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Mital R, Fisher K, Korman AM, Plaza JA, Kaffenberger BH, Chung CG. Histopathologic Findings of Evolving Mpox Lesions. Am J Dermatopathol 2024:00000372-990000000-00395. [PMID: 39141745 DOI: 10.1097/dad.0000000000002709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
ABSTRACT This article reports two cases of the 2022 mpox virus with notable histopathology, and includes a novel description of mpox pseudotumor in the perianal region which is not previously described. This article additionally includes literature review of characteristic histopathology through evolving lesions, as it is sparsely described in relation to the 2022 mpox outbreak. Case one describes a 42-year-old man who presented with umbilicated, smooth papules on the trunk and extremities, and milia-like papules on the face. Histopathology of an umbilicated lesion revealed epidermal acanthosis with keratinocyte pallor, ballooning degeneration, keratinocyte necrosis, and neutrophilic epitheliotropism. Case two describes a 51-year-old man who presented with scattered eroded papules as well as a perianal mass. Histopathology of the mass revealed ulceration with keratinocyte enlargement and pallor with a mixed inflammatory cell infiltrate. It additionally revealed rare multinucleated keratinocytes with nuclear molding. These cases are remarkable and contribute to literature as reports of the histopathology of the atypical 2022 mpox outbreak are rare. A combination of clinical, laboratory, and histopathologic evidence is useful in diagnosing mpox, and these cases contribute to describing the evolution of viral lesions.
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Affiliation(s)
- Rohan Mital
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH; and
| | - Kristopher Fisher
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH; and
| | - Abraham M Korman
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH; and
| | - Jose A Plaza
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH; and
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Benjamin H Kaffenberger
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH; and
| | - Catherine G Chung
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH; and
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
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2
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Kuehn R, Fox T, Guyatt G, Lutje V, Gould S. Infection prevention and control measures to reduce the transmission of mpox: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002731. [PMID: 38236835 PMCID: PMC10796032 DOI: 10.1371/journal.pgph.0002731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/28/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVES To make inferences regarding the effectiveness of respiratory interventions and case isolation measures in reducing or preventing the transmission of mpox based on synthesis of available literature. METHODS The WHO Clinical Management and Infection Prevention and Control 2022 guideline and droplet precautions in healthcare facilities and home isolation infection prevention control measures for patients with mpox. We conducted a systematic review that included a broad search of five electronic databases. In a two-stage process, we initially sought only randomized controlled trials and observational comparative studies; when the search failed to yield eligible studies, the subsequent search included all study designs including clinical and environmental sampling studies. RESULTS No studies were identified that directly addressed airborne and droplet precautions and home isolation infection prevention control measures. To inform the review questions the review team synthesized route of transmission data in mpox. There were 2366/4309 (54.9%) cases in which investigators identified mpox infection occurring following transmission through direct physical sexual contact. There were no reported mpox cases in which investigators identified inhalation as a single route of transmission. There were 2/4309 cases in which investigators identified fomite as a single route of transmission. Clinical and environmental sampling studies isolated mpox virus in a minority of saliva, oropharangeal swabs, mpox skin lesions, and hospital room air. CONCLUSIONS Current findings provide compelling evidence that transmission of mpox occurs through direct physical contact. Because investigators have not reported any cases of transmission via inhalation alone, the impact of airborne and droplet infection prevention control measures in reducing transmission will be minimal. Avoiding physical contact with others, covering mpox lesions and wearing a medical mask is likely to reduce onward mpox transmission; there may be minimal reduction in transmission from additionally physically isolating patients with mild disease at home.
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Affiliation(s)
- Rebecca Kuehn
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Tilly Fox
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Gordon Guyatt
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Canada
| | - Vittoria Lutje
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Susan Gould
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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3
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Shishido AA, Street S. Optimal management of severe mpox in patients with uncontrolled human immunodeficiency virus. J Med Virol 2023; 95:e29277. [PMID: 38078663 DOI: 10.1002/jmv.29277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023]
Abstract
In May 2022, a cluster of nontravel-related cases of human mpox were reported in the United Kingdom. The outbreak has since spread worldwide infecting over 85 000 patients and causing over 100 deaths. Recent data clearly suggest that patients infected with human immunodeficiency virus (HIV) with CD4 counts less than 200 cells per mm 3 suffer significantly worse outcomes than immunocompetent patients. The available countermeasures lack robust clinical data and are deployed based on in vitro and animal studies as well as extrapolations from use against other poxviruses. In many cases, despite administration of these available treatments, initiation of antiretroviral therapy (ART), and management of suspected immune reconstitution inflammatory syndrome after initiating ART, patients die. This review summarizes available data, identifies knowledge gaps and proposes recommendations on the management of severe mpox in people living with HIV.
