpox virus. The ongoing international outbreak since mid-2022 has spread worldwide, including Taiwan. Ocular involvement in Mpox infection is uncommon, including external and ocular surface lesions. Here, we describe a man who developed unilateral blepharoconjunctivitis and preseptal cellulitis, followed by the appearance of skin symptoms 6 days after the ocular manifestations. Samples taken from his oropharynx and skin lesions tested positive for the Mpox virus through a polymerase chain reaction test. He was hospitalized for isolation with topical lubricant, antibiotic, and acyclovir eye ointment until the skin lesions healed. However, on the day of discharge, punctate epithelial keratitis was observed in the same eye. The corneal lesion also tested positive for the Mpox virus. His keratitis progressed to dendritic ulceration, and treatment with tecovirimat was initiated. Initially, his corneal ulcer responded well to tecovirimat, but 12 days later, it deteriorated along with cells in the anterior chamber. To treat his condition, low-dose steroid and ganciclovir eye drops were administered. Eventually, the patient experienced resolution of the corneal lesion, leaving a scar.
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Affiliation(s)
- Liang Yi-Ting
- Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Huang Chien-Hsien
- Division of Infectious Disease, Department of Internal Medicine, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
- Department of Medicine, College of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Fang Hwa-Hsin
- Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Cheng Cheng-Kuo
- Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- Department of Medicine, College of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Peng Pai-Huei
- Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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4
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Rodríguez-Badillo P, Rodríguez-Aldama JC, Gabián-Fortes LDC, Sifuentes-Rentería S, Valdez-González MT, Pérez-Flores BE, Velasco-Ramos R, Fernández-Vizcaya O, Crabtree-Ramírez B, Pérez-Barragán E. Mpox-Related Ophthalmic Disease: A Retrospective Observational Study in a Single Center in Mexico. J Infect Dis 2024; 229:S255-S259. [PMID: 37683095 DOI: 10.1093/infdis/jiad372] [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: 07/06/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Mpox-related ophthalmic disease has been reported as infrequent. We retrospectively describe the ocular manifestations present in 11 of 100 patients with confirmed mpox; 9 were people with HIV. We suggest that an ophthalmological evaluation should be performed in all patients with ocular symptoms or moderate and severe mpox disease.
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Affiliation(s)
| | | | | | - Sergio Sifuentes-Rentería
- Department of Inflammatory Ocular Diseases, Fundación Hospital Nuestra Señora de la Luz, Mexico City, Mexico
| | | | | | - Regina Velasco-Ramos
- Department of Cornea, Fundación Hospital Nuestra Señora de la Luz, Mexico City, Mexico
| | | | - Brenda Crabtree-Ramírez
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | - Edgar Pérez-Barragán
- Department of Infectious Diseases, Clínica Especializada Condesa Iztapalapa, Mexico City, Mexico
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Cuppari N, Shah M, Dastjerdi M. Report of Two Cases of Ocular Monkeypox. Semin Ophthalmol 2024; 39:176-179. [PMID: 37671883 DOI: 10.1080/08820538.2023.2253893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
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Speiser LJ, Wonnaparhown AM, Blair J, Shah A, Patel DR, McCullough AE, Nicolasora N, Khalsa AM, Orenstein R, Vikram HR, Huang V, Seville MT. A Case of Sustained Viral Shedding of Mpox With Ocular Involvement Resulting in Vision Loss. Open Forum Infect Dis 2024; 11:ofad632. [PMID: 38264094 PMCID: PMC10805344 DOI: 10.1093/ofid/ofad632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/11/2023] [Indexed: 01/25/2024] Open
Abstract
Mpox, caused by infection with Monkeypox virus, usually presents as a mild, self-limited illness in immunocompetent persons that resolves within 2-4 weeks. Serious complications have been reported when mpox lesions involve vulnerable anatomic sites, such as the eye, and in those with substantial immunosuppression. We describe a patient with advanced human immunodeficiency virus infection and sustained viral shedding of mpox with ocular involvement, which resulted in vision loss.
