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Acharya A, Kumar N, Singh K, Byrareddy SN. "Mpox in MSM: Tackling Stigma, Minimizing Risk Factors, Exploring Pathogenesis, and Treatment Approaches". Biomed J 2024:100746. [PMID: 38734408 DOI: 10.1016/j.bj.2024.100746] [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: 11/20/2023] [Revised: 04/07/2024] [Accepted: 05/05/2024] [Indexed: 05/13/2024] Open
Abstract
Mpox is a zoonotic disease caused by the monkeypox virus (MPV), primarily found in Central and West African countries. The typical presentation of the disease before the 2022 mpox outbreak includes a febrile prodrome 5-13 days post-exposure, accompanied by lymphadenopathy, malaise, headache, and muscle aches. Unexpectedly, during the 2022 outbreak, several cases of atypical presentations of the disease were reported, such as the absence of prodromal symptoms and the presence of genital skin lesions suggestive of sexual transmission. As per the World Health Organization (WHO), as of March 20, 2024, 94,707 cases of mpox were reported worldwide, resulting in 181 deaths (22 in African endemic regions and 159 in non-endemic countries). The United States Centers for Disease Control and Prevention (CDC) reports a total of 32,063 cases (33.85% of total cases globally), with 58 deaths (32.04% of global deaths) due to mpox. Person-to-person transmission of mpox can occur through respiratory droplets and sustained close contact. However, during the 2022 outbreak of mpox, a high incidence of anal and perianal lesions among MSMs indicated sexual transmission of MPV as a major route of transmission. Since MSMs are disproportionately at risk for HIV transmission, this review discusses the risk factors, transmission patterns, pathogenesis, vaccine, and treatment options for mpox among MSM and people living with HIV (PLWH). Furthermore, we provide a brief perspective on the evolution of the MPV in immunocompromised people like PLWH.
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Affiliation(s)
- Arpan Acharya
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Narendra Kumar
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kamal Singh
- Department of Veterinary Pathobiology, College of Veterinary Medicine, and Bond Life Sciences Center, University of Missouri, Columbia, Missouri, USA
| | - Siddappa N Byrareddy
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA; Department of Genetics, Cell Biology and Anatomy, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA; Department of Biochemistry and Molecular Biology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
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Zelencik S, VanDine A, Campos-Bovee M, Goitia K, Cela V, Walblay K, Galanto D, Pacilli M, Kim DY, Black SR. Health Care Personnel Exposure Risk Assessment and Management During a Mpox Outbreak in Chicago, Illinois, 17 May to 8 July 2022. J Infect Dis 2024; 229:S207-S212. [PMID: 38019754 DOI: 10.1093/infdis/jiad531] [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: 07/31/2023] [Revised: 11/17/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023] Open
Abstract
This report summarizes risk assessment interviews and follow-up with health care personnel (HCP) after exposure to patients with mpox disease during 17 May to 8 July 2022. HCP-case interactions were assessed using a standard questionnaire to categorize the risk associated with patient encounters. We assessed 150 interactions among 142 HCP and 30 cases. Four (2.7%) interactions were defined as high risk, 5 (3.3%) intermediate, 107 (71.3%) low, and 31 (20.7%) no risk. High and intermediate exposures were offered postexposure prophylaxis; 4 accepted. No documented mpox transmission after exposure was identified. These findings suggest transmission risk in health care settings during routine patient care is low.
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Affiliation(s)
- Shane Zelencik
- Chicago Department of Public Health, Chicago, Illinois, USA
| | - Alison VanDine
- Chicago Department of Public Health, Chicago, Illinois, USA
| | | | | | - Valbona Cela
- Chicago Department of Public Health, Chicago, Illinois, USA
| | - Kelly Walblay
- Chicago Department of Public Health, Chicago, Illinois, USA
| | - Daniel Galanto
- Chicago Department of Public Health, Chicago, Illinois, USA
| | | | - Do Young Kim
- Chicago Department of Public Health, Chicago, Illinois, USA
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3
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McLean J, Gunaratne S, Zucker J. Update on Mpox: What the Primary Care Clinician Should Know. Med Clin North Am 2024; 108:355-371. [PMID: 38331485 PMCID: PMC10853636 DOI: 10.1016/j.mcna.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Mpox is a viral infection, which primarily caused sporadic outbreaks in West and Central Africa until causing a global epidemic in 2022. The disease has disproportionately affected people with human immunodeficiency virus and men who have sex with men. Transmission is through close physical contact, including sexual contact. Infection presents with a characteristic rash, with frequent anogenital involvement-polymerase chain reaction of skin lesions is diagnostic. Vaccination is available for primary prevention and postexposure prophylaxis. Treatment consists of supportive care, with antiviral medications available via clinical trials and/or for patients with severe disease.
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Affiliation(s)
- Jacob McLean
- Division of Infectious Diseases, Columbia University Medical Center, 630 W 168th Street, Suite 876, New York, NY 10032, USA.
| | - Shauna Gunaratne
- Division of Infectious Diseases, Columbia University Medical Center, 630 W 168th Street, Suite 876, New York, NY 10032, USA
| | - Jason Zucker
- Division of Infectious Diseases, Columbia University Medical Center, 630 W 168th Street, Suite 876, New York, NY 10032, USA
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Zebardast A, Latifi T, Shafiei-Jandaghi NZ, Gholami Barzoki M, Shatizadeh Malekshahi S. Plausible reasons for the resurgence of Mpox (formerly Monkeypox): an overview. Trop Dis Travel Med Vaccines 2023; 9:23. [PMID: 38143281 PMCID: PMC10749502 DOI: 10.1186/s40794-023-00209-6] [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: 05/29/2023] [Accepted: 09/28/2023] [Indexed: 12/26/2023] Open
Abstract
Poxviruses are large and diversified viruses that cause an emerging zoonotic disease known as monkeypox (mpox). In the past, mpox predominated primarily in the rural rainforests of Central and West Africa. Recently, the exportation of mpoxv from Africa to other continents has been progressively reported. However, the lack of travel history to Africa in most of the currently reported cases in 2022 promotes the sign of changing epidemiology of this disease. Concerns over the geographic distribution and continued resurgence of mpox is growing. In this review, we addressed the geographic distribution, transmission, reasons for the resurgence of mpox, and vaccination. Although the precise cause of the resurgence in mpox cases is mostly unknown, several suggested factors are believed to be waning immunity, accumulation of unvaccinated people, ecological conditions, risk behaviors of men who have sex with men, and genetic evolution.
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Affiliation(s)
- Arghavan Zebardast
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Tayebeh Latifi
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mehdi Gholami Barzoki
- Department of Virology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Taha AM, Katamesh BE, Hassan AR, Abdelwahab OA, Rustagi S, Nguyen D, Silva-Cajaleon K, Rodriguez-Morales AJ, Mohanty A, Bonilla-Aldana DK, Sah R. Environmental detection and spreading of mpox in healthcare settings: a narrative review. Front Microbiol 2023; 14:1272498. [PMID: 38179458 PMCID: PMC10764434 DOI: 10.3389/fmicb.2023.1272498] [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: 08/04/2023] [Accepted: 11/16/2023] [Indexed: 01/06/2024] Open
Abstract
Monkeypox virus (MPXV), which causes Monkeypox (Mpox), has recently been found outside its usual geographic distribution and has spread to 117 different nations. The World Health Organization (WHO) designated the epidemic a Public Health Emergency of International Concern (PHEIC). Humans are at risk from MPXV's spread, which has raised concerns, particularly in the wake of the SARS-CoV-2 epidemic. The risk of virus transmission may rise due to the persistence of MPXV on surfaces or in wastewater. The risk of infection may also increase due to insufficient wastewater treatment allowing the virus to survive in the environment. To manage the infection cycle, it is essential to investigate the viral shedding from various lesions, the persistence of MPXV on multiple surfaces, and the length of surface contamination. Environmental contamination may contribute to virus persistence and future infection transmission. The best possible infection control and disinfection techniques depend on this knowledge. It is thought to spread mainly through intimate contact. However, the idea of virus transmission by environmental contamination creates great concern and discussion. There are more cases of environmental surfaces and wastewater contamination. We will talk about wastewater contamination, methods of disinfection, and the present wastewater treatment in this review as well as the persistence of MPXV on various environmental surfaces.