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Affiliation(s)
- Akira A Shishido
- Division of Infectious Diseases, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Stacy Street
- Division of Acute Care Surgical Services, Virginia Commonwealth University, Richmond, Virginia, USA
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Scarabello A, Adebanjo GAR, Volpe S, Parisella FR, Greco ME, Balampanos CG, Tammaro A. Mpox lesions in two patients with multiple comorbidities. Int J Dermatol 2023; 62:e631-e633. [PMID: 37608467 DOI: 10.1111/ijd.16805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/13/2023] [Accepted: 08/02/2023] [Indexed: 08/24/2023]
Affiliation(s)
| | | | | | | | - Maria E Greco
- NESMOS Department, Sapienza University of Rome, Rome, Italy
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Shah J, Saak TM, Desai AN, Gudis DA, Cheema HA, Abuelazm M, Preciado D, Zucker J, Overdevest JB. Otolaryngologic manifestations among MPOX patients: A systematic review and meta-analysis. Am J Otolaryngol 2023; 44:103991. [PMID: 37487464 DOI: 10.1016/j.amjoto.2023.103991] [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: 06/01/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE MPOX has numerous otolaryngologic presentations that have been recognized as clinically important, especially with the onset of the 2022 outbreak. However, how these features vary across region and outbreak have yet to be elucidated or supported by meta-analysis. The objective of this study is to identify the otolaryngologic manifestations of MPOX across previous and current outbreaks and among endemic and non-endemic regions. BASIC PROCEDURES Data sources of MEDLINE (PubMed), the Cochrane Library, Scopus, Embase, Web of Science, Google Scholar, and OpenGrey were searched through August 2022. All observational studies reporting data on laboratory-confirmed MPOX patients with otolaryngologic symptoms were included. Two authors independently performed the screening process while a third resolved disagreements. Data were extracted into a structured form by two authors independently. We performed a meta-analysis of the prevalence of otorhinolaryngologic symptoms using MetaXL software (version 5.3) under a random-effects model. MAIN FINDINGS 38 studies with 5952 patients were included. The four most prevalent manifestations were headache at 31 % (95 % CI [0.16-0.49], I 2 = 99 %), sore throat at 22 % (95 % CI [0.09-0.37], I 2 = 99 %), cough at 16 % (95 % CI [0.05-0.30], I 2 = 99 %), and cervical lymphadenopathy at 10 % (95 % CI [0.01-0.26], I 2 = 100 %). Otolaryngologic features were more prevalent in previous outbreaks as compared to the 2022 outbreak including 37 % prevalence of headache (95 % CI [0.11-0.66], I 2 = 100 %), 33 % prevalence of cough (95 % CI [0.21-0.47], I 2 = 98 %), 27 % prevalence of sore throat (95 % CI [0.07-0.53], I 2 = 99 %), 15 % prevalence of cervical lymphadenopathy (95 % CI [0.00-0.428], I 2 = 100 %), 13 % prevalence of oral ulcers (95 % CI [0.02-0.30], I 2 = 99 %), 6 % prevalence of oral exanthem (95 % CI [0.00-0.17], I 2 = 99 %), 5 % prevalence of dysphagia (95 % CI [0.00-0.18], I 2 = 99 %), and 5 % prevalence of tonsillar signs (95 % CI [0.00-0.13], I 2 = 99 %). Features that were more prevalent in endemic areas versus non-endemic areas include 27 % prevalence of cough (95 % CI [0.14-0.41], I 2 = 99 %), 15 % prevalence of oral ulcers (95 % CI [0.02-0.36], I 2 = 99 %), 6 % prevalence of tonsillar signs (95 % CI [0.00-0.18], I 2 = 99 %), and 19 % prevalence of cervical lymphadenopathy (95 % CI [0.00-0.48], I 2 = 100 %), while the only feature more prevalent in non-endemic areas was headache with a prevalence of 36 % (95 % CI [0.24-0.47], I 2 = 96 %). PRINCIPAL CONCLUSIONS In this systematic review and meta-analysis, four symptoms - headache, sore throat, cough, and cervical lymphadenopathy - were found to be the most prevalent otolaryngologic features of MPOX. Otolaryngologic manifestations of MPOX were more pronounced in prior outbreaks and in endemic areas as compared to the 2022 outbreak and non-endemic areas. These findings may aid MPOX recognition in an otolaryngology setting.
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Affiliation(s)
- Jaffer Shah
- Weill Cornell Medicine, NY, New York, United States of America
| | - Tiana M Saak
- Columbia University Vagelos College of Physicians and Surgeons, NY, New York, United States of America
| | - Angel N Desai
- Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, CA, United States of America
| | - David A Gudis
- Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, NY, New York, United States of America
| | | | | | - Diego Preciado
- Department of Otolaryngology-Head & Neck Surgery, George Washington University, Children's National Hospital, Washington, DC, United States of America
| | - Jason Zucker
- Division of Infectious Disease, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, NY, New York, United States of America
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, NY, New York, United States of America.
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Li X, Zhao M, Li Y, Zhang A, Liu Y, Li J, Li D, Guo J, Ma L, Mu Q. Enhancing diagnostic accuracy in common human poxvirus infections during mpox outbreak: A dermoscopy review. Skin Res Technol 2023; 29:e13489. [PMID: 37881051 PMCID: PMC10541801 DOI: 10.1111/srt.13489] [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] [Received: 09/17/2023] [Accepted: 09/23/2023] [Indexed: 10/27/2023]
Abstract
Poxviruses belong to the Poxviridae family, a group of pathogens known for their high infectivity in humans, posing significant health threats. One of the most well-known representatives of poxvirus infections is smallpox, which has been successfully eradicated. However, in recent years, there has been a resurgence in cases of mpox, another member of the Poxviridae family, raising concerns about the potential for a global pandemic or a worldwide health crisis. While the typical clinical presentation of mpox and other poxvirus infections often involves cutaneous lesions, there have been reports of various atypical and non-classic clinical manifestations. Dermoscopy has emerged as a crucial diagnostic tool, aiding dermatologists in clinical practice to make informed decisions. In this summary, we provide an overview of the clinical and dermoscopic features of representative cutaneous lesions associated with human poxvirus infections, including mpox, orf, milker's nodule, and molluscum contagiosum.
