1
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Mital R, Fisher K, Korman AM, Plaza JA, Kaffenberger BH, Chung CG. Histopathologic Findings of Evolving Mpox Lesions. Am J Dermatopathol 2024:00000372-990000000-00395. [PMID: 39141745 DOI: 10.1097/dad.0000000000002709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
ABSTRACT This article reports two cases of the 2022 mpox virus with notable histopathology, and includes a novel description of mpox pseudotumor in the perianal region which is not previously described. This article additionally includes literature review of characteristic histopathology through evolving lesions, as it is sparsely described in relation to the 2022 mpox outbreak. Case one describes a 42-year-old man who presented with umbilicated, smooth papules on the trunk and extremities, and milia-like papules on the face. Histopathology of an umbilicated lesion revealed epidermal acanthosis with keratinocyte pallor, ballooning degeneration, keratinocyte necrosis, and neutrophilic epitheliotropism. Case two describes a 51-year-old man who presented with scattered eroded papules as well as a perianal mass. Histopathology of the mass revealed ulceration with keratinocyte enlargement and pallor with a mixed inflammatory cell infiltrate. It additionally revealed rare multinucleated keratinocytes with nuclear molding. These cases are remarkable and contribute to literature as reports of the histopathology of the atypical 2022 mpox outbreak are rare. A combination of clinical, laboratory, and histopathologic evidence is useful in diagnosing mpox, and these cases contribute to describing the evolution of viral lesions.
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Affiliation(s)
- Rohan Mital
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH; and
| | - Kristopher Fisher
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH; and
| | - Abraham M Korman
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH; and
| | - Jose A Plaza
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH; and
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Benjamin H Kaffenberger
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH; and
| | - Catherine G Chung
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH; and
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
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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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Zinnah MA, Uddin MB, Hasan T, Das S, Khatun F, Hasan MH, Udonsom R, Rahman MM, Ashour HM. The Re-Emergence of Mpox: Old Illness, Modern Challenges. Biomedicines 2024; 12:1457. [PMID: 39062032 PMCID: PMC11274818 DOI: 10.3390/biomedicines12071457] [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: 01/12/2024] [Revised: 06/06/2024] [Accepted: 06/10/2024] [Indexed: 07/28/2024] Open
Abstract
The Mpox virus (MPXV) is known to cause zoonotic disease in humans. The virus belongs to the genus Orthopoxvirus, of the family Poxviridae, and was first reported in monkeys in 1959 in Denmark and in humans in 1970 in the Congo. MPXV first appeared in the U.S. in 2003, re-emerged in 2017, and spread globally within a few years. Wild African rodents are thought to be the reservoir of MPXV. The exotic trade of animals and international travel can contribute to the spread of the Mpox virus. A phylogenetic analysis of MPXV revealed two distinct clades (Central African clade and West African clade). The smallpox vaccine shows cross-protection against MPXV infections in humans. Those who have not previously been exposed to Orthopoxvirus infections are more vulnerable to MPXV infections. Clinical manifestations in humans include fever, muscle pain, headache, and vesicle formation on the skin of infected individuals. Pathognomonic lesions include ballooning degenerations with Guarnieri-like inclusions in vesicular epithelial cells. Alterations in viral genome through genetic mutations might favor the re-emergence of a version of MPXV with enhanced virulence. As of November 2023, 92,783 cases and 171 deaths have been reported in 116 countries, representing a global public health concern. Here, we provide insights on the re-emergence of MPXV in humans. This review covers the origin, emergence, re-emergence, transmission, pathology, diagnosis, control measures, and immunomodulation of the virus, as well as clinical manifestations. Concerted efforts of health professionals and scientists are needed to prevent the disease and stop its transmission in vulnerable populations.
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Affiliation(s)
- Mohammad Ali Zinnah
- Department of Microbiology and Public Health, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur 1706, Bangladesh
| | - Md Bashir Uddin
- Department of Medicine, Faculty of Veterinary, Animal and Biomedical Sciences, Sylhet Agricultural University, Sylhet 3100, Bangladesh
| | - Tanjila Hasan
- Department of Medicine and Surgery, Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Shobhan Das
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30458, USA
| | - Fahima Khatun
- Department of Pathobiology, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur 1706, Bangladesh
| | - Md Hasibul Hasan
- Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj 8100, Bangladesh
| | - Ruenruetai Udonsom
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok 73170, Thailand
| | - Md Masudur Rahman
- Department of Pathology, Faculty of Veterinary, Animal and Biomedical Sciences, Sylhet Agricultural University, Sylhet 3100, Bangladesh
- ABEx Bio-Research Center, East Azampur, Dhaka 1230, Bangladesh
| | - Hossam M. Ashour
- Department of Integrative Biology, College of Arts and Sciences, University of South Florida, St. Petersburg, FL 33701, USA
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4
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Tamashunas NL, Williamson SJ, Wypasek E, DiSano K, Somach S, Ray AJ, Crowe DR. Necrotic ulcers in a HIV-positive man. JAAD Case Rep 2024; 47:14-16. [PMID: 38576902 PMCID: PMC10993132 DOI: 10.1016/j.jdcr.2023.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Affiliation(s)
| | | | - Evan Wypasek
- Department of Internal Medicine, MetroHealth Medical Center, Cleveland, Ohio
| | - Katherine DiSano
- Department of Dermatology, MetroHealth Medical Center, Cleveland, Ohio
| | - Stephen Somach
- Department of Dermatology, MetroHealth Medical Center, Cleveland, Ohio
| | - Amy J. Ray
- Department of Infectious Disease, MetroHealth Medical Center, Cleveland, Ohio
| | - David R. Crowe
- Department of Dermatology, MetroHealth Medical Center, Cleveland, Ohio
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5
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Andrieu J, Valade M, Lebideau M, Bretelle F, Mège JL, Wurtz N, Mezouar S, La Scola B, Baudoin JP. Pan-microscopic examination of monkeypox virus in trophoblasts cells reveals new insights into virions release through filopodia-like projections. J Med Virol 2024; 96:e29620. [PMID: 38647027 DOI: 10.1002/jmv.29620] [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: 12/19/2023] [Revised: 03/04/2024] [Accepted: 03/31/2024] [Indexed: 04/25/2024]