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Affiliation(s)
- Amira Mohamed Taha
- Faculty of Medicine, Fayoum University, Fayoum, Egypt
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, United States
| | - Basant E. Katamesh
- Faculty of Medicine, Tanta University, Tanta, Egypt
- Mayo Clinic, Rochester, MN, United States
| | | | - Omar Ahmed Abdelwahab
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, United States
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun, India
| | - Dang Nguyen
- Massachusetts General Hospital, Corrigan Minehan Heart Center and Harvard Medical School, Boston, MA, United States
| | | | - Alfonso J. Rodriguez-Morales
- Faculty of Environmental Sciences, Universidad Científica del Sur, Lima, Peru
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de lasAméricas-Institución Universitaria Visión de las Américas, Pereira, Colombia
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Aroop Mohanty
- Department of Clinical Microbiology, All India Institute of Medical Sciences, Gorakhpur, India
| | | | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Kathmandu, Nepal
- Department of Clinical Microbiology, DY Patil Medical College, Hospital and Research Centre, DY Patil Vidyapeeth, Pune, India
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Parikh T, Goti A, Yashi K, Dankhara N, Kadam S, Dihora R, Paiwal K, Parmar N. Monkeypox in humans: Transmission, pathophysiology, diagnosis, treatment, prevention, and all recent updates. World J Clin Infect Dis 2023; 13:31-36. [DOI: 10.5495/wjcid.v13.i4.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/21/2023] [Accepted: 10/23/2023] [Indexed: 11/22/2023] Open
Abstract
The Centers for Disease Control and Prevention (CDC) is monitoring an epidemic of monkeypox infection in the United States. The outbreak is now global and more than 6900 cases have already been reported. There are 83 confirmed cases among children and adolescents, as shown in the report published on November 3, 2022, in the USA. However, monkeypox in pediatric patients is still infrequent (< 0.3% of total cases). Among cases in the United States, 16 cases were in children < 5 years, 12 in the age group 5-12 years, and 55 cases in adolescents 13-17 years old. In the adolescent age group, 89% were male. For children < 12 years of age, close physical contact with an adult household with monkeypox was the primary exposure, but for adolescents, male-to-male sexual contact was found more frequently. The CDC advised United States healthcare providers to remain vigilant for patients with a rash resembling monkeypox, even if there is no history of travel to a country with high risk. This article summarizes the history and epidemiology of monkeypox with a specific emphasis on clinical features and management in pediatric patients.
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Affiliation(s)
- Taral Parikh
- Department of Pediatrics, Hamilton Health Center, Harrisburg, PA 17104, United States
| | - Ashish Goti
- Department of Pediatric, Tulane Medical Center, New Orleans, LA 70112, United States
| | - Kanica Yashi
- Adult Medicine, Bassett Medical Center, Cooperstown, NY 13326, United States
| | - Nilesh Dankhara
- Department of Pediatric and Neonatology, University of Mississippi Medical Center, Jackson, MS 39216, United States
| | - Sandhya Kadam
- Department of Pediatric, Family Healthcare Network, Visalia, CA 93277, United States
| | - Ramesh Dihora
- Department of Pediatric, Nice Children Hospital, Surat 395003, India
| | - Kapil Paiwal
- Oral Maxillofacial Surgeon, Daswani Dental College and Research Center, Kota 324005, India
| | - Narendrasinh Parmar
- Department of Pediatrics, Brookdale University Hospital Medical Center, Brooklyn, NY 11212, United States
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7
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Carugno A, Parietti M, Ciccarese G, Campanati A, Diotallevi F, Atzori L, Balestri R, Caccavale S, Bellinato F, Benatti SV, Venturelli S, Vezzoli P, Sena P, Papini M. Clinical-epidemiological aspects of the Monkeypox 2022 epidemic: A multicentre study by the Italian SIDeMaST Group of Sexually Transmitted, Infectious and Tropical Diseases. J Eur Acad Dermatol Venereol 2023; 37:e1277-e1279. [PMID: 37328930 DOI: 10.1111/jdv.19265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/09/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Andrea Carugno
- Dermatology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
- Ph.D. Program in Molecular and Translational Medicine (DIMET), University of Milan-Bicocca, Milan, Italy
| | | | - Giulia Ciccarese
- Unit of Dermatology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Anna Campanati
- Department of Clinical and Molecular Sciences-Dermatological Clinic, Polytechnic Marche University, Ancona, Italy
| | - Federico Diotallevi
- Department of Clinical and Molecular Sciences-Dermatological Clinic, Polytechnic Marche University, Ancona, Italy
| | - Laura Atzori
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Stefano Caccavale
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Bellinato
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | | | | | - Pamela Vezzoli
- Dermatology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Sena
- Dermatology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Manuela Papini
- Department of Medicine and Surgery, University of Perugia, Dermatology Clinic of Terni, Terni, Italy
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Decousser JW, Romano-Bertrand S, Aho Glele LS, Baron R, Carre Y, Cassier P, Dananche C, Depaix-Champagnac F, Fournier S, Racaud J, Rogues AM, Tamames C, Keita-Perse O, Parneix P, Lavigne T. Healthcare worker protection against mpox contamination: position paper of the French Society for Hospital Hygiene. J Hosp Infect 2023; 140:156-164. [PMID: 37562588 DOI: 10.1016/j.jhin.2023.08.004] [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: 06/25/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
In the context of the recent re-emergence of mpox worldwide, the French Society for Hospital Hygiene (SF2H) performed a literature review of the transmission paths and proposed specific recommendations for healthcare workers (HCWs) caring for patients with suspected or confirmed MPXV. In developed countries, the risk of contamination among HCWs in healthcare facilities seemed to be very low, limited to contamination through needle stick injuries. Two additional contamination cases were reported and not fully explained. Beyond healthcare settings, the analysis of the literature highlighted (i) a main contamination route during sexual intercourse, mainly among men who have sex with men, and (ii) a very low secondary attack rate in other contexts, such as schools or jails. Numerous studies have reported molecular or virus identification on surfaces or in the air surrounding patients, without any association with the low secondary case incidence; moreover, the minimum infectious dose through air or mucosal exposure is still unknown. Owing to the lack of evidence of MPXV respiratory transmission in the healthcare setting, the SF2H recommends the implementation of standard and contact precautions combined with medical/surgical mask use. Owing to the lack of evidence of transcutaneous contamination, the SF2H recommends the use of gloves only if contact with cutaneous lesions or mucous membranes occurs. Regarding the risk of contamination from the environment in healthcare facilities, additional studies must be conducted to investigate this.
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Affiliation(s)
- J-W Decousser
- Equipe Opérationnelle d'Hygiène, Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris, UR DYNAMYC 7380, Faculté de Santé, Univ Paris-Est Créteil (UPEC), Enva, USC ANSES, Créteil, France.
| | - S Romano-Bertrand
- HydroSciences Montpellier, IRD, CNRS, Montpellier University, Hospital Hygiene and Infection Control Department, University Hospital of Montpellier, Montpellier, France
| | - L S Aho Glele
- Epidémiologie et hygiène hospitalière, Centre Hospitalo-Universitaire de Dijon, hôpital d'enfants, Dijon, France
| | - R Baron
- Service Hygiène Hospitalière, Pôle Recherche et Santè Publique, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Y Carre
- CHU de Bordeaux, Pôle de Santé Publique, Infection Control Unit, Bordeaux, France
| | - P Cassier
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, Institut des Agents Infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - C Dananche
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, Service Hygiène, épidémiologie, infectiovigilance et prévention Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| | | | - S Fournier
- Service Prévention du risque infectieux, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - J Racaud
- Service de lutte des infections nosocomiales, Centre Hospitalier Alpes-Leman, Contamine-sur-Arve, France
| | - A-M Rogues
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, CHU Bordeaux, Hygiene Hospitalière, Bordeaux, France
| | - C Tamames
- Service de Prévention et contrôle de l'infection, site Pitié Salpêtrière, Paris, France
| | - O Keita-Perse
- Service d'Epidémiologie et d'Hygiène Hospitalière, Centre Hospitalier Princesse Grace, Monaco
| | - P Parneix
- Nouvelle Aquitaine Healthcare-Associated Infection Control Centre, Bordeaux University Hospital, Bordeaux, France
| | - T Lavigne
- Service d'Hygiène Hospitalière, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Safir A, Safir M, Henig O, Nahari M, Halutz O, Levytskyi K, Mizrahi M, Yakubovsky M, Adler A, Ben-Ami R, Sprecher E, Dekel M. Nosocomial transmission of MPOX virus to health care workers -an emerging occupational hazard: A case report and review of the literature. Am J Infect Control 2023; 51:1072-1076. [PMID: 36736902 PMCID: PMC9891803 DOI: 10.1016/j.ajic.2023.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 02/04/2023]
Abstract
We present an unusual case of monkeypox (MPOX) virus transmission to a dermatology resident during examination of affected patients. Viral DNA sequencing led to the identification of the most likely contact. This case, along with a review of all published cases so far, emphasizes the possible hazard of MPOX transmission to health care personnel, even when wearing personal protective equipment. It also emphasizes the need for maintaining high index of suspicion when examining patients with new dermatological lesions and strict compliance with the revised Centers for Disease Control and Prevention recommendations for specimen collection from such patients.
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Affiliation(s)
- Ari Safir
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.
| | - Margarita Safir
- Ophthalmology Department, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Oryan Henig
- Infection Prevention and Control unit, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel- Aviv, Israel
| | - Meital Nahari
- Infection Prevention and Control unit, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ora Halutz
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Katia Levytskyi
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Michal Mizrahi
- Department of Emergency Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel- Aviv, Israel
| | - Michal Yakubovsky
- Department of Infectious diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel- Aviv, Israel
| | - Amos Adler
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel- Aviv, Israel
| | - Ronen Ben-Ami
- Department of Infectious diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel- Aviv, Israel
| | - Eli Sprecher
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel- Aviv, Israel
| | - Michal Dekel
- Department of Infectious diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel- Aviv, Israel
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Saied AA, Chandran D, Chakraborty S, Emran TB, Dhama K. Mpox and healthcare workers — a minireview of our present knowledge. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2023; 35:46. [DOI: 10.1186/s43162-023-00233-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/14/2023] [Indexed: 09/01/2023] Open
Abstract
Abstract
Introduction
Workers in the healthcare industry form the backbone of health systems everywhere. In the face of global health crises like the current monkeypox (mpox) outbreak, healthcare workers like doctors, dentists, pharmacists, nurses, midwives, paramedics, administrators, support staff, laboratory technicians, and community health workers all play crucial roles in providing care and containing the spread of the disease.