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Affiliation(s)
- Xu Li
- Department of DermatologyThe First Hospital of HohhotHohhotChina
- Department of AllergyThe First Hospital of HohhotHohhotChina
| | - Mutong Zhao
- Department of DermatologyBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Yanfei Li
- Department of DermatologyThe First Hospital of HohhotHohhotChina
- Department of AllergyThe First Hospital of HohhotHohhotChina
| | - Anda Zhang
- Department of DermatologyInternational Mongolian Hospital of Inner MongoliaHohhotChina
| | - Ying Liu
- Department of DermatologyBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Jiaojiao Li
- Department of DermatologyThe First Hospital of HohhotHohhotChina
| | - Dan Li
- Department of DermatologyThe First Hospital of HohhotHohhotChina
| | - Jingxue Guo
- Department of DermatologyThe First Hospital of HohhotHohhotChina
| | - Lin Ma
- Department of DermatologyBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Qiri Mu
- Department of DermatologyInternational Mongolian Hospital of Inner MongoliaHohhotChina
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Diaz A, Tai H, Gulati N. Common warts superinfected with monkeypox. Int J Dermatol 2023; 62:1208-1209. [PMID: 36371716 DOI: 10.1111/ijd.16513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/12/2022] [Accepted: 11/05/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Aisleen Diaz
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hansen Tai
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicholas Gulati
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Maronese CA, Avallone G, Aromolo IF, Spigariolo CB, Quattri E, Ramoni S, Carrera CG, Marzano AV. Mpox: an updated review of dermatological manifestations in the current outbreak. Br J Dermatol 2023; 189:260-270. [PMID: 37146166 DOI: 10.1093/bjd/ljad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/07/2023]
Abstract
Mpox is a disease caused by a double-stranded DNA orthopoxvirus discovered in 1958. In 2022, an outbreak on an unprecedented scale marked its transition from neglected, zoonotic disease circulating almost exclusively within African borders to sexually transmitted infection (STI) of international concern. Although phylogenetic evidence suggests progressive evolution from the strain associated with the 2018 outbreak in Nigeria, epidemiological links with previous cases have still not been completely elucidated. Clinically, mpox presents with systemic symptoms, such as fever, headache, malaise and a characteristic cutaneous eruption, similar to that of cognate viruses (e.g. smallpox). Mpox pseudopustules evolve through several stages, including umbilication and crusting, and resolve in the span of 2-3 weeks. The hallmarks that set the 2022 outbreak apart from classic mpox were a disproportionate number of cases occurring in men who have sex with men, an often localized cutaneous picture and a significant burden in terms of concomitant STIs. Investigations into the disease pathogenesis, related immune response, clinical and dermoscopic features, in addition to studies aimed at defining novel management strategies, have advanced mpox knowledge considerably. Herein, recent findings on mpox are reviewed, with a keen focus on dermatological manifestations and their implications in the current diagnostic scenario, reinforcing the pivotal role of dermatologists in managing suspect cases and preventing further spread of the contagion.
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Affiliation(s)
- Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Gianluca Avallone
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - Italo Francesco Aromolo
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Cristina Beatrice Spigariolo
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Eleonora Quattri
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Stefano Ramoni
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Giovanni Carrera
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Schmidle P, Leson S, Wieland U, Böer-Auer A, Metze D, Braun SA. Lives of Skin Lesions in Monkeypox: Histomorphological, Immunohistochemical, and Clinical Correlations in a Small Case Series. Viruses 2023; 15:1748. [PMID: 37632089 PMCID: PMC10458687 DOI: 10.3390/v15081748] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Monkeypox (mpox), a former rare viral zoonosis, has increasingly made it into the public eye since the major outbreak that started in May 2022. Mpox presents with skin lesions that change over time and go through different stages (macular, papular, pustular, and early and late ulceration). In this study, we evaluated skin biopsies of all stages. Therefore, five biopsies from four patients were analyzed histologically, immunohistochemically with anti-Vaccinia virus antibodies, and electron-microscopically. Notably, the early macular stage only showed subtle viropathic changes; it did not express of Orthopoxvirus proteins in immunohistochemistry and therefore can easily be missed histologically. In later stages, immunohistochemistry with anti-Vaccinia virus antibodies might be useful to distinguish mpox from differential diagnoses such as herpes virus infections. In the ulcerative stages, the identified occlusive vasculopathic changes could be an explanation for the severe pain of the lesions reported by some patients. Despite the small number of samples examined, our analysis suggests that the histological findings of mpox are highly dependent on the stage of the biopsied lesion. Therefore, knowledge of all different stages of histology is necessary to reliably diagnose mpox histologically, especially when molecular testing is not available.
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Affiliation(s)
- Paul Schmidle
- Department of Dermatology, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany; (S.L.); (A.B.-A.); (D.M.); (S.A.B.)
| | - Sonja Leson
- Department of Dermatology, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany; (S.L.); (A.B.-A.); (D.M.); (S.A.B.)
| | - Ulrike Wieland
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany;
| | - Almut Böer-Auer
- Department of Dermatology, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany; (S.L.); (A.B.-A.); (D.M.); (S.A.B.)
- Dermatologikum Hamburg, 20354 Hamburg, Germany
| | - Dieter Metze
- Department of Dermatology, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany; (S.L.); (A.B.-A.); (D.M.); (S.A.B.)
| | - Stephan A. Braun
- Department of Dermatology, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany; (S.L.); (A.B.-A.); (D.M.); (S.A.B.)