Abstract
Vertical transmission has been described following monkeypox virus (MPXV) infection in pregnant women. The presence of MPXV has been reported in the placenta from infected women, but whether pathogens colonize placenta remains unexplored. We identify trophoblasts as a target cell for MPXV replication. In a pan-microscopy approach, we decipher the specific infectious cycle of MPXV and inner cellular structures in trophoblasts. We identified the formation of a specialized region for viral morphogenesis and replication in placental cells. We also reported infection-induced cellular remodeling. We found that MPXV stimulates cytoskeleton reorganization with intercellular extensions for MPXV cell spreading specifically to trophoblastic cells. Altogether, the specific infectious cycle of MPXV in trophoblast cells and these protrusions that were structurally and morphologically similar to filopodia reveal new insights into the infection of MPXV.
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Affiliation(s)
- Jonatane Andrieu
- Centre National de la Recherche Scientifique, Établissement Français du Sang, Anthropologie bio-culturelle, Droit, Éthique et Santé, Aix-Marseille University, Marseille, France
| | - Margaux Valade
- Institut Recherche Développement, Assistance Publique-Hôpitaux de Marseille, Microbe, Evolution, Phylogeny Infection, Aix-Marseille University, Marseille, France
| | - Marion Lebideau
- Institut Recherche Développement, Assistance Publique-Hôpitaux de Marseille, Microbe, Evolution, Phylogeny Infection, Aix-Marseille University, Marseille, France
| | - Florence Bretelle
- Institut Recherche Développement, Assistance Publique-Hôpitaux de Marseille, Microbe, Evolution, Phylogeny Infection, Aix-Marseille University, Marseille, France
- Département de gynécologie et d'obstétrique, Gynépole, La Conception, AP-HM, Marseille, France
| | - Jean-Louis Mège
- Centre National de la Recherche Scientifique, Établissement Français du Sang, Anthropologie bio-culturelle, Droit, Éthique et Santé, Aix-Marseille University, Marseille, France
- Laboratoire d'Immunologie, Assistance Publique Hôpitaux de Marseille (APHM), Marseille, France
| | - Nathalie Wurtz
- Institut Recherche Développement, Assistance Publique-Hôpitaux de Marseille, Microbe, Evolution, Phylogeny Infection, Aix-Marseille University, Marseille, France
| | - Soraya Mezouar
- Centre National de la Recherche Scientifique, Établissement Français du Sang, Anthropologie bio-culturelle, Droit, Éthique et Santé, Aix-Marseille University, Marseille, France
| | - Bernard La Scola
- Institut Recherche Développement, Assistance Publique-Hôpitaux de Marseille, Microbe, Evolution, Phylogeny Infection, Aix-Marseille University, Marseille, France
| | - Jean-Pierre Baudoin
- Institut Recherche Développement, Assistance Publique-Hôpitaux de Marseille, Microbe, Evolution, Phylogeny Infection, Aix-Marseille University, Marseille, France
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6
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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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7
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Grau-Echevarría A, Peñuelas-Leal R, Labrandero-Hoyos C, Blaya-Imbernón D, Finello M, González-García Á, Pérez-Zafrilla E, Pérez-Ferriols A, Hernández-Bel P. Widespread necrotic vesicles with genital involvement. Clin Exp Dermatol 2024; 49:422-425. [PMID: 38048444 DOI: 10.1093/ced/llad420] [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: 08/04/2023] [Revised: 10/30/2023] [Accepted: 11/10/2023] [Indexed: 12/06/2023]
Abstract
We present a clinicopathological challenge consisting of disseminated herpes zoster that simulated mpox. We emphasize the utility of diagnosis with the Tzanck test and skin biopsy, as well as the importance of understanding the clinical picture, owing to its potential severity
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Affiliation(s)
- Andrés Grau-Echevarría
- Dermatology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Rodrigo Peñuelas-Leal
- Dermatology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | | | - Daniel Blaya-Imbernón
- Dermatology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Malena Finello
- Dermatology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Ángel González-García
- Dermatology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Elena Pérez-Zafrilla
- Dermatology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Amparo Pérez-Ferriols
- Dermatology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Pablo Hernández-Bel
- Dermatology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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8
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Venturi C, Guadagno A, Varesano S, Ricucci V, Nigro N, Di Biagio A, Bassetti M, Nozza P, Drago F, Parodi A, Ciccarese G. Histopathologic and transmission electron microscopic findings in monkeypox cutaneous lesions. LE INFEZIONI IN MEDICINA 2024; 32:76-82. [PMID: 38456031 PMCID: PMC10917568 DOI: 10.53854/liim-3201-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/25/2024] [Indexed: 03/09/2024]
Abstract
Background a few pathologic and ultrastructural findings of monkeypox skin lesions are available in the literature. To integrate such evidence, we aimed to describe the pathologic features of monkeypox skin lesions and to show monkeypox virions by transmission electron microscopy (TEM). Methods we studied the cutaneous biopsies of three patients affected by monkeypox during the 2022 monkeypox outbreak. Skin biopsies have been collected only from body sites with a recent laboratory-confirmed mpox virus infection, defined by a polymerase chain reaction (PCR) positive result in specimens taken through skin swabs. Results in all the samples the epidermis showed keratinocytes ballooning degeneration; perivascular/periadnexal infiltrates composed of neutrophils and lymphocytes were observed in the deep dermis. Immunohistochemistry showed that the infiltrate was mostly composed of CD3+ T-cells. TEM revealed monkeypox virus-like particles in various stages of morphogenesis in the dermis and epidermis; virions were interspersed among keratinocytes and within their cytoplasm. At the intracellular level, virions showed a biconcaveshaped central core, surrounded by lateral bodies and an external membrane; they also appeared as rectangular, brick-shaped, or oval particles with eccentric nucleoids. The histologic features of our skin samples confirmed the few other studies on this topic, except for the eosinophilic inclusions of the cytoplasm of keratinocytes (Guarnieri's bodies). Conclusion the role of molecular biology is crucial for monkeypox diagnosis but when it is not disposable and/or in doubtful cases, skin biopsy and TEM may be helpful to establish the diagnosis.