Aim
Therefore, in the wake of concerns about mpox recurrence, we seek to shed light on the occupational transmission of mpox infection and the possible risk to healthcare personnel.
Results
Contamination of the environment of the household of cases of mpox and environment of the patient care units with the viral DNA has been reported besides asymptomatic cases and detection of viral DNA in air samples; therefore, more research on non-lesion-based testing for human mpox infection for screening asymptomatic people, particularly among populations at high risk of infection, in the event of asymptomatic transmission and potential transmission via aerosols is necessary. Monitoring efforts can be aided by incorporating mpox testing into locations where people are more likely to contract illnesses and seek medical attention. We must take a precautionary infection control approach to control the spread of the virus while completing urgent research to understand better the human-to-human mpox transmission process.
Conclusions
In this minireview, we discuss the potential routes of mpox transmission to healthcare and preventative strategies and measures that should be taken and considered.
Graphical Abstract
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11
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Silva SJRD, Kohl A, Pena L, Pardee K. Clinical and laboratory diagnosis of monkeypox (mpox): Current status and future directions. iScience 2023; 26:106759. [PMID: 37206155 PMCID: PMC10183700 DOI: 10.1016/j.isci.2023.106759] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
The emergence and rapid spread of the monkeypox virus (MPXV) to non-endemic countries has brought this once obscure pathogen to the forefront of global public health. Given the range of conditions that cause similar skin lesions, and because the clinical manifestation may often be atypical in the current mpox outbreak, it can be challenging to diagnose patients based on clinical signs and symptoms. With this perspective in mind, laboratory-based diagnosis assumes a critical role for the clinical management, along with the implementation of countermeasures. Here, we review the clinical features reported in mpox patients, the available laboratory tests for mpox diagnosis, and discuss the principles, advances, advantages, and drawbacks of each assay. We also highlight the diagnostic platforms with the potential to guide ongoing clinical response, particularly those that increase diagnostic capacity in low- and middle-income countries. With the outlook of this evolving research area, we hope to provide a resource to the community and inspire more research and the development of diagnostic alternatives with applications to this and future public health crises.
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Affiliation(s)
| | - Alain Kohl
- MRC-University of Glasgow Centre for Virus Research, Glasgow G61 1QH, UK
| | - Lindomar Pena
- Department of Virology, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), 50670-420 Recife, Pernambuco, Brazil
| | - Keith Pardee
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto ON M5S 3M2, Canada
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto ON M5S 3G8, Canada
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12
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ALAKUŞ TB. Prediction of Monkeypox on the Skin Lesion with the Siamese Deep Learning Model. BALKAN JOURNAL OF ELECTRICAL AND COMPUTER ENGINEERING 2023; 11:225-231. [DOI: 10.17694/bajece.1255798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
One of the viral diseases that started to cause concern in various parts of the world after the COVID-19 pandemic is the monkeypox virus, which has recently emerged. The virus, which was known in previous years and mostly seen in the Western and Central parts of the African continent, has recently begun to affect different human populations in different ways. Monkeypox is transmitted to humans from an animal infected with the virus or from another human being infected with monkeypox. Among the most basic symptoms are high fever, back and muscle aches, chills, and blisters on the skin. These blisters seen on the skin are sometimes confused with chickenpox and measles, and this causes the diagnosis and, accordingly, the treatment process to be wrong. Therefore, the need for computer-aided systems has increased and the need for more robust and reliable approaches has arisen. In this study, using the deep learning model, the distinction of the blisters seen in the body was made and it was decided whether the disease was monkeypox or another disease (chickenpox and measles). The study consisted of three stages. In the first stage, data were obtained and images of both chickenpox and other diseases were used. In the second stage, the Siamese deep learning model was used, and data were classified. In the last stage, the performance of the classifier was evaluated and accordingly accuracy, precision, recall, F1-score, and confusion matrix were used. At the end of the study, an accuracy score of 91.09% was obtained. This result showed that the developed deep learning-based model can be used in this field.
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Nayak T, Chadaga K, Sampathila N, Mayrose H, Gokulkrishnan N, Bairy G M, Prabhu S, S SK, Umakanth S. Deep learning based detection of monkeypox virus using skin lesion images. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2023; 18:100243. [PMID: 37293134 PMCID: PMC10236906 DOI: 10.1016/j.medntd.2023.100243] [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: 03/07/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023] Open
Abstract
As we set into the second half of 2022, the world is still recovering from the two-year COVID-19 pandemic. However, over the past three months, the outbreak of the Monkeypox Virus (MPV) has led to fifty-two thousand confirmed cases and over one hundred deaths. This caused the World Health Organisation to declare the outbreak a Public Health Emergency of International Concern (PHEIC). If this outbreak worsens, we could be looking at the Monkeypox virus causing the next global pandemic. As Monkeypox affects the human skin, the symptoms can be captured with regular imaging. Large samples of these images can be used as a training dataset for machine learning-based detection tools. Using a regular camera to capture the skin image of the infected person and running it against computer vision models is beneficial. In this research, we use deep learning to diagnose monkeypox from skin lesion images. Using a publicly available dataset, we tested the dataset on five pre-trained deep neural networks: GoogLeNet, Places365-GoogLeNet, SqueezeNet, AlexNet and ResNet-18. Hyperparameter was done to choose the best parameters. Performance metrics such as accuracy, precision, recall, f1-score and AUC were considered. Among the above models, ResNet18 was able to obtain the highest accuracy of 99.49%. The modified models obtained validation accuracies above 95%. The results prove that deep learning models such as the proposed model based on ResNet-18 can be deployed and can be crucial in battling the monkeypox virus. Since the used networks are optimized for efficiency, they can be used on performance limited devices such as smartphones with cameras. The addition of explainable artificial intelligence techniques LIME and GradCAM enables visual interpretation of the prediction made, helping health professionals using the model.
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Affiliation(s)
- Tushar Nayak
- Department of Biomedical Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Krishnaraj Chadaga
- Department of Computer Science and Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Niranjana Sampathila
- Department of Biomedical Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Hilda Mayrose
- Department of Biomedical Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Nitila Gokulkrishnan
- Department of Biomedical Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Muralidhar Bairy G
- Department of Biomedical Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Srikanth Prabhu
- Department of Computer Science and Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Swathi K S
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Shashikiran Umakanth
- Department of Medicine, Dr. T.M.A. Pai Hospital, Manipal Academy of Higher Education, Udupi, Karnataka, 576101, India
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14
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Ullah M, Li Y, Munib K, Zhang Z. Epidemiology, host range, and associated risk factors of monkeypox: an emerging global public health threat. Front Microbiol 2023; 14:1160984. [PMID: 37213509 PMCID: PMC10196482 DOI: 10.3389/fmicb.2023.1160984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/27/2023] [Indexed: 05/23/2023] Open
Abstract
Based on recent multiregional epidemiological investigations of Monkeypox (MPX), on 24 July 2022, the World Health Organization declared it a global public health threat. Retrospectively MPX was an ignored zoonotic endemic infection to tropical rainforest regions of Western and Central African rural communities until a worldwide epidemic in May 2022 verified the potential threat of monkeypox virus (MPXV) to be propagated across the contemporary world via transnational tourism and animal movements. During 2018-2022, different cases of MPX diagnosed in Nigerian travelers have been documented in Israel, the United Kingdom, Singapore, and the United States. More recently, on 27 September 2022, 66,000 MPX cases have been confirmed in more than 100 non-endemic countries, with fluctuating epidemiological footprinting from retrospective epidemics. Particular disease-associated risk factors fluctuate among different epidemics. The unpredicted appearance of MPX in non-endemic regions suggests some invisible transmission dynamic. Hence, broad-minded and vigilant epidemiological attention to the current MPX epidemic is mandatory. Therefore, this review was compiled to highlight the epidemiological dynamic, global host ranges, and associated risk factors of MPX, concentrating on its epidemic potential and global public health threat.
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Affiliation(s)
- Munib Ullah
- State Key Laboratory of Veterinary Etiological Biology, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China
- Department of Clinical Studies, Faculty of Veterinary and Animal Sciences, PMAS-Arid Agriculture University Rawalpindi, Rawalpindi, Pakistan
| | - Yanmin Li
- College of Animal Husbandry and Veterinary Medicine, Southwest Minzu University, Chengdu, China
| | - Kainat Munib
- Department of Sociology, Allama Iqbal Open University Islamabad, Islamabad, Pakistan
| | - Zhidong Zhang
- College of Animal Husbandry and Veterinary Medicine, Southwest Minzu University, Chengdu, China
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15
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Teo CT, Wu JS, Chan K, Ng SWB, Somani J, Loh W. What does the anesthesiologist need to know about monkeypox? Can J Anaesth 2023; 70:893-900. [PMID: 36899136 PMCID: PMC10005856 DOI: 10.1007/s12630-023-02441-2] [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: 07/20/2022] [Revised: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 03/12/2023] Open
Abstract
PURPOSE Monkeypox (or "mpox" as preferred by the World Health Organization) is an emerging infectious disease with sustained global transmission occurring outside of West Africa and the Democratic Republic of Congo. The recent 2022 mpox outbreak has involved widespread atypical presentations. Infected patients requiring surgery can increase the exposure of health care professionals and other patients to the virus. As it is a relatively new infectious disease internationally, there is less familiarity in managing this risk, especially in the surgical and anesthesia setting. This paper aims to provide information about mpox and how to manage suspected or confirmed cases. SOURCE Various authorities such as the World Health Organization, Infection Prevention and Control Canada, Public Health Agency of Canada, the Centers for Disease Control and Prevention (USA), and the National Centre for Infectious Diseases (Singapore) have recommended that public health and hospital systems prepare to recognize, isolate, and care for suspected and confirmed cases appropriately, as well as manage any possible exposure of staff and patients. PRINCIPAL FINDINGS Local authorities and hospitals should set up protocols for health care providers (HCPs) to minimize nosocomial transmission and risk to HCPs. Antivirals used in patients with more severe disease may cause renal or hepatic impairment and thus anesthetic drug pharmacology. Anesthesiologists and surgeons should be able to recognize mpox, and work with local infection control and epidemiologic programs to familiarize themselves with relevant infection prevention guidelines. CONCLUSION Essential measures include clear protocols for transferring and managing surgical patients who are suspected or confirmed to be infected with the virus. Care in use of personal protective equipment and handling contaminated material is necessary to prevent inadvertent exposure. Risk stratification after exposure should be done to determine need for post-exposure prophylaxis for staff.