- Department of Dermatology, Medical Faculty, Heinrich-Heine University, 40225 Duesseldorf, Germany
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Moltrasio C, Boggio FL, Romagnuolo M, Cagliani R, Sironi M, Di Benedetto A, Marzano AV, Leone BE, Vergani B. Monkeypox: A Histopathological and Transmission Electron Microscopy Study. Microorganisms 2023; 11:1781. [PMID: 37512953 PMCID: PMC10385849 DOI: 10.3390/microorganisms11071781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
The global outbreak of human monkeypox virus (hMPXV1) in 2022 highlighted the usefulness of dermatological manifestations for its diagnosis. Infection by the human monkeypox virus thus necessitated inclusion in the diagnostic repertoire of dermatopathology. To assess the histopathological and microscopical findings of cutaneous lesions related to hMPXV infection, we analyzed skin biopsies from patients with positive MPXV DNA polymerase chain reaction presenting with a typical course of hMPXV1 infection. The most prominent histopathological findings were ascribable to a pustular stage in which epidermal necrosis with areas of non-viable keratinocytes and a "shadow cell" appearance were evident; in some cases, the deep portion of the hair follicle and the acrosyringial epithelium were affected. The main cytopathic modifications included ballooning keratinocytes, followed by Guarnieri bodies and a ground glass appearance of the keratinocytes' nuclei, together with a dense mixed inflammatory cell infiltrate with prominent neutrophil exocytosis. Transmission electron microscopy analysis demonstrated viral particle aggregates in the cytoplasm of keratinocytes, without any involvement of the nucleus. Interestingly, we also found the presence of viral particles in infected mesenchymal cells, although to a lesser extent than in epithelial cells. Through this study, we contributed to expanding the histological and microscopic knowledge of the human mpox virus, a key step to understanding current and potential future trends of the disease, as well as of other Orthopoxvirus infections.
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Affiliation(s)
- Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Francesca Laura Boggio
- Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Maurizio Romagnuolo
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, 20122 Milan, Italy
| | - Rachele Cagliani
- Scientific Institute IRCCS E. MEDEA, Bioinformatics, 23842 Bosisio Parini, Italy
| | - Manuela Sironi
- Scientific Institute IRCCS E. MEDEA, Bioinformatics, 23842 Bosisio Parini, Italy
| | - Alessandra Di Benedetto
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, 20122 Milan, Italy
| | - Biagio Eugenio Leone
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Barbara Vergani
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
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Okoli GN, Van Caeseele P, Askin N, Abou-Setta AM. Comparative evaluation of the clinical presentation and epidemiology of the 2022 and previous Mpox outbreaks: a rapid review and meta-analysis. Infect Dis (Lond) 2023:1-19. [PMID: 37200216 DOI: 10.1080/23744235.2023.2214609] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND In 2022, there were outbreaks of Mpox where the disease is not endemic. We summarised and compared the findings from published observational studies on the clinical presentation and epidemiology of the 2022 and previous outbreaks of Mpox. METHODS We registered a review protocol with the Open Science Framework (osf.io/j3kb7). We searched MEDLINE, Embase, CENTRAL, CINAHL and Scopus databases, and relevant websites up to August 30, 2022. Retrieved literature citations were screened for eligibility, and summary clinical presentation and epidemiological data from the included studies were pooled, when possible, using an inverse variance, random-effects model. RESULTS Seventy-nine studies met the eligibility. Irrespective of outbreak, fever, headache, myalgia, lymphadenopathy, pleomorphic skin lesions, oral lesions, and sore throat were potentially highly relevant Mpox manifestations, while conjunctivitis, cough, and possibly reactivation of varicella zoster virus may be part of the clinical presentation. The mean incubation period for the 2022 outbreaks was 7.4 d (6.4-8.4 d, I2 64.2%; 4 studies: 270 cases) and for previous outbreaks, 12.9 d (10.4-15.5 d; one study: 31 cases), p < .001. None of the male cases from previous outbreaks was reported to have sex with men (MSM) whereas almost all reported male cases from the 2022 outbreak were MSM. Concomitant sexually transmitted infections and perianal lesions were reported only among male cases from the 2022 outbreak, with the cases mostly presenting with genital lesions. CONCLUSIONS The 2022 Mpox outbreaks appear to be mostly among MSM and have a lower incubation period compared with previous outbreaks.Key messages79 studies met the review's inclusion criteria.The 2022 Mpox outbreaks appear to have shorter incubation period compared with previous outbreaks.Established clinical presentation of Mpox includes fever, headache, myalgia, lymphadenopathy, pleomorphic skin lesions, oral lesions, and sore throat.Almost all reported cases from the 2022 Mpox outbreaks were men who had sex with men (MSM).Concomitant sexually transmitted infections and perianal lesions were only reported among cases from the 2022 Mpox outbreaks.A significantly higher proportion of Mpox cases from the 2022 outbreaks had genital lesions compared with cases from previous outbreaks.The 2022 Mpox outbreaks appear to be mostly among MSM.