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Affiliation(s)
- Consuelo Venturi
- Pathology Unit, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Antonio Guadagno
- Pathology Unit, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Serena Varesano
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Nicola Nigro
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Di Biagio
- Department of Specialist Medicine, Infectious Disease Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences, Division of Infectious Diseases, University of Genoa, Genoa, Italy
| | - Paolo Nozza
- Pathology Unit, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Francesco Drago
- Section of Dermatology, DISSAL, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Aurora Parodi
- Section of Dermatology, DISSAL, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giulia Ciccarese
- Unit of Dermatology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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9
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Obermeier PE, Buder SC, Hillen U. Pockenvirusinfektionen in der Dermatologie: Poxvirus infections in dermatology - the neglected, the notable, and the notorious. J Dtsch Dermatol Ges 2024; 22:56-96. [PMID: 38212918 DOI: 10.1111/ddg.15257_g] [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: 01/31/2023] [Accepted: 08/20/2023] [Indexed: 01/13/2024]
Abstract
ZusammenfassungDie Familie Poxviridae umfasst derzeit 22 Gattungen, die Wirbeltiere infizieren können. Humanpathogene Pockenviren gehören den Gattungen Ortho‐, Para‐, Mollusci‐ und Yatapoxvirus an. Bis zur Eradikation der Variola vera im Jahr 1979 waren die Pocken, im Volksmund auch Blattern genannt, eine schwerwiegende Gesundheitsbedrohung für die Bevölkerung. Noch heute sind Dermatologen mit zahlreichen Pockenvirusinfektionen konfrontiert, wie den Bauernhofpocken, die als Zoonosen nach Tierkontakten in ländlichen Gebieten oder nach Massenversammlungen auftreten können. In den Tropen können Erkrankungen durch Tanapox‐ oder Vaccinia‐Viren zu den Differenzialdiagnosen gehören. Dellwarzen sind weltweit verbreitet und werden in bestimmten Fällen als sexuell übertragbare Pockenvirusinfektion angesehen. In jüngster Zeit hatten sich Mpox (Affenpocken) zu einer gesundheitlichen Notlage von internationaler Tragweite entwickelt, die eine rasche Identifizierung und angemessene Behandlung durch Dermatologen und Infektiologen erfordert. Fortschritte und neue Erkenntnisse über Epidemiologie, Diagnose, klinische Manifestationen und Komplikationen sowie Behandlung und Prävention von Pockenvirusinfektionen erfordern ein hohes Maß an Fachwissen und interdisziplinärer Zusammenarbeit in den Bereichen Virologie, Infektiologie und Dermatologie. Dieser CME‐Artikel bietet einen aktualisierten systematischen Überblick, um praktizierende Dermatologen bei der Identifizierung, Differenzialdiagnose und Behandlung klinisch relevanter Pockenvirusinfektionen zu unterstützen.