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Affiliation(s)
- Chao Tong Teo
- Department of Anesthesia, National University Hospital, Singapore, Singapore.
- Department of Anesthesia, National University Hospital, Level 3, Main Building, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
| | - Jiawei Sean Wu
- Division of Infectious Diseases, National University Hospital, Singapore, Singapore
| | - Karen Chan
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Su Wei Bryan Ng
- Department of Anesthesia, National University Hospital, Singapore, Singapore
| | - Jyoti Somani
- Division of Infectious Diseases, National University Hospital, Singapore, Singapore
- National University Hospital, Singapore, Singapore
| | - Will Loh
- Department of Anesthesia, National University Hospital, Singapore, Singapore
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16
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Pinto P, Costa MA, Gonçalves MFM, Rodrigues AG, Lisboa C. Mpox Person-to-Person Transmission-Where Have We Got So Far? A Systematic Review. Viruses 2023; 15:v15051074. [PMID: 37243160 DOI: 10.3390/v15051074] [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: 03/28/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
The recent multi-country outbreak of Mpox (Monkeypox disease) constituted a public health emergency. Although animal-to-human transmission is known to be the primary way of transmission, an increasing number of cases transmitted by person-to-person contact have been reported. During the recent Mpox outbreak sexual or intimate contact has been considered the most important way of transmission. However, other routes of transmission must not be ignored. The knowledge of how the Monkeypox Virus (MPXV) spreads is crucial to implement adequate measures to contain the spread of the disease. Therefore, this systematic review aimed to collect scientific data published concerning other implicated sources of infection beyond sexual interaction, such as the involvement of respiratory particles, contact with contaminated surfaces and skin-to-skin contact. The current study was performed using the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Publications analyzing contacts of Mpox index cases and their outcome after contact were included. A total of 7319 person-to-person contacts were surveyed and 273 of them became positive cases. Positive secondary transmission of MPXV was verified after contact with people cohabiting in the same household, with family members, with healthcare workers, or within healthcare facilities, and sexual contact or contact with contaminated surfaces. Using the same cup, sharing the same dishes, and sleeping in the same room or bed were also positively associated with transmission. Five studies showed no evidence of transmission despite contact with surfaces, skin-to-skin contact, or through airway particles within healthcare facilities where containment measures were taken. These records support the case for person-to-person transmission and suggest that other types of contact beyond sexual contact pose a significant risk of acquiring the infection. Further investigation is crucial to elucidate MPXV transmission dynamics, and to implement adequate measures to contain the spread of the infection.
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Affiliation(s)
- Pedro Pinto
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Miguel Alves Costa
- Department of Dermatology and Venereology, Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Porto, Portugal
| | - Micael F M Gonçalves
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Acácio Gonçalves Rodrigues
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Centre for Health Technology and Services Research/Rede de Investigação em Saúde (CINTESIS@RISE), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Carmen Lisboa
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Centre for Health Technology and Services Research/Rede de Investigação em Saúde (CINTESIS@RISE), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Dermatology and Venereology, University Hospital Centre of São João, 4200-319 Porto, Portugal
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17
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Amer F, Khalifa HES, Elahmady M, ElBadawy NE, Zahran WA, Abdelnasser M, Rodríguez-Morales AJ, Wegdan AA, Tash RME. Monkeypox: Risks and Approaches to Prevention. J Infect Public Health 2023; 16:901-910. [PMID: 37062165 PMCID: PMC10074767 DOI: 10.1016/j.jiph.2023.04.001] [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: 10/14/2022] [Revised: 03/24/2023] [Accepted: 04/02/2023] [Indexed: 04/08/2023] Open
Abstract
Since early May 2022, an outbreak due to Mpox virus (formerly called monkeypox) has occurred in many countries around the world. On July 23, the World Health Organization declared the outbreak ‘Public Health Emergency of International Concern’. In order to combat the outbreak, it is important to have effective infection prevention and control plans. The first step is to qualitatively and quantitatively determine the risks of infections, followed by the design and implementation of infection prevention and control measures. Mpox is transmitted through direct, indirect, and prolonged contact, through sexual transmission, and via the respiratory route. Men who have sex with men are identified as the most vulnerable population. Home pet-raisers, and health care workers are at risk of catching the disease. The outcome of infection is catastrophic among the elderly, immunocompromised individuals, pregnant female and children. The spillover to animals is of great concern. It is important to communicate the risks and have community engagement in the control of this outbreak. The availability of vaccines will add to the capability of containing the outbreak. It is critical to prevent the virus from spreading further. Hence, we review the recent findings on the risk management of Mpox along with the preventive strategies.
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Affiliation(s)
- Fatma Amer
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt; Executive Committee member International Society for Antimicrobial Chemotherapy (ISAC); Viral Infection Working Group/International Society for Antimicrobial Chemotherapy (ISAC).
| | - Hend E S Khalifa
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt; Microbiology and Immunology, Qatar Armed Forces Hospital, Qatar
| | - Mohammed Elahmady
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt; Microbiology laboratory, Al Ahli Hospital, Doha, Qatar
| | - Nissreen E ElBadawy
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Wafaa Ahmed Zahran
- Medical Microbiology and Immunology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Moustafa Abdelnasser
- Microbiology and Immunology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Alfonso J Rodríguez-Morales
- Faculty of Health Sciences, Universidad Científica del Sur, Lima 15067, Peru; Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut 1102, Lebanon
| | - Ahmed A Wegdan
- Microbiology and Immunology Department, Faculty of Medicine, El-Fayoum University, El-Fayoum, Egypt
| | - Rehab M Elsaid Tash
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt; Viral Infection Working Group/International Society for Antimicrobial Chemotherapy (ISAC)
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18
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Salcedo RM, Madariaga MG. Monkeypox (hMPXV Infection): A Practical Review. Am J Med 2023; 136:234-243. [PMID: 36495937 PMCID: PMC9729686 DOI: 10.1016/j.amjmed.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 12/13/2022]
Abstract
Monkeypox, a neglected disease previously confined to Africa, is causing a worldwide outbreak affecting predominantly males who have sex with males, especially those who are infected with HIV. The clinical presentation during the current outbreak differs from endemic cases. Treatment with tecovirimat and other antivirals is available. Immunization may be used as preexposure and postexposure prophylaxis.
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Affiliation(s)
| | - Miguel G Madariaga
- Physician Manager, Infectious Disease Associates of Naples, Naples, Fla.
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19
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Clinical features and outcome of human Mpox (Monkeypox) in Saudi Arabia: An observational study of travel-related cases. J Infect Public Health 2023; 16:341-345. [PMID: 36680849 PMCID: PMC9838079 DOI: 10.1016/j.jiph.2023.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/28/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The 2022 Monkeypox virus (Mpox) outbreak had involved multiple countries around the globe. Here, we report clinical features and outcome of human Mpox of the first cases in Saudi Arabia. METHODS We obtained records of confirmed Mpox cases in Saudi Arabia from the public electronic health information system, Health Electronic Surveillance Network (HESN) and the healthcare providers completed a de-identified structured clinical data collection form. RESULTS The reported seven cases were travel-related and all were males between 24 and 41 years of age (mean age + SD) was 30.14 (+ 6.69) years. Of the cases, three (43 %) had heterosexual contact and the others had other intimate encounters while traveling abroad. They presented with skin lesions (100 %), fever (86 %), and lymphadenopathy (71 %). The illness was mild to moderate, did not require antiviral medications, and lasted 7-15 days. The mean duration of skin rash (+ SD) was 10 (+ 2.68) days. Routine laboratory tests (CBC, BUN, serum electrolytes, and liver enzymes) were within normal limits, and initial screening for HIV was negative. Expanded contact tracing did not reveal secondary cases of Mpox in the community or the healthcare setting. CONCLUSION The current study showed heterosexual transmission of Mpox and the clinical course was mild and non-complicated. Therefore, clinicians and public health professionals should consider Mpox among individuals presenting with skin rash especially in the context of the investigation of HIV and other sexually transmitted diseases.