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Affiliation(s)
- George N Okoli
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
- College of Pharmacy, University of Manitoba, Winnipeg, Canada
| | - Paul Van Caeseele
- Department of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Cadham Provincial Laboratory, Winnipeg, Canada
| | - Nicole Askin
- Neil John Maclean Library, University of Manitoba, Winnipeg, Canada
| | - Ahmed M Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
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12
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Rodríguez-Cuadrado FJ, Nájera L, Suárez D, Silvestre G, García-Fresnadillo D, Roustan G, Sánchez-Vázquez L, Jo M, Santonja C, Garrido-Ruiz MC, Vicente-Montaña AM, Rodríguez-Peralto JL, Requena L. Clinical, histopathologic, immunohistochemical, and electron microscopic findings in cutaneous monkeypox: A multicenter retrospective case series in Spain. J Am Acad Dermatol 2023; 88:856-863. [PMID: 36581043 PMCID: PMC9794029 DOI: 10.1016/j.jaad.2022.12.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/22/2022] [Accepted: 12/16/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND The worldwide outbreak of monkeypox has evidenced the usefulness of the dermatologic manifestations for its diagnosis. OBJECTIVE To describe the histopathologic and immunohistochemical findings of monkeypox cutaneous lesions. METHODS This is a retrospective histopathologic and immunohistochemical study of 20 patients with positive Monkeypox virus DNA polymerase chain reaction and immunohistochemical positivity for Vaccinia virus in cutaneous lesions. Four cases were also examined by electron microscopy. RESULTS The most characteristic histopathologic findings consisted of full-thickness epidermal necrosis with hyperplasia and keratinocytic ballooning at the edges. In some cases, the outer root sheath of the hair follicle and the sebaceous gland epithelium were affected. Intraepithelial cytoplasmic inclusion bodies and scattered multinucleated keratinocytes were occasionally found. Immunohistochemically, strong positivity with anti-Vaccinia virus antibody was seen in the cytoplasm of ballooned keratinocytes. Electron microscopy study demonstrated numerous viral particles of monkeypox in affected keratinocytes. LIMITATIONS Small sample size. Electron microscopic study was only performed in 4 cases. CONCLUSION Epidermal necrosis and keratinocytic ballooning are the most constant histopathologic findings. Immunohistochemical positivity for Vaccinia virus was mostly detected in the cytoplasm of the ballooned keratinocytes. These findings support the usefulness of histopathologic and immunohistochemical studies of cutaneous lesions for diagnosis of monkeypox.
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Affiliation(s)
| | - Laura Nájera
- Department of Pathology, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma, Madrid, Spain
| | - Dolores Suárez
- Department of Pathology, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma, Madrid, Spain
| | - Gala Silvestre
- Department of Pathology, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma, Madrid, Spain
| | - Diego García-Fresnadillo
- Department of Pathology, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma, Madrid, Spain
| | - Gaston Roustan
- Department of Dermatology, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma, Madrid, Spain
| | - Laura Sánchez-Vázquez
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Margarita Jo
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Carlos Santonja
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | | | | | | | - Luis Requena
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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13
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Rodríguez-Cuadrado FJ, Elosua-González M, Roustan-Gullón G, Alfageme-Roldán F. Dermatoscopic features in monkeypox. J Eur Acad Dermatol Venereol 2023; 37:e560-e561. [PMID: 36222743 DOI: 10.1111/jdv.18650] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/03/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - Marta Elosua-González
- Department of Dermatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Gaston Roustan-Gullón
- Department of Dermatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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14
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Avallone G, Maronese CA, Quattri E, Roccuzzo G, Mastorino L, Alberti-Violetti S, Ramoni S, Lucchini A, Delmonte S, Quaglino P, Marzano AV, Ribero S. Maculopapular rash: An overlooked monkeypox diagnostic clue? J Eur Acad Dermatol Venereol 2023; 37:e553-e556. [PMID: 36308513 DOI: 10.1111/jdv.18695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/26/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Gianluca Avallone
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy.,Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Eleonora Quattri
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Gabriele Roccuzzo
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luca Mastorino
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Silvia Alberti-Violetti
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Stefano Ramoni
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Lucchini
- CEMUSS - Dip. di Prevenzione - ASL "Cittá di Torino", Torino, Italy
| | - Sergio Delmonte
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Simone Ribero
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
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15
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Aromolo IF, Maronese CA, Avallone G, Beretta A, Boggio FL, Murgia G, Marletta DA, Barei F, Carrera CG, Ramoni S, Di Benedetto A, Marzano AV. Clinical spectrum of human monkeypox: An Italian single-centre case series. J Eur Acad Dermatol Venereol 2023; 37:e368-e371. [PMID: 36166329 DOI: 10.1111/jdv.18612] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/21/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Italo F Aromolo
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Carlo A Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Gianluca Avallone
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - Andrea Beretta
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Francesca L Boggio
- Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Murgia
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Dario A Marletta
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Francesca Barei
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Carlo G Carrera
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Ramoni
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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16
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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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17
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Forni D, Moltrasio C, Sironi M, Mozzi A, Quattri E, Venegoni L, Zamprogno M, Citterio A, Clerici M, Marzano AV, Cagliani R. Whole-genome sequencing of hMPXV1 in five Italian cases confirms the occurrence of the predominant epidemic lineage. J Med Virol 2023; 95:e28493. [PMID: 36633196 PMCID: PMC10108130 DOI: 10.1002/jmv.28493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
The ongoing outbreak of monkeypox virus (hMPXV1) is the largest recorded in historically nonendemic countries. Genomic surveillance has emerged as a pivotal tool to track the spread and monitor the evolution of viral pathogens. Therefore, to assess the genetic diversity of circulating hMPXV1 in northern Italy in June to July 2022, we sequenced and analyzed five complete genomes of viruses sampled from patients presenting with a typical course of hMPXV1 infection. Phylogenetic analysis confirmed that all five genomes belong to the predominant epidemic lineage (B.1). Inspection of genetic changes and comparison with the reference sequence showed the presence of 12 nucleotide substitutions. Seven are nonsynonymous mutations leading to amino acid changes in six proteins belonging to different functional classes. Moreover, 11 of these 12 nucleotide mutations involve GA>AA or TC>TT replacements, suggesting that host APOBEC3 enzymes are responsible for the generation of substitutions in circulating viruses. Finally, metagenomic analysis evidenced bacterial superinfection (Streptococcus pyogenes) in one patient. Through this study, we contributed to expand the number of complete genomes of viruses circulating in Italy and characterize them as belonging to the predominant outbreak lineage.