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Affiliation(s)
- Patrick E Obermeier
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
- Abteilung für Infektionskrankheiten, Vaccine Safety Initiative, Berlin, Deutschland
| | - Susanne C Buder
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
- Konsiliarlabor für Gonokokken, Fachgebiet Sexuell übertragbare bakterielle Krankheitserreger, Robert Koch-Institut, Berlin, Deutschland
| | - Uwe Hillen
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
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10
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Obermeier PE, Buder SC, Hillen U. Poxvirus infections in dermatology - the neglected, the notable, and the notorious. J Dtsch Dermatol Ges 2024; 22:56-93. [PMID: 38085140 DOI: 10.1111/ddg.15257] [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: 01/31/2023] [Accepted: 08/20/2023] [Indexed: 12/22/2023]
Abstract
The family Poxviridae currently comprises 22 genera that infect vertebrates. Of these, members of the Ortho-, Para-, Mollusci- and Yatapoxvirus genera have been associated with human diseases of high clinical relevance in dermatology. Historically, smallpox had been a notorious health threat until it was declared eradicated by the World Health Organization in 1979. Today, dermatologists are confronted with a variety of poxviral infections, such as farmyard pox, which occurs as a zoonotic infection after contact with animals. In the tropics, tanapox or vaccinia may be in the differential diagnosis as neglected tropical dermatoses. Molluscum contagiosum virus infection accounts for significant disease burden worldwide and is classified as a sexually transmitted infection in certain scenarios. Recently, mpox (monkeypox) has emerged as a public health emergency of international concern, requiring rapid recognition and appropriate management by dermatologists and infectious disease specialists. Advances and new insights into the epidemiology, diagnosis, clinical manifestations and complications, treatment, and prevention of poxviral infections require a high level of expertise and interdisciplinary skills from healthcare professionals linking virology, infectious diseases, and dermatology. This CME article provides a systematic overview and update to assist the practicing dermatologist in the identification, differential diagnosis, and management of poxviral infections.
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Affiliation(s)
- Patrick E Obermeier
- Department of Dermatology and Venereology, Vivantes Hospital Neukölln, Berlin, Germany
- Department of Infectious Diseases, Vaccine Safety Initiative, Berlin, Germany
| | - Susanne C Buder
- Department of Dermatology and Venereology, Vivantes Hospital Neukölln, Berlin, Germany
- German Reference Laboratory for Gonococci, Unit Sexually Transmitted Bacterial Pathogens, Department for Infectious Diseases, Robert Koch-Institute, Berlin, Germany
| | - Uwe Hillen
- Department of Dermatology and Venereology, Vivantes Hospital Neukölln, Berlin, Germany
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11
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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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12
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Shishido AA, Street S. Optimal management of severe mpox in patients with uncontrolled human immunodeficiency virus. J Med Virol 2023; 95:e29277. [PMID: 38078663 DOI: 10.1002/jmv.29277] [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: 09/20/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023]
Abstract
In May 2022, a cluster of nontravel-related cases of human mpox were reported in the United Kingdom. The outbreak has since spread worldwide infecting over 85 000 patients and causing over 100 deaths. Recent data clearly suggest that patients infected with human immunodeficiency virus (HIV) with CD4 counts less than 200 cells per mm 3 suffer significantly worse outcomes than immunocompetent patients. The available countermeasures lack robust clinical data and are deployed based on in vitro and animal studies as well as extrapolations from use against other poxviruses. In many cases, despite administration of these available treatments, initiation of antiretroviral therapy (ART), and management of suspected immune reconstitution inflammatory syndrome after initiating ART, patients die. This review summarizes available data, identifies knowledge gaps and proposes recommendations on the management of severe mpox in people living with HIV.
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Affiliation(s)
- Akira A Shishido
- Division of Infectious Diseases, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Stacy Street
- Division of Acute Care Surgical Services, Virginia Commonwealth University, Richmond, Virginia, USA
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13
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Gulinaizhaer A, Yang C, Zou M, Ma S, Fan X, Wu G. Detection of monkeypox virus using helicase dependent amplification and recombinase polymerase amplification combined with lateral flow test. Virol J 2023; 20:274. [PMID: 37996921 PMCID: PMC10668421 DOI: 10.1186/s12985-023-02223-8] [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: 06/20/2023] [Accepted: 10/31/2023] [Indexed: 11/25/2023] Open
Abstract
The monkeypox virus (MPXV) is a zoonotic DNA virus that belongs to the poxvirus family. Conventional laboratory methods for detecting MPXV are complex and expensive, making them unsuitable for detecting the virus in regions with limited resources. In this study, we using the Helicase dependent amplification (HDA) method and the Recombinase polymerase amplification (RPA) technique in combination with the lateral flow test (LFT), together with a self-designed qPCR technique for the detection of the MPXV specific conserved fragment F3L, to compare the sensitivity and specificity of the three assays. By analyzing the sensitivity detection results using Probit, it can be seen that the limit of detection (LOD) of the HDA-LFT detection target is 9.86 copies/µL (95% confidence interval, CI 7.52 copies/µL lower bound), the RPA-LFT detection target is 6.97 copies/µL (95% CI 3.90 copies/µL lower bound), and the qPCR detection target is 479.24 copies/mL (95% CI 273.81 copies/mL lower bound). The specificity test results showed that the specificity of the three methods mentioned above was higher than 90% in detecting pseudoviruses of the same genus of MPXV. The simple, highly sensitive, and specific MPXV assay developed in this study is anticipated to provide a solid foundation for future applications in the early screening, diagnosis, and evaluation of the efficacy of MPXV. This is the first time the HDA-LFT assay has been utilized to detect MPXV infection.
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Affiliation(s)
- Abudushalamu Gulinaizhaer
- Zhongda Hospital, Center of Clinical Laboratory Medicine, Medical School, Southeast University, Nanjing, 210009, People's Republic of China
| | - Chuankun Yang
- Zhongda Hospital, Center of Clinical Laboratory Medicine, Medical School, Southeast University, Nanjing, 210009, People's Republic of China
| | - Mingyuan Zou
- Zhongda Hospital, Center of Clinical Laboratory Medicine, Medical School, Southeast University, Nanjing, 210009, People's Republic of China
| | - Shuo Ma
- Zhongda Hospital, Center of Clinical Laboratory Medicine, Medical School, Southeast University, Nanjing, 210009, People's Republic of China
| | - Xiaobo Fan
- Zhongda Hospital, Center of Clinical Laboratory Medicine, Medical School, Southeast University, Nanjing, 210009, People's Republic of China.