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20
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Catala A, Riera J, Fuertes I. [Translated article] Mpox - Formerly Monkey Pox - in Dermatology: A Review of Epidemiologic Features, Clinical Presentation, Diagnosis, and Treatment. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T318-T326. [PMID: 36848956 PMCID: PMC9972588 DOI: 10.1016/j.ad.2023.02.012] [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: 11/23/2022] [Accepted: 01/08/2023] [Indexed: 02/27/2023] Open
Abstract
Mpox is an emerging zoonotic disease that has spread rapidly around the world. It has been declared a public health emergency of international concern by the World Health Organization. This review is an update for dermatologists on the epidemiology, clinical presentation, diagnosis, and treatment of Mpox. The primary mode of transmission in the current outbreak is close physical contact during sexual activity. Although most of the initial cases were reported in men who have sex with men, anyone who has close contact with an infected person or contaminated fomites is at risk. Classic prodromal features of Mpox include subclinical manifestations and a mild rash. Complications are common but rarely require hospitalization. Polymerase chain reaction analysis of mucocutaneous lesions is the test of choice for a definitive diagnosis. In the absence of specific treatments, management focuses on symptomatic relief.
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Affiliation(s)
- A Catala
- Servicio de Dermatología y Venereología, Hospital Clínic, Barcelona, Spain.
| | - J Riera
- Servicio de Dermatología y Venereología, Hospital Clínic, Barcelona, Spain
| | - I Fuertes
- Servicio de Dermatología y Venereología, Hospital Clínic, Barcelona, Spain
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21
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Ford ES, Papanicolaou GA, Dadwal SS, Pergam S, Spallone A. Frequently Asked Questions about Mpox (Formerly Monkeypox Disease) for Hematopoietic Cell Transplantation and Chimeric Antigen Receptor T Cell Recipients from the American Society for Transplantation and Cellular Therapy. Transplant Cell Ther 2023; 29:289-292. [PMID: 36746374 PMCID: PMC9899127 DOI: 10.1016/j.jtct.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023]
Affiliation(s)
- Emily S Ford
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington; Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | | | - Sanjeet S Dadwal
- Division of Infectious Diseases, City of Hope National Medical Center, Duarte, California
| | - Steve Pergam
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington; Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Amy Spallone
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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22
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Pan D, Nazareth J, Sze S, Martin CA, Decker J, Fletcher E, Déirdre Hollingsworth T, Barer MR, Pareek M, Tang JW. Transmission of monkeypox/mpox virus: A narrative review of environmental, viral, host, and population factors in relation to the 2022 international outbreak. J Med Virol 2023; 95:e28534. [PMID: 36708091 PMCID: PMC10107822 DOI: 10.1002/jmv.28534] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/05/2022] [Accepted: 01/24/2023] [Indexed: 01/29/2023]
Abstract
Monkeypox virus (MPXV) has spread globally. Emerging studies have now provided evidence regarding MPXV transmission, that can inform rational evidence-based policies and reduce misinformation on this topic. We aimed to review the evidence on transmission of the virus. Real-world studies have isolated viable viruses from high-touch surfaces for as long as 15 days. Strong evidence suggests that the current circulating monkeypox (mpox) has evolved from previous outbreaks outside of Africa, but it is yet unknown whether these mutations may lead to an inherently increased infectivity of the virus. Strong evidence also suggests that the main route of current MPXV transmission is sexual; through either close contact or directly, with detection of culturable virus in saliva, nasopharynx, and sperm for prolonged periods and the presence of rashes mainly in genital areas. The milder clinical presentations and the potential presence of presymptomatic transmission in the current circulating variant compared to previous clades, as well as the dominance of spread amongst men who have sex with men (MSMs) suggests that mpox has a developed distinct clinical phenotype that has increased its transmissibility. Increased public awareness of MPXV transmission modalities may lead to earlier detection of the spillover of new cases into other groups.
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Affiliation(s)
- Daniel Pan
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
- Department of Infectious Diseases and HIV MedicineUniversity Hospitals of Leicester NHS TrustLeicesterUK
- Li Ka Shing Centre for Health Information and Discovery, Big Data InstituteUniversity of OxfordOxfordUK
- NIHR Leicester Biomedical Research CentreLiecesterUK
| | - Joshua Nazareth
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
- Department of Infectious Diseases and HIV MedicineUniversity Hospitals of Leicester NHS TrustLeicesterUK
- NIHR Leicester Biomedical Research CentreLiecesterUK
| | - Shirley Sze
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
| | - Christopher A. Martin
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
- Department of Infectious Diseases and HIV MedicineUniversity Hospitals of Leicester NHS TrustLeicesterUK
- NIHR Leicester Biomedical Research CentreLiecesterUK
| | - Jonathan Decker
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
| | - Eve Fletcher
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
| | - T. Déirdre Hollingsworth
- Li Ka Shing Centre for Health Information and Discovery, Big Data InstituteUniversity of OxfordOxfordUK
| | - Michael R. Barer
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
- Department of Clinical MicrobiologyUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | - Manish Pareek
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
- Department of Infectious Diseases and HIV MedicineUniversity Hospitals of Leicester NHS TrustLeicesterUK
- NIHR Leicester Biomedical Research CentreLiecesterUK
| | - Julian W. Tang
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
- Department of VirologyUniversity Hospitals of Leicester NHS TrustLeicesterUK
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23
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Català A, Riera J, Fuertes I. Mpox - Formerly Monkey Pox - in Dermatology: A Review of Epidemiologic Features, Clinical Presentation, Diagnosis, and Treatment. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:318-326. [PMID: 36682683 PMCID: PMC9854265 DOI: 10.1016/j.ad.2023.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/27/2022] [Accepted: 01/08/2023] [Indexed: 01/22/2023] Open
Abstract
Mpox is an emerging zoonotic disease that has spread rapidly around the world. It has been declared a public health emergency of international concern by the World Health Organization. This review is an update for dermatologists on the epidemiology, clinical presentation, diagnosis, and treatment of Mpox. The primary mode of transmission in the current outbreak is close physical contact during sexual activity. Although most of the initial cases were reported in men who have sex with men, anyone who has close contact with an infected person or contaminated fomites is at risk. Classic prodromal features of Mpox include subclinical manifestations and a mild rash. Complications are common but rarely require hospitalization. Polymerase chain reaction analysis of mucocutaneous lesions is the test of choice for a definitive diagnosis. In the absence of specific treatments, management focuses on symptomatic relief.
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24
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Mitjà O, Ogoina D, Titanji BK, Galvan C, Muyembe JJ, Marks M, Orkin CM. Monkeypox. Lancet 2023; 401:60-74. [PMID: 36403582 PMCID: PMC9671644 DOI: 10.1016/s0140-6736(22)02075-x] [Citation(s) in RCA: 148] [Impact Index Per Article: 148.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/12/2022] [Accepted: 10/19/2022] [Indexed: 11/19/2022]
Abstract
Monkeypox is a zoonotic illness caused by the monkeypox virus, an Orthopoxvirus in the same genus as the variola, vaccinia, and cowpox viruses. Since the detection of the first human case in the Democratic Republic of the Congo in 1970, the disease has caused sporadic infections and outbreaks, mainly restricted to some countries in west and central Africa. In July, 2022, WHO declared monkeypox a Public Health Emergency of International Concern, on account of the unprecedented global spread of the disease outside previously endemic countries in Africa and the need for global solidarity to address this previously neglected disease. The 2022 outbreak has been primarily associated with close intimate contact (including sexual activity) and most cases have been diagnosed among men who have sex with men, who often present with novel epidemiological and clinical characteristics. In the 2022 outbreak, the incubation period ranges from 7 days to 10 days and most patients present with a systemic illness that includes fever and myalgia and a characteristic rash, with papules that evolve to vesicles, pustules, and crusts in the genital, anal, or oral regions and often involve the mucosa. Complications that require medical treatment (eg, antiviral therapy, antibacterials, and pain control) occur in up to 40% of patients and include rectal pain, odynophagia, penile oedema, and skin and anorectal abscesses. Most patients have a self-limited illness; between 1% and 13% require hospital admission (for treatment or isolation), and the case-fatality rate is less than 0·1%. A diagnosis can be made through the presence of Orthopoxvirus DNA in PCRs from lesion swabs or body fluids. Patients with severe manifestations and people at risk of severe disease (eg, immunosuppressed people) could benefit from antiviral treatment (eg, tecovirimat). The current strategy for post-exposure prophylaxis or pre-exposure prophylaxis for people at high risk is vaccination with the non-replicating modified vaccinia Ankara. Antiviral treatment and vaccines are not yet available in endemic countries in Africa.