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Affiliation(s)
- Diego Forni
- Scientific Institute IRCCS E. MEDEA, Bioinformatics, Bosisio Parini, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Manuela Sironi
- Scientific Institute IRCCS E. MEDEA, Bioinformatics, Bosisio Parini, Italy
| | - Alessandra Mozzi
- Scientific Institute IRCCS E. MEDEA, Bioinformatics, Bosisio Parini, Italy
| | - Eleonora Quattri
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Luigia Venegoni
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Marzia Zamprogno
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Citterio
- Laboratory of Molecular Biology, Scientific Institute IRCCS E. MEDEA, Bosisio Parini, Italy
| | - Mario Clerici
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Don C. Gnocchi Foundation ONLUS, IRCCS, Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Rachele Cagliani
- Scientific Institute IRCCS E. MEDEA, Bioinformatics, Bosisio Parini, Italy
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18
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Ciccarese G, Di Biagio A, Bruzzone B, Guadagno A, Taramasso L, Oddenino G, Brucci G, Labate L, De Pace V, Mastrolonardo M, Broccolo F, Robello G, Drago F, Bassetti M, Parodi A. Monkeypox outbreak in Genoa, Italy: Clinical, laboratory, histopathologic features, management, and outcome of the infected patients. J Med Virol 2023; 95:e28560. [PMID: 36757085 DOI: 10.1002/jmv.28560] [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: 11/15/2022] [Revised: 01/23/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023]
Abstract
Since May 2022, multiple human Monkeypox cases were identified in nonendemic countries, mainly among men who have sex with men. We aimed to report the features, clinical course, management, and outcome of the Monkeypox cases diagnosed in the Dermatology and Infectious Disease Units of the San Martino Hospital, Genoa, Italy. We performed an observational study of the Monkeypox cases diagnosed from July 1 until August 31, 2022, collecting clinical, laboratory, and histological data. We studied 16 Monkeypox-infected men (14 homosexual, 2 bisexual) with a median age of 37 years. Three were HIV-infected. All patients reported multiple sexual partners and/or unprotected sex in the 2 weeks before the diagnosis. Most patients had prodromal signs/symptoms before the appearance of the skin/mucosal eruption, consisting of erythematous papules/vesicles/pustules in the anogenital area, which tended to erode evolving into crusts and ulcers. Lesions were often associated with local and/or systemic symptoms. Histopathology showed overlapping features in all cases: epidermal ulceration and dermal inflammatory infiltrate consisting of lymphocytes and neutrophils with an interstitial and perivascular/peri-adnexal pattern and endothelial swelling. Concomitant sexually transmitted infections (STIs) (gonococcal/nongonococcal proctitis and anal high-risk human papillomavirus [HR-HPV] infection) were frequent. Four patients were hospitalized, and one received specific treatment. The overall outcome was good. At the follow-up visit, three patients presented skin scars. Our series confirms the features of the current Monkeypox outbreak; however, different from other studies, we found a considerable rate of concomitant STIs, such as anal HR-HPV infection, that should be kept in mind because this persistent infection is the main cause of anal cancers.
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Affiliation(s)
- Giulia Ciccarese
- Department of Medical and Surgical Sciences, Unit of Dermatology, University of Foggia, Foggia, Italy
| | - Antonio Di Biagio
- Department of Specialist Medicine, Infectious Disease Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences, Division of Infectious Diseases, University of Genoa, Genoa, Italy
| | - Bianca Bruzzone
- Department of Health Sciences, Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Guadagno
- Pathology Unit, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Lucia Taramasso
- Department of Specialist Medicine, Infectious Disease Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giorgio Oddenino
- Department of Health Sciences, Section of Dermatology, DISSAL, University of Genoa, Ospedale-Policlinico San Martino, IRCCS, Genova, Italy
| | - Giorgia Brucci
- Department of Specialist Medicine, Infectious Disease Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences, Division of Infectious Diseases, University of Genoa, Genoa, Italy
| | - Laura Labate
- Department of Specialist Medicine, Infectious Disease Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences, Division of Infectious Diseases, University of Genoa, Genoa, Italy
| | - Vanessa De Pace
- Department of Health Sciences, Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Mastrolonardo
- Department of Medical and Surgical Sciences, Unit of Dermatology, University of Foggia, Foggia, Italy
| | - Francesco Broccolo
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
| | - Giacomo Robello
- Department of Health Sciences, Section of Dermatology, DISSAL, University of Genoa, Ospedale-Policlinico San Martino, IRCCS, Genova, Italy
| | - Francesco Drago
- Department of Health Sciences, Section of Dermatology, DISSAL, University of Genoa, Ospedale-Policlinico San Martino, IRCCS, Genova, Italy
| | - Matteo Bassetti
- Department of Specialist Medicine, Infectious Disease Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences, Division of Infectious Diseases, University of Genoa, Genoa, Italy
| | - Aurora Parodi
- Department of Health Sciences, Section of Dermatology, DISSAL, University of Genoa, Ospedale-Policlinico San Martino, IRCCS, Genova, Italy
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19
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Pourriyahi H, Aryanian Z, Afshar ZM, Goodarzi A. A systematic review and clinical atlas on mucocutaneous presentations of the current monkeypox outbreak: With a comprehensive approach to all dermatologic and nondermatologic aspects of the new and previous monkeypox outbreaks. J Med Virol 2023; 95:e28230. [PMID: 36254380 DOI: 10.1002/jmv.28230] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/03/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022]
Abstract
Monkeypox is a zoonotic disease, endemic in central and west African regions, and has re-emerged, currently causing an outbreak as of May 2022. In this systematic review, we aimed to characterize the current face of the disease, with a detailed categorization of mucocutaneous, as well as systemic symptoms of the disease. We searched four main online databases with the keywords "monkeypox" and "Orthopoxvirus". A total of 46 articles were included, with a cumulative number of 1984 confirmed cases. Patients were predominantly men who have sex with men, who were mostly in their 30s, with a history of unprotected sexual contact or international travel. Among mucocutaneous manifestations, anogenital lesions were the most commonly observed, followed by lesions on the limbs, face, trunk, and palms or soles. Among lesion types, vesiculopustular, pustular or pseudo-pustular, vesicular-umbilicated and papular lesions were the most common, mainly presenting asynchronously, with less than 10 lesions on each patient. Almost all patients also reported systemic manifestations, namely fever, lymphadenopathy, fatigue, myalgia, headaches, pharyngitis, and proctitis. Sexual contact is the main pathway of transmission in the current outbreak, with viral shedding in bodily fluids playing a key role. We've compared these idiosyncratic findings of the new outbreak with previous outbreaks. We've also gathered and categorized images from our included studies to make a "clinical atlas" for this "new" face of monkeypox, which can be of utmost importance for clinicians to be familiarized with, and have a clear picture of monkeypox for their differential diagnoses.