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Affiliation(s)
- Lisa J Speiser
- Department of Medicine, Division of Infectious Diseases, The Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Alex M Wonnaparhown
- Department of Medicine, Division of Allergy and Immunology, The Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Janis Blair
- Department of Medicine, Division of Infectious Diseases, The Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Ami Shah
- Department of Ophthalmology, The Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Dharmendra R Patel
- Department of Ophthalmology, The Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Ann E McCullough
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, The Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Nelson Nicolasora
- Department of Medicine, Banner University Medical Center, Phoenix, Arizona, USA
| | - Ann M Khalsa
- Department of Family Medicine, Valleywise Health Medical Center, Phoenix, Arizona, USA
| | - Robert Orenstein
- Department of Medicine, Division of Infectious Diseases, The Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Holenarasipur R Vikram
- Department of Medicine, Division of Infectious Diseases, The Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Vivian Huang
- Maricopa County Department of Public Health, Division of Epidemiology and Public Health Informatics, Phoenix, Arizona, USA
- Department of Medical Affairs, Novavax Inc., Gaithersburg, Maryland, USA
| | - Maria Teresa Seville
- Department of Medicine, Division of Infectious Diseases, The Mayo Clinic Arizona, Phoenix, Arizona, USA
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Pieretti VM, Agriello M, Delgado Molina MM, Bonaura P, Ramallo CA, Miraglia E, Dauria F, Garritano MV, Maradeo MR. [Monkeypox: case series]. REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2023; 80:321-334. [PMID: 38150198 PMCID: PMC10851401 DOI: 10.31053/1853.0605.v80.n4.42303] [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: 08/21/2023] [Accepted: 10/08/2023] [Indexed: 12/28/2023] Open
Abstract
Introduction the recent mpox outbreak was considered an international public health emergency. Objective describe the epidemiological and clinical characteristics of mpox in a hospital in the province of Buenos Aires. Methods case series study in patients ≥15 years of age in the Dermatology service of the Hospital Interzonal General de Agudos "San Martín" in La Plata between August and November 2022. Results 10 patients were included. The mean age of presentation was 35 years. Seven of the patients were men and the remaining three were women. Most of them presented risky sexual intercourse as an epidemiological history. Pseudopustules were observed in 70% of the patients and all had genital, gluteal or perianal lesions. The complications observed were: local edema, proctitis, conjunctivitis and pharyngitis. Conclusion we present 3 female patients out of a total of 24 women reported in the country, which represent only 2% of mpox infections in Argentina. In most cases we observe pseudopustules, an elementary lesion recently described for this entity. One patient presented ocular involvement, a complication reported in 1% of cases in the current outbreak.
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Affiliation(s)
| | - Marina Agriello
- Hospital Interzonal General de Agudos "José de San Martín", La Plata, Buenos Aires, Argentina..
| | | | - Paula Bonaura
- Hospital Interzonal General de Agudos "José de San Martín", La Plata, Buenos Aires, Argentina..
| | - Camila Anabel Ramallo
- Hospital Interzonal General de Agudos "José de San Martín", La Plata, Buenos Aires, Argentina..
| | - Eugenia Miraglia
- Hospital Interzonal General de Agudos "José de San Martín", La Plata, Buenos Aires, Argentina..
| | - Florencia Dauria
- Hospital Interzonal General de Agudos "José de San Martín", La Plata, Buenos Aires, Argentina..
| | | | - Maria Roxana Maradeo
- Hospital Interzonal General de Agudos "José de San Martín", La Plata, Buenos Aires, Argentina..
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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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Valentino M, Muscat K, Gauci A, Gamoudi D, Padovese V. Clinical features and diagnostic challenges of mpox (monkeypox) outbreak in Malta: a retrospective cohort study. Int J Dermatol 2023; 62:1266-1271. [PMID: 37592818 DOI: 10.1111/ijd.16811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/14/2023] [Accepted: 08/04/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND In May of 2022, an mpox (formerly known as monkeypox) outbreak was reported from countries where the disease is not endemic, rising worldwide concern. Malta, the smallest European Union member state, faced unique challenges, with high infection rates compared to the rest of Europe. The aim of the study is to describe the clinical characteristics, diagnostic challenges, and unique demographics of mpox patients diagnosed in Malta. METHODS This is a retrospective analysis of medical records of all mpox cases recorded from May to September 2022. Demographic data, sexual behaviors and practices, travel history, comorbidities, and HIV status were investigated. RESULTS In the study period, we recorded 33 mpox cases, 97% of them were male, in the age group 30-39 (39%). Ninety percent were gay or bisexual men and 76% non-Maltese. The most common clinical presentations included skin rash (78%), lymphadenopathy (71%), anogenital lesions (67%), and fever (67%). Twenty-seven percent of the patients were people living with HIV. In terms of coinfection with STIs, 27% of patients tested positive for gonorrhea, 12% for syphilis, 15% for chlamydia, 9% for herpes simplex virus, and 3% for hepatitis C virus. CONCLUSION The results shed light on unique challenges faced by the local sexual health clinic and call for more resources in response to the global emerging of infectious diseases.