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Affiliation(s)
- Oriol Mitjà
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections section, Hospital Universitari Germans Trías i Pujol, Badalona, Spain; Fight Infectious Diseases Foundation, Badalona, Spain; School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea.
| | - Dimie Ogoina
- Department of Internal Medicine, Infectious Diseases Unit, Niger Delta University and Niger Delta University Teaching Hospital, Bayelsa, Nigeria
| | - Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA; Medecins du Cameroun (Medcamer), Yaoundé, Cameroon
| | | | - Jean-Jacques Muyembe
- Institut National de Recherche Biomedicale, Kinshasa, Democratic Republic of the Congo
| | - Michael Marks
- London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, University College London Hospital, London, UK; Division of Infection and Immunology, University College London, London, UK
| | - Chloe M Orkin
- Centre for Immunobiology, Blizard Institute, Queen Mary University, London, UK
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Phelippeau M, Loison G, Rucay P, Le Guillou-Guillemette H, Ndiaye D, Dubée V, Legeay C. Fortuitous diagnosis of monkeypox in a patient hospitalized for several days: risk assessment and follow-up for exposed healthcare workers. J Hosp Infect 2023; 131:244-246. [PMID: 36379369 PMCID: PMC9652207 DOI: 10.1016/j.jhin.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Affiliation(s)
- M. Phelippeau
- Infectious and Tropical Diseases Department, Angers University Hospital, Angers, France
| | - G. Loison
- Infection Control and Prevention Team, Angers University Hospital, Angers, France
| | - P. Rucay
- Occupational Health Services, Angers University Hospital, Angers, France
| | | | - D. Ndiaye
- Infectious and Tropical Diseases Department, Angers University Hospital, Angers, France
| | - V. Dubée
- Infectious and Tropical Diseases Department, Angers University Hospital, Angers, France
| | - C. Legeay
- Infection Control and Prevention Team, Angers University Hospital, Angers, France,Corresponding author. Address: Infection Control and Prevention Team, Angers University Hospital, Angers, France. Tel.: +33 2 41 35 49 36; fax: +33 2 41 35 53 18
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26
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Kaufman AR, Chodosh J, Pineda R. Monkeypox Virus and Ophthalmology-A Primer on the 2022 Monkeypox Outbreak and Monkeypox-Related Ophthalmic Disease. JAMA Ophthalmol 2023; 141:78-83. [PMID: 36326768 DOI: 10.1001/jamaophthalmol.2022.4567] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Importance An ongoing global monkeypox virus outbreak in 2022 includes the US and other nonendemic countries. Monkeypox ophthalmic manifestations may present to the ophthalmologist, or the ophthalmologist may be involved in comanagement. This narrative review creates a primer for the ophthalmologist of clinically relevant information regarding monkeypox, its ophthalmic manifestations, and the 2022 outbreak. Observations Monkeypox virus is an Orthopoxvirus (genus includes variola [smallpox] and vaccinia [smallpox vaccine]). The 2022 outbreak is of clade II (historically named West African clade), specifically subclade IIb. In addition to historic transmission patterns (skin lesions, bodily fluids, respiratory droplets), sexual transmission has also been theorized in the current outbreak due to disproportionate occurrence in men who have sex with men. Monkeypox causes a characteristic skin eruption and mucosal lesions and may cause ophthalmic disease. Monkeypox-related ophthalmic disease (MPXROD) includes a spectrum of ocular pathologies including eyelid/periorbital skin lesions, blepharoconjunctivitis, and keratitis). Smallpox vaccination may reduce MPXROD occurrence. MPXROD seems to be rarer in the 2022 outbreaks than in historical outbreaks. MPXROD may result in corneal scarring and blindness. Historical management strategies for MPXROD include lubrication and prevention/management of bacterial superinfection in monkeypox keratitis. Case reports and in vitro data for trifluridine suggest a possible role in MPXROD. Tecovirimat, cidofovoir, brincidofovir and vaccinia immune globulin intravenous may be used for systemic infection. There is a theoretical risk for monkeypox transmission by corneal transplantation, and the Eye Bank Association of America has provided guidance. Smallpox vaccines (JYNNEOS [Bavarian Nordic] and ACAM2000 [Emergent Product Development Gaithersburg Inc]) provide immunity against monkeypox. Conclusions and Relevance The ophthalmologist may play an important role in the diagnosis and management of monkeypox. MPXROD may be associated with severe ocular and visual morbidity. As the current outbreak evolves, up-to-date guidance from public health organizations and professional societies are critical.
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Affiliation(s)
- Aaron R Kaufman
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston.,Department of Ophthalmology & Visual Sciences, University of New Mexico School of Medicine, Albuquerque
| | - Roberto Pineda
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
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27
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Shenoy ES, Wright SB, Barbeau DN, Foster LA, King AD, Gordon PS, Mehrotra P, Pepe DE, Caroff DA, Kim LR, McGrath SE, Courtney A, Fahy M, Hooper DC, Macdonald K, Searle EF, Shearer JA, Zachary KC, Bouton L, Cumming M, Hopkins B, Jacoboski J, Mann E, Osborne M, Perez C, Schultz J, Scotland S, Traphagen E, Madoff LC, Brown CM. Contact Tracing and Exposure Investigation in Response to the First Case of Monkeypox Virus Infection in the United States During the 2022 Global Monkeypox Outbreak. Ann Intern Med 2022; 175:1639-1647. [PMID: 36343347 DOI: 10.7326/m22-2721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In May 2022, the first case of monkeypox virus (MPXV) infection in the United States in the current global outbreak was identified. As part of the public health and health care facility response, a contact tracing and exposure investigation was done. OBJECTIVE To describe the contact tracing, exposure identification, risk stratification, administration of postexposure prophylaxis (PEP), and exposure period monitoring for contacts of the index patient, including evaluation of persons who developed symptoms possibly consistent with MPXV infection. DESIGN Contact tracing and exposure investigation. SETTING Multiple health care facilities and community settings in Massachusetts. PARTICIPANTS Persons identified as contacts of the index patient. INTERVENTION Contact notification, risk stratification, and symptom monitoring; PEP administration in a subset of contacts. MEASUREMENTS Epidemiologic and clinical data collected through standard surveillance procedures at each facility and then aggregated and analyzed. RESULTS There were 37 community and 129 health care contacts identified, with 4 at high risk, 49 at intermediate risk, and 113 at low or uncertain risk. Fifteen health care contacts developed symptoms during the monitoring period. Three met criteria for MPXV testing, with negative results. Two community contacts developed symptoms. Neither met criteria for MPXV testing, and neither showed disease progression consistent with monkeypox. Among 4 persons with high-risk exposures offered PEP, 3 elected to receive PEP. Among 10 HCP with intermediate-risk exposures for which PEP was offered as part of informed clinical decision making, 2 elected to receive PEP. No transmissions were identified at the conclusion of the 21-day monitoring period, despite the delay in recognition of monkeypox in the index patient. LIMITATION Descriptions of exposures are subject to recall bias, which affects risk stratification. CONCLUSION In a contact tracing investigation involving 166 community and health care contacts of a patient with monkeypox, no secondary cases were identified. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Erica S Shenoy
- Harvard Medical School and Regional Emerging Special Pathogens Treatment Center, Infection Control Unit, and Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (E.S.S., K.C.Z.)
| | - Sharon B Wright
- Harvard Medical School and Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, and Division of Infection Prevention and Control, Beth Israel Lahey Health, Cambridge, Massachusetts (S.B.W.)
| | - Deborah N Barbeau
- Harvard T. H. Chan School of Public Health and Employee Health Management, Beth Israel Deaconess Medical Center, Boston, and Occupational and Environmental Health Network, Marlborough, Massachusetts (D.N.B.)
| | - Lisa A Foster
- Employee Health Department, Beth Israel Lahey Health, Burlington, Massachusetts (L.A.F.)
| | - Aleah D King
- Division of Infection Prevention and Control, Beth Israel Lahey Health, Cambridge, Massachusetts (A.D.K.)
| | - Patrick S Gordon
- Division of Infection Control/Hospital Epidemiology, Silverman Institute for Health Care Quality and Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts (P.S.G.)
| | - Preeti Mehrotra
- Harvard Medical School, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, and Division of Infection Control/Hospital Epidemiology, Silverman Institute for Health Care Quality and Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts (P.M., D.E.P.)
| | - Dana E Pepe
- Harvard Medical School, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, and Division of Infection Control/Hospital Epidemiology, Silverman Institute for Health Care Quality and Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts (P.M., D.E.P.)
| | - Daniel A Caroff
- Tufts University School of Medicine, Boston, and Division of Hospital Epidemiology and Infection Prevention and Division of Infectious Diseases, Lahey Hospital and Medical Center, Burlington, Massachusetts (D.A.C.)
| | - Lindsey R Kim
- Division of Hospital Epidemiology and Infection Prevention, Lahey Hospital and Medical Center, Burlington, Massachusetts (L.R.K., S.E.M.)
| | - Shannon E McGrath
- Division of Hospital Epidemiology and Infection Prevention, Lahey Hospital and Medical Center, Burlington, Massachusetts (L.R.K., S.E.M.)
| | - Amy Courtney
- Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts (A.C.)
| | - Meredith Fahy
- Regional Emerging Special Pathogens Treatment Center and Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts (M.F.)
| | - David C Hooper
- Harvard Medical School, Infection Control Unit and Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (D.C.H.)
| | - Kaitlin Macdonald
- Occupational Health Services, Mass General Brigham, Boston, Massachusetts (K.M.)
| | - Eileen F Searle
- Regional Emerging Special Pathogens Treatment Center and Center for Disaster Medicine, Massachusetts General Hospital, Boston, Massachusetts (E.F.S.)
| | - Jennifer A Shearer
- Center for Disaster Medicine, Massachusetts General Hospital, and Department of Emergency Preparedness and Business Continuity, Mass General Brigham, Boston, Massachusetts (J.A.S.)
| | - Kimon C Zachary
- Harvard Medical School and Regional Emerging Special Pathogens Treatment Center, Infection Control Unit, and Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (E.S.S., K.C.Z.)
| | - Lindsay Bouton
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts (L.B., M.C., B.H., J.J., E.M., M.O., C.P., J.S., S.S., E.T., C.M.B.)
| | - Melissa Cumming
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts (L.B., M.C., B.H., J.J., E.M., M.O., C.P., J.S., S.S., E.T., C.M.B.)
| | - Brandi Hopkins
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts (L.B., M.C., B.H., J.J., E.M., M.O., C.P., J.S., S.S., E.T., C.M.B.)
| | - Juliana Jacoboski
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts (L.B., M.C., B.H., J.J., E.M., M.O., C.P., J.S., S.S., E.T., C.M.B.)
| | - Erin Mann
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts (L.B., M.C., B.H., J.J., E.M., M.O., C.P., J.S., S.S., E.T., C.M.B.)
| | - Matthew Osborne
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts (L.B., M.C., B.H., J.J., E.M., M.O., C.P., J.S., S.S., E.T., C.M.B.)
| | - Carley Perez
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts (L.B., M.C., B.H., J.J., E.M., M.O., C.P., J.S., S.S., E.T., C.M.B.)
| | - Jordan Schultz
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts (L.B., M.C., B.H., J.J., E.M., M.O., C.P., J.S., S.S., E.T., C.M.B.)
| | - Sarah Scotland
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts (L.B., M.C., B.H., J.J., E.M., M.O., C.P., J.S., S.S., E.T., C.M.B.)
| | - Elizabeth Traphagen
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts (L.B., M.C., B.H., J.J., E.M., M.O., C.P., J.S., S.S., E.T., C.M.B.)
| | - Lawrence C Madoff
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, and Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts (L.C.M.)
| | - Catherine M Brown
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts (L.B., M.C., B.H., J.J., E.M., M.O., C.P., J.S., S.S., E.T., C.M.B.)