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Affiliation(s)
- Homa Pourriyahi
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zeinab Aryanian
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Dermatology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza Hospital Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, School of Medicine, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran
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20
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Monkeypox Outbreak 2022: Clinical and Virological Features of 30 Patients at the Sexually Transmitted Diseases Centre of Sant' Orsola Hospital, Bologna, Northeastern Italy. J Clin Microbiol 2023; 61:e0136522. [PMID: 36598196 PMCID: PMC9879125 DOI: 10.1128/jcm.01365-22] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Monkeypox infection is a zoonosis first described in humans in 1970 in Congo. While previously manifesting in small, confined outbreaks, the disease is rapidly spreading globally. The aim of this study was to investigate microbiological samples (skin, rectal, and oropharyngeal swab samples and plasma and urine samples) that can help in adequate diagnostic, therapeutic, and prognostic management. We present 30 laboratory-confirmed monkeypox patients with peculiar clinical and virological features admitted to the Sexually Transmitted Diseases Centre of Sant' Orsola Hospital, University of Bologna, in the period between 20 June and 10 August 2022. Demographic, anamnestic, and clinical data were obtained, and microbiological samples were collected and analyzed by real-time PCR to detect the presence of monkeypox virus (MPXV) DNA. All monkeypox patients were adult men who have sex with men (MSM) (mean age, 37.5 years). Nonskin samples were collected from 29 patients during the acute phase of the infection. The detection rates of MPXV DNA in plasma, urine, and oropharyngeal swab samples (82.3%, 64.7%, and 75.0%, respectively) were highest in samples collected 4 to 6 days after symptom onset. The presence of MPXV in plasma and urine samples was analyzed 11 to 38 days after symptom onset to monitor viral shedding duration. Interestingly, MPXV DNA was detected in a urine sample collected on day 21 in one patient. Prolonged positivity in urine after the clinical recovery suggests a potential source of infection by contamination of wastewater and sewage and transmission to possible animal reservoirs and highlights the need for further investigations on nonskin samples to extend and more adequately standardize the patient isolation period.
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21
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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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22
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Prieto-Pérez L, Vicente Montaña AM, Santonja C, Fortes J, García-Fresnadillo D, Jo-Velasco M, Requena L, Cabello A, Fernández-Roblas R, Álvarez B, Carrillo I, Górgolas M. Clinical, histopathological and ultrastructural features of human monkeypox infection in the 2022 outbreak: report of a case with immunohistochemistry for vaccinia virus. Clin Exp Dermatol 2023; 48:60-63. [PMID: 36669191 DOI: 10.1093/ced/llac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 01/21/2023]
Abstract
We provide a full description of the clinical, histopathological, immunohistochemical and ultrastructural features of the current human monkeypox virus. A skin snip was obtained in a HIV-infected patient in the wake of the monkeypox outbreak in Spain. Immunohistochemistry was strongly positive for anti-vaccinia virus. Under electron microscopy, mature viruses and virions were clearly visible.
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Affiliation(s)
- L Prieto-Pérez
- University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - A M Vicente Montaña
- ICTS-National Centre of Electron Microscopy, Complutense University of Madrid, Spain
| | - C Santonja
- University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - J Fortes
- University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | | | - M Jo-Velasco
- University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - L Requena
- University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - A Cabello
- University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | | | - B Álvarez
- University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - I Carrillo
- University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - M Górgolas
- University Hospital Fundación Jiménez Díaz, Madrid, Spain
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23
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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: 166] [Impact Index Per Article: 166.0] [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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24
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Neves LO, Cordeiro AD, Rezende BDC. Dermoscopic findings in human monkeypox infection. An Bras Dermatol 2023; 98:131-133. [PMID: 36411147 PMCID: PMC9674327 DOI: 10.1016/j.abd.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 11/19/2022] Open
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25
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León-Figueroa DA, Barboza JJ, Saldaña-Cumpa HM, Moreno-Ramos E, Bonilla-Aldana DK, Valladares-Garrido MJ, Sah R, Rodriguez-Morales AJ. Detection of Monkeypox Virus according to The Collection Site of Samples from Confirmed Cases: A Systematic Review. Trop Med Infect Dis 2022; 8:tropicalmed8010004. [PMID: 36668911 PMCID: PMC9865842 DOI: 10.3390/tropicalmed8010004] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Due to the rapid evolution of the monkeypox virus, the means by which the monkeypox virus is spread is subject to change. Therefore, the present study aims to analyze the detection of the monkeypox virus according to the collection site of samples from confirmed monkeypox cases. A systematic literature review was performed using PubMed, Scopus, Web of Science, and Embase databases until 5 October 2022. A total of 1022 articles were retrieved using the search strategy. After removing duplicates (n = 566) and examining by title, abstract, and full text, 65 studies reporting monkeypox case reports were included with a detailed description of risk factors, sexually transmitted infections (STIs), site of monkeypox virus-positive specimens, location of skin lesions, and diagnostic test. A total of 4537 confirmed monkeypox cases have been reported, of which 98.72% of the cases were male with a mean age of 36 years, 95.72% had a sexual behavior of being men who have sex with men, and 28.1% had human immunodeficiency virus (HIV). The most frequent locations of lesions in patients diagnosed with monkeypox were: 42.85% on the genitalia and 37.1% in the perianal region. All confirmed monkeypox cases were diagnosed by reverse transcriptase polymerase chain reaction (RT-PCR), and the most frequent locations of samples collected for diagnosis that tested positive for monkeypox virus were: 91.85% from skin lesions, 20.81% from the oropharynx, 3.19% from blood, and 2.43% from seminal fluid. The disease course of the cases with monkeypox was asynchronous, with no severe complications, and most patients did not report specific treatment but simply followed a symptomatic treatment.