- Diagnostics Department, Medical School of Southeast University, Nanjing, 210009, People's Republic of China.
| | - Guoqiu Wu
- Zhongda Hospital, Center of Clinical Laboratory Medicine, Medical School, Southeast University, Nanjing, 210009, People's Republic of China.
- Diagnostics Department, Medical School of Southeast University, Nanjing, 210009, People's Republic of China.
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Southeast University, Nanjing, 210009, People's Republic of China.
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14
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Duarte-Neto AN, Gonçalves AM, Eliodoro RHDA, Martins WD, Claro IM, Valença IN, Paes VR, Teixeira R, Sztajnbok J, França E Silva ILA, Leite LAF, Malaque CMS, Borges LMS, Gonzalez MP, Barra LAC, Junior LCP, Mello CF, Queiroz W, Atomya AN, Fernezlian SDM, Alves VAF, Leite KRM, Ferreira CR, Saldiva PHN, Mauad T, da Silva LFF, Faria NR, Mendes Corrêa MCJ, Sabino EC, Sotto MN, Dolhnikoff M. Main autopsy findings of visceral involvement by fatal mpox in patients with AIDS: necrotising nodular pneumonia, nodular ulcerative colitis, and diffuse vasculopathy. THE LANCET. INFECTIOUS DISEASES 2023; 23:1218-1222. [PMID: 37827188 DOI: 10.1016/s1473-3099(23)00574-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Amaro Nunes Duarte-Neto
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Ana Maria Gonçalves
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Wilker Dias Martins
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ingra Morales Claro
- Instituto de Medicina Tropical de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Imperial College London, MRC Centre for Global Infectious Disease Analysis, London, UK
| | - Ian Nunes Valença
- Instituto de Medicina Tropical de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Imperial College London, MRC Centre for Global Infectious Disease Analysis, London, UK
| | - Vitor Ribeiro Paes
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Thais Mauad
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; and Serviço de Verificação de Óbitos da Capital, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Nuno R Faria
- Imperial College London, MRC Centre for Global Infectious Disease Analysis, London, UK; University of Oxford, Department of Zoology, Oxford, UK
| | - Maria Cássia Jacinto Mendes Corrêa
- Instituto de Medicina Tropical de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Departamento de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ester Cerdeira Sabino
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Instituto de Medicina Tropical de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Mirian Nacagami Sotto
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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15
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Ramírez-Amador V, Figueroa-Ramos A, Valencia-Mayoral P, Mayo-Rangel A, Anaya-Saavedra G. Clinicopathological and molecular approaches to the diagnosis of oral lesions in Mpox: Case report. Int J STD AIDS 2023; 34:990-993. [PMID: 37464736 DOI: 10.1177/09564624231190422] [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: 07/20/2023]
Abstract
Mpox virus infection (MPXV) has recently been recognized as a public health emergency by the World Health Organization. While several studies have described the clinical characteristics of MPXV-oral lesions, there remains a dearth of information regarding the histological and ultrastructural oral findings. A 24-year-old HIV-positive man presented with a shallow ulcer, covered by a fibrinoid membrane, and surrounded by an erythematous halo in the hard and soft palate. The clinical appearance of the lesion raised suspicion of a viral infection; thus, the diagnosis was based on histological and electronic microscopy findings and confirmed by RT-PCR testing in the skin specimen. This case report aims to offer comprehensive insights into the clinical, histopathological, and ultrastructural features of oral lesions caused by MPXV in an individual with HIV. This report provides valuable information about the characteristics of MPXV infection in the oral mucosa, particularly in people living with HIV.
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Affiliation(s)
- Velia Ramírez-Amador
- Oral Pathology and Medicine Postgraduate Program, Metropolitan Autonomous University, Mexico City, Mexico
| | - Alexia Figueroa-Ramos
- Oral Pathology and Medicine Postgraduate Program, Metropolitan Autonomous University, Mexico City, Mexico
| | | | - Angélica Mayo-Rangel
- Pathology Department, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Gabriela Anaya-Saavedra
- Oral Pathology and Medicine Postgraduate Program, Metropolitan Autonomous University, Mexico City, Mexico
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16
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Derrick KM, Marson JW, Chakka S, Heilman ER. Mpox virus and coinfections: An approach to rapid diagnosis. J Cutan Pathol 2023; 50:878-883. [PMID: 37423617 DOI: 10.1111/cup.14490] [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: 08/16/2022] [Revised: 03/27/2023] [Accepted: 06/13/2023] [Indexed: 07/11/2023]
Abstract
We report a case of a 42-year-old immunocompromised (human immunodeficiency virus [HIV], CD4 count 86 cells/μL) Black male who presented with fever, oropharyngeal candidiasis, and phimosis, followed by eruption of umbilicated papulovesicles most concentrated on the face. The patient was diagnosed with Mpox (MPXV, formerly monkeypox), herpes simplex virus 1 (HSV1), varicella-zoster virus (VZV), and late latent syphilis. Tzanck smear of a Mpox lesion proved a useful and rapidly obtained pertinent negative test, lacking the typical changes of HSV/VZV (multinucleation, margination, and molding). A biopsy specimen showed viral changes consistent with both Mpox (ballooning degeneration and multinucleated keratinocytes) and herpesvirus (multinucleated epithelial giant cell within a zone of follicular necrosis). Lesion PCR was positive for HSV1 and MPXV, and negative for HSV2 and VZV. Immunohistochemistry was positive for VZV and orthopoxvirus. Empiric treatment for HSV/VZV in patients with suspected or confirmed Mpox should be considered for patients with HIV or other immunocompromised patients. It is important to recognize that MPXV, HSV, and VZV may all be present and difficult to distinguish clinically. More than one test modality (PCR, H&E, immunohistochemistry, and Tzanck) and multiple lesion samples may be required to thoroughly evaluate widespread papulovesicular eruptions, especially in immunocompromised patients.