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28
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Ogoina D, Ogunsola FT. Monkeypox and the health-care environment. THE LANCET. MICROBE 2022; 3:e889-e890. [PMID: 36215985 PMCID: PMC9546517 DOI: 10.1016/s2666-5247(22)00286-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Dimie Ogoina
- Department of Internal Medicine, Infectious Diseases Unit, Niger Delta University/Niger Delta University Teaching Hospital, Bayelsa PMB 100, Nigeria
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29
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Marshall KE, Barton M, Nichols J, de Perio MA, Kuhar DT, Spence-Davizon E, Barnes M, Herlihy RK, Czaja CA. Health care personnel exposures to subsequently laboratory-confirmed monkeypox patients - Colorado, 2022. Am J Transplant 2022; 22:2699-2703. [PMID: 36346086 DOI: 10.1111/ajt.16681] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kristen E Marshall
- Colorado Department of Public Health and Environment.,Career Epidemiology Field Officer Program, CDC
| | - Marlee Barton
- Colorado Department of Public Health and Environment
| | | | | | | | | | - Meghan Barnes
- Colorado Department of Public Health and Environment
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30
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Cacoub P, Halfon P. [Monkeypox virus infection]. Rev Med Interne 2022; 43:637-639. [PMID: 36333007 PMCID: PMC9623426 DOI: 10.1016/j.revmed.2022.10.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 06/07/2023]
Affiliation(s)
- P Cacoub
- UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), UPMC Université Paris 06, Sorbonne Universités, 75005 Paris, France; Inserm, UMR_S 959, 75013, Paris, France; CNRS, FRE3632, 75005 Paris, France; Department of Internal Medicine and Clinical Immunology, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
| | - P Halfon
- Pôle de médecine interne et maladies infectieuses, hôpital européen, 13000 Marseille, France; Laboratoire Alphabio, 13000 Marseille, France
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31
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Carvalho LB, Casadio LVB, Polly M, Nastri AC, Turdo AC, de Araujo Eliodoro RH, Sabino EC, Levin AS, de Proença ACT, Higashino HR. Monkeypox Virus Transmission to Healthcare Worker through Needlestick Injury, Brazil. Emerg Infect Dis 2022; 28:2334-2336. [PMID: 36121391 PMCID: PMC9622260 DOI: 10.3201/eid2811.221323] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We describe monkeypox virus (MPXV) transmission from a patient to a healthcare worker through needlestick injury. A lesion appeared at the inoculation site 5 days after injury. Blood tested MPXV-positive by PCR before symptoms worsened; blood remained MPXV-positive at discharge 19 days after symptom onset. Postexposure prophylaxis could prevent potential MPXV bloodborne transmission.
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32
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Jeyaraman M, Selvaraj P, Halesh MB, Jeyaraman N, Nallakumarasamy A, Gupta M, Maffulli N, Gupta A. Monkeypox: An Emerging Global Public Health Emergency. LIFE (BASEL, SWITZERLAND) 2022; 12:life12101590. [PMID: 36295025 PMCID: PMC9604746 DOI: 10.3390/life12101590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022]
Abstract
The virus causing monkeypox, a rare zoonotic viral disease, belongs to the Poxviridae family and the Orthopoxvirus genus. On 23 July 2022, the World Health Organization (WHO) declared the monkeypox outbreak as a Public Health Emergency of International Concern (PHEIC). From May to July 2022, a multi-country outbreak of monkeypox was reported in both endemic and non-endemic regions. Major goals of managing monkeypox are to identify the suspected cases, detect generic orthopoxvirus DNA at a state or commercial laboratory, and establish the Centers for Disease Control and Prevention real-time polymerase chain reaction testing. Currently, there are no approved treatments for monkeypox virus infection. However, a variety of antiviral medications originally designed for the treatment of smallpox and other viral infections could be considered. Pre-exposure prophylaxis for laboratory and health care employees and post-exposure prophylaxis for individuals with high-risk or intermediate-risk exposures are to be considered. The CDC Emergency Operations Center is available for advice on the appropriate use of medical countermeasures, and can help in obtaining antiviral drugs and vaccines from the National Strategic Stockpile. This review gives an overview of the global scenario, clinical presentation, and management of monkeypox in the light of a global public health emergency.
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Affiliation(s)
- Madhan Jeyaraman
- Department of Orthopaedics, Faculty of Medicine, Sri Lalithambigai Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai 600095, Tamil Nadu, India
- South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX 78045, USA
| | - Preethi Selvaraj
- Department of Community Medicine, Faculty of Medicine, Sri Lalithambigai Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai 600095, Tamil Nadu, India
| | | | - Naveen Jeyaraman
- Department of Orthopaedics, Atlas Hospitals, Tiruchirappalli 620002, Tamil Nadu, India
| | - Arulkumar Nallakumarasamy
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India
| | - Manu Gupta
- Polar Aesthetics Dental & Cosmetic Center, Noida 201301, Uttar Pradesh, India
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, 84084 Fisciano, Italy
- San Giovanni di Dio e Ruggi D’Aragona Hospital “Clinica Ortopedica” Department, Hospital of Salerno, 84124 Salerno, Italy
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4DG, UK
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent ST5 5BG, UK
- Correspondence: (N.M.); (A.G.)
| | - Ashim Gupta
- South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX 78045, USA
- BioIntegrate, Lawrenceville, GA 30043, USA
- Future Biologics, Lawrenceville, GA 30043, USA
- Regenerative Orthopaedics, Noida 201301, Uttar Pradesh, India
- Correspondence: (N.M.); (A.G.)
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33
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Hasan S, Saeed S. Monkeypox Disease: An Emerging Public Health Concern in the Shadow of COVID-19 Pandemic: An Update. Trop Med Infect Dis 2022; 7:tropicalmed7100283. [PMID: 36288024 PMCID: PMC9607171 DOI: 10.3390/tropicalmed7100283] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
The last few decades have witnessed an appalling rise in several emerging and re-emerging viral and zoonotic outbreaks. Such outbreaks are a lesson to learn from and seek insight into better disease monitoring and surveillance, thus preventing future outbreaks. Monkeypox, a viral zoonotic illness caused by the monkeypox virus, may no longer be endemic to the tropical rainforests of Central and West Africa. However, the current monkeypox outbreak in nonendemic countries is most likely due to failure to curb the disease dissemination in endemic African regions despite decades of constant outbreaks. The clinical manifestations are typified by a prodromal phase (fever, myalgia, malaise, and lymphadenopathy) followed by maculopapular or vesicular, or pustular cutaneous eruptions that eventually form encrustations and peel off. Children and the elderly, pregnant females, and individuals living with comorbidities (diabetes, HIV/AIDS, and lymphoproliferative ailments) are at a high risk of severe disease. Monkeypox is a self-limiting disorder, but its complications and pandemic potential signify its immense public health relevance. The recent ongoing monkeypox outbreak in nonendemic nations areas was identified with increased propensity in men who have sex with men (MSMs) with no travel history to endemic regions, emphasizing the changing trends in disease transmission. This review article provides an updated overview of the monkeypox disease taxonomy, pathogenesis, transmission, epidemiology, clinical and oral features, diagnostic aids, differential diagnosis, preventive aspects, and treatment protocol.