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Affiliation(s)
- Matthew Valentino
- Genito-Urinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta
| | - Katya Muscat
- Genito-Urinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta
| | - Alexandra Gauci
- Genito-Urinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta
| | - Donia Gamoudi
- Genito-Urinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta
| | - Valeska Padovese
- Genito-Urinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta
- Migrant Health Dermatology Working Group of International Foundation for Dermatology, London, UK
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Abdelaal A, Reda A, Hassan AR, Mashaal A, Abu Serhan H, Katamesh BE, Abdelazeem B, Mohanty A, Padhi BK, Rodriguez-Morales AJ, Sah R. Monkeypox-Associated Manifestations and Complications Involving the Eye: A Systematic Review and Meta-Analysis of Previous and Current Outbreaks. Asia Pac J Ophthalmol (Phila) 2023; 12:326-337. [PMID: 37249903 DOI: 10.1097/apo.0000000000000608] [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: 10/12/2022] [Accepted: 03/13/2023] [Indexed: 05/31/2023] Open
Abstract
PURPOSE The purpose of this study was to pool the prevalence rate of monkeypox-associated eye manifestations and/or complications during the current and previous outbreaks. DESIGN A systematic review and meta-analysis. MATERIALS AND METHODS On August 7, 2022, PubMed, Scopus, Web of Science, EMBASE, and Google Scholar were searched for relevant articles. We included all studies that reported the involvement of the eye (either as a manifestation or a complication) among patients with monkeypox. The primary outcome included pooling the effect size (ES) of reported manifestations and complications, and the secondary outcome included the conduct of a subgroup analysis based on the timing of the monkeypox outbreak (before vs. during 2022). RESULTS Eleven studies reporting 3179 monkeypox-confirmed cases were included. Eye manifestations included conjunctivitis, corneal, conjunctival, and eyelid lesions, photophobia, and eye pain. Compared with previous monkeypox outbreaks, the current outbreak revealed much lower rates of ocular involvement in terms of conjunctivitis (ES=1%; 95% CI: 0%-1% vs. ES=17%; 95% CI: 11%-22%), corneal and conjunctival lesions (ES=1%; 95% CI: 0%-2% vs. ES=13%; 95% CI: 4%-22%), and eyelid lesions (ES=1%; 95% CI: 0%-4% vs. ES=13%; 95% CI: 5%-28%). Monkeypox-associated eye complications were reported only in the previous outbreaks which included keratitis (ES=4%; 95% CI: 3%-6%), corneal ulceration (ES=4%; 95% CI: 2%-5%), unilateral (ES=3%; 95% CI: 1%-4%) and bilateral blindness (ES=0%; 95% CI: 0%-2%), and impaired vision (ES=4%; 95% CI: 1%-8%). CONCLUSIONS Ophthalmic manifestations and complications are common among monkeypox-confirmed cases. Although these data are mainly related to previous outbreaks, health care workers should familiarize themselves with these signs to provide better care for monkeypox patients.
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Affiliation(s)
- Abdelaziz Abdelaal
- Tanta Research Team, Tanta, El-Gharbia Governorate, Egypt
- Harvard Medical School, Boston, MA, US
- Boston University School of Medicine, Boston, MA, US
- Doheny Eye Institute, University of California, Los Angeles, Los Angeles, CA, US
- Faculty of Medicine, Tanta University, Tanta, El-Gharbia Governorate, Egypt
| | - Abdullah Reda
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdul Rhman Hassan
- Tanta Research Team, Tanta, El-Gharbia Governorate, Egypt
- Faculty of Medicine, Tanta University, Tanta, El-Gharbia Governorate, Egypt
| | - Abdelhafeez Mashaal
- Tanta Research Team, Tanta, El-Gharbia Governorate, Egypt
- Faculty of Medicine, Tanta University, Tanta, El-Gharbia Governorate, Egypt
| | - Hashem Abu Serhan
- Tanta Research Team, Tanta, El-Gharbia Governorate, Egypt
- Department of Ophthalmology, Hamad Medical Corporations, Doha, Qatar
| | - Basant E Katamesh
- Tanta Research Team, Tanta, El-Gharbia Governorate, Egypt
- Faculty of Medicine, Tanta University, Tanta, El-Gharbia Governorate, Egypt
- Mayo Clinic, Rochester, MN, US
| | - Basel Abdelazeem
- McLaren Health Care, Flint, Michigan, US
- Michigan State University, East Lansing, Michigan, US
| | - Aroop Mohanty
- All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Bijaya K Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alfonso J Rodriguez-Morales
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
- Master's Program of Clinical Epidemiology and Biostatistics, Scientific University of the South (Universidad Científica del Sur), Lima, Peru
| | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
- Department of Microbiology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
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11
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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: 9] [Impact Index Per Article: 9.0] [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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