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Affiliation(s)
- Kristina M Derrick
- Department of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Justin W Marson
- Department of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Srita Chakka
- Department of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Edward R Heilman
- Department of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
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17
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Dubey T, Chakole S, Agrawal S, Gupta A, Munjewar PK, Sharma R, Yelne S. Enhancing Nursing Care in Monkeypox (Mpox) Patients: Differential Diagnoses, Prevention Measures, and Therapeutic Interventions. Cureus 2023; 15:e44687. [PMID: 37809174 PMCID: PMC10551575 DOI: 10.7759/cureus.44687] [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: 08/04/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Monkeypox (Mpox), a rare zoonotic viral infection caused by the monkeypox virus, has been gaining attention due to its potential for human-to-human transmission and its clinical resemblance to other poxvirus infections, such as smallpox and chickenpox. Enhancing nursing care for monkeypox patients is imperative to manage and contain its spread effectively. This review analyzes the key aspects of enhancing nursing care in monkeypox patients, focusing on differential diagnoses, prevention measures, and therapeutic interventions. Differential diagnosis is crucial in terms of the early recognition and management of monkeypox. Given its similarity to other poxvirus infections, a thorough assessment of clinical symptoms, travel history, and exposure to potential reservoir hosts is essential. Nursing professionals play a pivotal role in eliciting comprehensive patient histories and relaying this information to the medical team for accurate diagnosis. Prevention measures constitute a vital component of nursing care in monkeypox management. Implementing stringent infection prevention and control practices, including isolation protocols, personal protective equipment (PPE) usage, and hand hygiene, is imperative to curbing nosocomial transmission. Nurses are at the forefront of enforcing these measures, educating patients, families, and healthcare staff about their significance, and ensuring strict adherence. Therapeutic interventions in monkeypox largely focus on supportive care and symptom management. Nurses occupy a central role in administering antiviral medications, providing wound care for skin lesions, and monitoring patients for potential complications such as secondary bacterial infections. Psychosocial support is equally important, as patients often experience fear and anxiety due to the disease's contagious nature. Nursing professionals offer compassionate care, address patients' emotional needs, and facilitate communication between patients and their families. Enhancing nursing care for monkeypox entails a multifaceted approach involving differential diagnoses, prevention measures, and therapeutic interventions. Nursing professionals serve as frontline caregivers, pivotal in early diagnosis, effective prevention strategies, and comprehensive patient management. As the global healthcare community faces an influx of emerging infectious diseases, the lessons learned from managing monkeypox can contribute to the creation of a more resilient and responsive nursing workforce capable of effectively addressing future health challenges.
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Affiliation(s)
- Tanishq Dubey
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swarupa Chakole
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suyash Agrawal
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anannya Gupta
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratiksha K Munjewar
- Medical Surgical Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ranjana Sharma
- Medical Surgical Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Seema Yelne
- Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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18
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Pinto-Pulido EL, Fernández-Parrado M, Rodríguez-Cuadrado FJ. Atypical clinical features of mpox (monkeypox): a diagnostic challenge - Reply. An Bras Dermatol 2023; 98:734-735. [PMID: 37230922 PMCID: PMC10203993 DOI: 10.1016/j.abd.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Affiliation(s)
- Elena Lucía Pinto-Pulido
- Department of Dermatology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Madrid, Spain.
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19
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Miranda MD, Caldas GC, Ferreira VN, Barth OM, da Silva ADPD, Silva MST, Grinsztejn B, Veloso VG, Souza TM, da Silva EE, Barreto-Vieira DF. Monkeypox (Mpox) virus isolation and ultrastructural characterisation from a Brazilian human sample case. Mem Inst Oswaldo Cruz 2023; 118:e230090. [PMID: 37646742 PMCID: PMC10469757 DOI: 10.1590/0074-02760230090] [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: 05/22/2023] [Accepted: 07/17/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND According to the last 2023 Monkeypox (Mpox) Outbreak Global Map from the Centres for Disease Control and Prevention (CDC), more than 100 countries with no Mpox infection report cases. Brazil stands out in this group and is the second country with the highest number of cases in the last outbreak. OBJECTIVE To contribute to knowledge of the virus infection effects in a cellular model, which is important for diagnosis infections not yet included in a provider´s differential diagnosis and for developing viral inhibition strategies. METHODS We describe a virus isolation protocol for a human clinical sample from a patient from Brazil, the viral growth in a cell model through plaque forming units (PFU) assay, reverse transcriptase polymerase chain reaction (RT-PCR) and transmission electron microscopy (TEM). FINDINGS We follow the viral isolation in Vero cell culture from a Mpox positive clinically diagnosed sample and show the infection effects on cellular structures using a TEM. MAIN CONCLUSIONS Understanding the impact of viral growth on cellular structures and its replication kinetics may offer better strategies for the development of new drugs with antiviral properties.