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Affiliation(s)
- Shamimul Hasan
- Department of Oral Medicine and Radiology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi 110025, India
| | - Shazina Saeed
- Amity Institute of Public Health, Amity University, Noida 201313, India
- Correspondence:
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34
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Sah R, Mohanty A, Singh P, Abdelaal A, Padhi BK. Monkeypox and occupational exposure: Potential risk toward healthcare workers and recommended actions. Front Public Health 2022; 10:1023789. [PMID: 36225764 PMCID: PMC9548554 DOI: 10.3389/fpubh.2022.1023789] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 09/05/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- Ranjit Sah
- Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal,Harvard Medical School, Boston, MA, United States,*Correspondence: Ranjit Sah ;
| | - Aroop Mohanty
- Department of Microbiology, All India Institute of Medical Sciences, Gorakhpur, India
| | - Parul Singh
- Department of Microbiology, All India Institute of Medical Sciences, Gorakhpur, India
| | - Abdelaziz Abdelaal
- Harvard Medical School, Boston, MA, United States,Bachelor of Medicine, Bachelor of Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India,Bijaya Kumar Padhi
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35
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Ilic I, Zivanovic Macuzic I, Ilic M. Global Outbreak of Human Monkeypox in 2022: Update of Epidemiology. Trop Med Infect Dis 2022; 7:tropicalmed7100264. [PMID: 36288005 PMCID: PMC9609983 DOI: 10.3390/tropicalmed7100264] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 01/18/2023] Open
Abstract
Background: Human monkeypox was a neglected zoonotic disease considered endemic to rainforests of rural parts of Central and Western Africa, until a global outbreak in May 2022. Methods: This review describes the epidemiological characteristics of human monkeypox. Results: Since the first confirmed case in the United Kingdom on 13 May 2022, and up until 19 September, more than 62,000 cases of human monkeypox were reported in 104 countries in the world (among them 97 countries where the monkeypox virus was not endemic). Up to today, 20 persons have died in this global outbreak. This outbreak predominantly affects men self-identifying as gay or bisexual or other men who have sex with men, and for now, there is no sign of continuous transmission of the disease in other populations. Today, the monkeypox outbreak is increasing alarmingly in many countries and presents a new challenge and a large issue for public health worldwide. The World Health Organization declared the global monkeypox outbreak a public health emergency of international concern on 24 July 2022. Before this outbreak, health professionals in many countries had a knowledge gap and a lack of experience in the management of monkeypox. Conclusions: Advances in the comprehension of the epidemiology of human monkeypox are necessary for effective prevention and outbreak response.
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Affiliation(s)
- Irena Ilic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Correspondence: ; Tel.: +381-11-3636300
| | - Ivana Zivanovic Macuzic
- Department of Anatomy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Milena Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
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36
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Marshall KE, Barton M, Nichols J, de Perio MA, Kuhar DT, Spence-Davizon E, Barnes M, Herlihy RK, Czaja CA. Health Care Personnel Exposures to Subsequently Laboratory-Confirmed Monkeypox Patients — Colorado, 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:1216-1219. [PMID: 36136939 PMCID: PMC9531564 DOI: 10.15585/mmwr.mm7138e2] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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37
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Menezes YR, Miranda ABD. Severe disseminated clinical presentation of monkeypox virus infection in an immunosuppressed patient: first death report in Brazil. Rev Soc Bras Med Trop 2022; 55:e0392. [PMID: 36037315 PMCID: PMC9425919 DOI: 10.1590/0037-8682-0392-2022] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/12/2022] [Indexed: 11/22/2022] Open
Abstract
Since May 2022, the number of monkeypox virus infections has sharply increased in countries where the disease has not been previously endemic. At present, most reports refer to low-severity cases. Herein, we present a severe case of the disease with disseminated skin lesions that progressed to death in an immunosuppressed patient in Belo Horizonte, Minas Gerais, Brazil.
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Affiliation(s)
- Yargos Rodrigues Menezes
- Fundação Hospitalar do Estado de Minas Gerais, Hospital Eduardo de Menezes, Programa de Residência Médica em Dermatologia, Belo Horizonte, MG, Brasil
| | - Alexandre Braga de Miranda
- Fundação Hospitalar do Estado de Minas Gerais, Hospital Eduardo de Menezes, Programa de Residência Médica em Infectologia, Belo Horizonte, MG, Brasil
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Basgoz N, Brown CM, Smole SC, Madoff LC, Biddinger PD, Baugh JJ, Shenoy ES. Case 24-2022: A 31-Year-Old Man with Perianal and Penile Ulcers, Rectal Pain, and Rash. N Engl J Med 2022; 387:547-556. [PMID: 35704401 DOI: 10.1056/nejmcpc2201244] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Nesli Basgoz
- From the Departments of Medicine (N.B., E.S.S.), Infectious Diseases (N.B., E.S.S.), and Emergency Medicine (P.D.B., J.J.B.) and the Infection Control Unit (E.S.S.), Massachusetts General Hospital, the Departments of Medicine (N.B., E.S.S.) and Emergency Medicine (P.D.B., J.J.B.), Harvard Medical School, and the Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health (C.M.B., S.C.S., L.C.M.), Boston, and the Department of Medicine, University of Massachusetts Chan Medical School, Worcester (L.C.M.) - all in Massachusetts
| | - Catherine M Brown
- From the Departments of Medicine (N.B., E.S.S.), Infectious Diseases (N.B., E.S.S.), and Emergency Medicine (P.D.B., J.J.B.) and the Infection Control Unit (E.S.S.), Massachusetts General Hospital, the Departments of Medicine (N.B., E.S.S.) and Emergency Medicine (P.D.B., J.J.B.), Harvard Medical School, and the Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health (C.M.B., S.C.S., L.C.M.), Boston, and the Department of Medicine, University of Massachusetts Chan Medical School, Worcester (L.C.M.) - all in Massachusetts
| | - Sandra C Smole
- From the Departments of Medicine (N.B., E.S.S.), Infectious Diseases (N.B., E.S.S.), and Emergency Medicine (P.D.B., J.J.B.) and the Infection Control Unit (E.S.S.), Massachusetts General Hospital, the Departments of Medicine (N.B., E.S.S.) and Emergency Medicine (P.D.B., J.J.B.), Harvard Medical School, and the Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health (C.M.B., S.C.S., L.C.M.), Boston, and the Department of Medicine, University of Massachusetts Chan Medical School, Worcester (L.C.M.) - all in Massachusetts
| | - Lawrence C Madoff
- From the Departments of Medicine (N.B., E.S.S.), Infectious Diseases (N.B., E.S.S.), and Emergency Medicine (P.D.B., J.J.B.) and the Infection Control Unit (E.S.S.), Massachusetts General Hospital, the Departments of Medicine (N.B., E.S.S.) and Emergency Medicine (P.D.B., J.J.B.), Harvard Medical School, and the Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health (C.M.B., S.C.S., L.C.M.), Boston, and the Department of Medicine, University of Massachusetts Chan Medical School, Worcester (L.C.M.) - all in Massachusetts
| | - Paul D Biddinger
- From the Departments of Medicine (N.B., E.S.S.), Infectious Diseases (N.B., E.S.S.), and Emergency Medicine (P.D.B., J.J.B.) and the Infection Control Unit (E.S.S.), Massachusetts General Hospital, the Departments of Medicine (N.B., E.S.S.) and Emergency Medicine (P.D.B., J.J.B.), Harvard Medical School, and the Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health (C.M.B., S.C.S., L.C.M.), Boston, and the Department of Medicine, University of Massachusetts Chan Medical School, Worcester (L.C.M.) - all in Massachusetts
| | - Joshua J Baugh
- From the Departments of Medicine (N.B., E.S.S.), Infectious Diseases (N.B., E.S.S.), and Emergency Medicine (P.D.B., J.J.B.) and the Infection Control Unit (E.S.S.), Massachusetts General Hospital, the Departments of Medicine (N.B., E.S.S.) and Emergency Medicine (P.D.B., J.J.B.), Harvard Medical School, and the Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health (C.M.B., S.C.S., L.C.M.), Boston, and the Department of Medicine, University of Massachusetts Chan Medical School, Worcester (L.C.M.) - all in Massachusetts
| | - Erica S Shenoy
- From the Departments of Medicine (N.B., E.S.S.), Infectious Diseases (N.B., E.S.S.), and Emergency Medicine (P.D.B., J.J.B.) and the Infection Control Unit (E.S.S.), Massachusetts General Hospital, the Departments of Medicine (N.B., E.S.S.) and Emergency Medicine (P.D.B., J.J.B.), Harvard Medical School, and the Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health (C.M.B., S.C.S., L.C.M.), Boston, and the Department of Medicine, University of Massachusetts Chan Medical School, Worcester (L.C.M.) - all in Massachusetts
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Abstract
Introduction Monkeypox is a viral zoonosis, with symptoms similar to those seen in smallpox patients, although the clinical presentation may be less severe. Until recently, human monkeypox infection was rare, and primarily occurred in Central and West Africa. Areas covered An international outbreak began in May 2022, and monkeypox has now been detected on every continent except Antarctica. The first recognized case from the current outbreak was confirmed in the United Kingdom on 6 May 2022, in an adult with travel links to Nigeria, but it has been suggested that cases had been spreading in Europe for months. On 23 July 2022 the Director-General of the World Health Organization declared the monkeypox outbreak a public health emergency of international concern. Expert opinion There are no treatments specifically for monkeypox virus infections. However, monkeypox and smallpox viruses are genetically similar, and therapeutics developed to combat smallpox may be used to treat monkeypox. This manuscripts reviews what is known about these potential treatments, including tecovirimat and brincidofovir, based on a literature search of PubMed through 9 August 2022, and explores how these therapeutics may be used in the future to address the expanding monkeypox pandemic.
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Affiliation(s)
- Matthew W McCarthy
- Weill Cornell Medicine, Department of Medicine, 525 East 68th Street, Box 130, New York, NY, 10065
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Xia J, Huang CL, Chu P, Kroshinsky D. Eczema Monkeypoxicum: Report of Monkeypox Transmission in Atopic Dermatitis. JAAD Case Rep 2022; 29:95-99. [PMID: 36212897 PMCID: PMC9534102 DOI: 10.1016/j.jdcr.2022.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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