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Affiliation(s)
- Milene Dias Miranda
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Morfologia e Morfogênese Viral, Rio de Janeiro, RJ, Brasil
| | - Gabriela Cardoso Caldas
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Morfologia e Morfogênese Viral, Rio de Janeiro, RJ, Brasil
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Patologia, Rio de Janeiro, RJ, Brasil
| | - Vivian Neuza Ferreira
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Morfologia e Morfogênese Viral, Rio de Janeiro, RJ, Brasil
| | - Ortrud Monika Barth
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Morfologia e Morfogênese Viral, Rio de Janeiro, RJ, Brasil
| | - Aline de Paula Dias da Silva
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Morfologia e Morfogênese Viral, Rio de Janeiro, RJ, Brasil
- Fundação Oswaldo Cruz-Fiocruz, Centro de Desenvolvimento Tecnológico em Saúde, Instituto Nacional de Ciência e Tecnologia de Gestão da Inovação em Doenças Negligenciadas, Rio de Janeiro, RJ, Brasil
| | - Mayara Secco Torres Silva
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Valdiléa Gonçalves Veloso
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brasil
| | - Thiago Moreno Souza
- Fundação Oswaldo Cruz-Fiocruz, Centro de Desenvolvimento Tecnológico em Saúde, Instituto Nacional de Ciência e Tecnologia de Gestão da Inovação em Doenças Negligenciadas, Rio de Janeiro, RJ, Brasil
| | - Edson Elias da Silva
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Vírus Respiratórios, Exantemáticos, Enterovírus e Emergências Virais, Rio de Janeiro, RJ, Brasil
| | - Debora Ferreira Barreto-Vieira
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Morfologia e Morfogênese Viral, Rio de Janeiro, RJ, Brasil
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20
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Maronese CA, Avallone G, Aromolo IF, Spigariolo CB, Quattri E, Ramoni S, Carrera CG, Marzano AV. Mpox: an updated review of dermatological manifestations in the current outbreak. Br J Dermatol 2023; 189:260-270. [PMID: 37146166 DOI: 10.1093/bjd/ljad151] [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: 12/12/2022] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/07/2023]
Abstract
Mpox is a disease caused by a double-stranded DNA orthopoxvirus discovered in 1958. In 2022, an outbreak on an unprecedented scale marked its transition from neglected, zoonotic disease circulating almost exclusively within African borders to sexually transmitted infection (STI) of international concern. Although phylogenetic evidence suggests progressive evolution from the strain associated with the 2018 outbreak in Nigeria, epidemiological links with previous cases have still not been completely elucidated. Clinically, mpox presents with systemic symptoms, such as fever, headache, malaise and a characteristic cutaneous eruption, similar to that of cognate viruses (e.g. smallpox). Mpox pseudopustules evolve through several stages, including umbilication and crusting, and resolve in the span of 2-3 weeks. The hallmarks that set the 2022 outbreak apart from classic mpox were a disproportionate number of cases occurring in men who have sex with men, an often localized cutaneous picture and a significant burden in terms of concomitant STIs. Investigations into the disease pathogenesis, related immune response, clinical and dermoscopic features, in addition to studies aimed at defining novel management strategies, have advanced mpox knowledge considerably. Herein, recent findings on mpox are reviewed, with a keen focus on dermatological manifestations and their implications in the current diagnostic scenario, reinforcing the pivotal role of dermatologists in managing suspect cases and preventing further spread of the contagion.
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Affiliation(s)
- Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Gianluca Avallone
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - Italo Francesco Aromolo
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Cristina Beatrice Spigariolo
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Eleonora Quattri
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Stefano Ramoni
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Giovanni Carrera
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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21
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Schmidle P, Leson S, Wieland U, Böer-Auer A, Metze D, Braun SA. Lives of Skin Lesions in Monkeypox: Histomorphological, Immunohistochemical, and Clinical Correlations in a Small Case Series. Viruses 2023; 15:1748. [PMID: 37632089 PMCID: PMC10458687 DOI: 10.3390/v15081748] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Monkeypox (mpox), a former rare viral zoonosis, has increasingly made it into the public eye since the major outbreak that started in May 2022. Mpox presents with skin lesions that change over time and go through different stages (macular, papular, pustular, and early and late ulceration). In this study, we evaluated skin biopsies of all stages. Therefore, five biopsies from four patients were analyzed histologically, immunohistochemically with anti-Vaccinia virus antibodies, and electron-microscopically. Notably, the early macular stage only showed subtle viropathic changes; it did not express of Orthopoxvirus proteins in immunohistochemistry and therefore can easily be missed histologically. In later stages, immunohistochemistry with anti-Vaccinia virus antibodies might be useful to distinguish mpox from differential diagnoses such as herpes virus infections. In the ulcerative stages, the identified occlusive vasculopathic changes could be an explanation for the severe pain of the lesions reported by some patients. Despite the small number of samples examined, our analysis suggests that the histological findings of mpox are highly dependent on the stage of the biopsied lesion. Therefore, knowledge of all different stages of histology is necessary to reliably diagnose mpox histologically, especially when molecular testing is not available.
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Affiliation(s)
- Paul Schmidle
- Department of Dermatology, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany; (S.L.); (A.B.-A.); (D.M.); (S.A.B.)
| | - Sonja Leson
- Department of Dermatology, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany; (S.L.); (A.B.-A.); (D.M.); (S.A.B.)
| | - Ulrike Wieland
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany;
| | - Almut Böer-Auer
- Department of Dermatology, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany; (S.L.); (A.B.-A.); (D.M.); (S.A.B.)
- Dermatologikum Hamburg, 20354 Hamburg, Germany
| | - Dieter Metze
- Department of Dermatology, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany; (S.L.); (A.B.-A.); (D.M.); (S.A.B.)
| | - Stephan A. Braun
- Department of Dermatology, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany; (S.L.); (A.B.-A.); (D.M.); (S.A.B.)
- Department of Dermatology, Medical Faculty, Heinrich-Heine University, 40225 Duesseldorf, Germany
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Nisar H, Saleem O, Sapna F, Sham S, Perkash RS, Kiran N, Anjali F, Mehreen A, Ram B. A Narrative Review on the Monkeypox Virus: An Ongoing Global Outbreak Hitting the Non-Endemic Countries. Cureus 2023; 15:e43322. [PMID: 37700987 PMCID: PMC10493466 DOI: 10.7759/cureus.43322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/14/2023] Open
Abstract
Monkeypox is a rare zoonotic DNA with lineage from the Poxviridae family, Chordopoxvirinae subfamily, and Orthopoxvirus genus. With a previous history of controlled and contained occasional outbreaks of the virus, currently, a widely erupted outbreak of monkeypox with progressively rising numbers has been reported since May 2022 in multiple countries of the western hemisphere that are not historically endemic for this infection, particularly the United Kingdom and European Union countries. We have written a comprehensive review article to help clinicians better understand the disease. The global cessation of smallpox vaccination has been hypothesized to cause the rise in monkeypox infections in recent years. Monkeypox, like any other viral infection, commences with prodromal symptoms; a maculopapular rash with centrifugal distribution usually follows. Polymerase chain reaction (PCR) confirms the diagnosis. Transmission in humans is possible through infected animals or humans. In the ongoing 2022 outbreak, the monkeypox virus has been undergoing novel mutations at an alarming rate. Treatment options for monkeypox are an area that still requires extensive research, and the utility of certain antiviral medications in treating monkeypox infection is currently being explored but is still controversial and debatable.
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Affiliation(s)
- Hira Nisar
- Nephrology, Sindh Institute of Urology and Transplantation, Karachi, PAK
- Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Omer Saleem
- Otolaryngology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Fnu Sapna
- Pathology, Montefiore Medical Center, Wakefield Campus, New York, USA
| | - Sunder Sham
- Pathology and Laboratory Medicine, Lenox Hill Hospital, New York City, USA
| | | | - Nfn Kiran
- Pathology, Staten Island University Hospital, New York, USA
| | - Fnu Anjali
- Internal Medicine, Sakhi Baba General Hospital, Pano Akil, PAK
| | - Ansa Mehreen
- Pathology and Laboratory Medicine, University of Chicago Pritzker School of Medicine, Evanston, USA
| | - Bebu Ram
- Pathology, University at Buffalo, Buffalo, USA
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23
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Moltrasio C, Boggio FL, Romagnuolo M, Cagliani R, Sironi M, Di Benedetto A, Marzano AV, Leone BE, Vergani B. Monkeypox: A Histopathological and Transmission Electron Microscopy Study. Microorganisms 2023; 11:1781. [PMID: 37512953 PMCID: PMC10385849 DOI: 10.3390/microorganisms11071781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
The global outbreak of human monkeypox virus (hMPXV1) in 2022 highlighted the usefulness of dermatological manifestations for its diagnosis. Infection by the human monkeypox virus thus necessitated inclusion in the diagnostic repertoire of dermatopathology. To assess the histopathological and microscopical findings of cutaneous lesions related to hMPXV infection, we analyzed skin biopsies from patients with positive MPXV DNA polymerase chain reaction presenting with a typical course of hMPXV1 infection. The most prominent histopathological findings were ascribable to a pustular stage in which epidermal necrosis with areas of non-viable keratinocytes and a "shadow cell" appearance were evident; in some cases, the deep portion of the hair follicle and the acrosyringial epithelium were affected. The main cytopathic modifications included ballooning keratinocytes, followed by Guarnieri bodies and a ground glass appearance of the keratinocytes' nuclei, together with a dense mixed inflammatory cell infiltrate with prominent neutrophil exocytosis. Transmission electron microscopy analysis demonstrated viral particle aggregates in the cytoplasm of keratinocytes, without any involvement of the nucleus. Interestingly, we also found the presence of viral particles in infected mesenchymal cells, although to a lesser extent than in epithelial cells. Through this study, we contributed to expanding the histological and microscopic knowledge of the human mpox virus, a key step to understanding current and potential future trends of the disease, as well as of other Orthopoxvirus infections.
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Affiliation(s)
- Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Francesca Laura Boggio
- Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Maurizio Romagnuolo
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, 20122 Milan, Italy
| | - Rachele Cagliani
- Scientific Institute IRCCS E. MEDEA, Bioinformatics, 23842 Bosisio Parini, Italy
| | - Manuela Sironi
- Scientific Institute IRCCS E. MEDEA, Bioinformatics, 23842 Bosisio Parini, Italy
| | - Alessandra Di Benedetto
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, 20122 Milan, Italy
| | - Biagio Eugenio Leone
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Barbara Vergani
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
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