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Affiliation(s)
- Darwin A. León-Figueroa
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 15011, Peru
- Centro de Investigación en Atención Primaria en Salud, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | - Joshuan J. Barboza
- Vicerrectorado de Investigación, Universidad Norbert Wiener, Lima 15046, Peru
- Correspondence: ; Tel.: +51-99-2108-520
| | - Hortencia M. Saldaña-Cumpa
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 15011, Peru
- Centro de Investigación en Atención Primaria en Salud, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | | | | | - Mario J. Valladares-Garrido
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 15011, Peru
- Oficina de Epidemiología, Hospital Regional Lambayeque, Chiclayo 14012, Peru
- Facultad de Medicina, Universidad Cesar Vallejo, Piura 20002, Peru
| | - Ranjit Sah
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu 44600, Nepal
- Dr. D.Y Patil Medical College, Hospital and Research Center, Dr. D.Y. Patil Vidyapeeth, Pune 411018, Maharashtra, India
| | - Alfonso J. Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundacion Universitaria Autonoma de las Americas, Pereira 660001, Risaralda, Colombia
- Latin American Network of Monkeypox Virus Research (LAMOVI), Pereira 660003, Risaralda, Colombia
- Master of Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur, Lima 15067, Peru
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut 1102, Lebanon
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26
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Turco M, Mancuso FR, Pisano L. A monkeypox virus infection mimicking primary syphilis. Br J Dermatol 2022; 187:e194-e195. [PMID: 36005947 DOI: 10.1111/bjd.21847] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 01/05/2023]
Abstract
Given the current monkeypox virus (MPXV) outbreak in at-risk men who have sex with men (MSM), clinicians should consider MPXV a differential diagnosis of syphilis, in any patient with a solitary painless genital nodule.
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Affiliation(s)
- Martina Turco
- Section of Dermatology, Health Sciences Department, University of Florence, Florence, Italy
| | - Fabrizio R Mancuso
- Section of Dermatology, Health Sciences Department, University of Florence, Florence, Italy
| | - Luigi Pisano
- Section of Dermatology, Health Sciences Department, University of Florence, Florence, Italy
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27
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Proietti I, Santoro PE, Skroza N, Tieghi T, Bernardini N, Tolino E, Dybala AE, Di Guardo A, Rallo A, Di Fraia M, Rossi MF, Vitiello M, Moscato U, Pellacani G, Lichtner M, Potenza C. A Case Report of Monkeypox in an Adult Patient from Italy: Clinical and Dermoscopic Manifestations, Diagnosis and Management. Vaccines (Basel) 2022; 10:1903. [PMID: 36366410 PMCID: PMC9694441 DOI: 10.3390/vaccines10111903] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/27/2022] [Accepted: 11/07/2022] [Indexed: 01/16/2024] Open
Abstract
Monkeypox infection is an emerging problem and a new challenge for modern medicine. With an increasing number of new cases worldwide, new data regarding the clinical manifestations, characteristics of the patients, risk factors and treatment options are coming to light. Knowing more about the disease will allow to elaborate new helpful methods to facilitate its diagnosis. Special attention should be paid to the careful dermatologic and dermoscopic examination of the patient. The analysis of available data also suggests possible strategies for the prevention of Monkeypox virus spread; the vaccine against Smallpox seems to be an effective solution. This case report describes the diagnostic approach and management of a non-vaccinated adult patient with several risk factors and a history of sexually transmitted disease. The patient had no history of travel abroad. Even though a clinical diagnose of Monkeypox can be challenging due to its similarities with skin rashes caused by other Orthopoxviral infections, there are fine differences between the rashes which can be helpful in their differentiation, although laboratory analysis is required for a definitive identification. A careful study of the characteristics of the rash, such as diameter, its presence on palms and soles and its evolution in time, provided important clues for the diagnosis of Monkeypox infection. The lack of vaccinations in the history of the patient was another crucial finding in the diagnostic process.
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Affiliation(s)
- Ilaria Proietti
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit “Daniele Innocenzi”, Sapienza University of Rome, Polo Pontino, Fiorini Hospital, 04019 Terracina, Italy
| | - Paolo Emilio Santoro
- Department of Health Science and Public Health, Catholic University of the Sacred Heart, 00168 Roma, Italy
| | - Nevena Skroza
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit “Daniele Innocenzi”, Sapienza University of Rome, Polo Pontino, Fiorini Hospital, 04019 Terracina, Italy
| | - Tiziana Tieghi
- Department of Neurosciences Public Health and Organs of Sense, Infectious Diseases Unit, Sapienza University of Rome, Santa Maria Goretti Hospital, 04100 Latina, Italy
| | - Nicoletta Bernardini
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit “Daniele Innocenzi”, Sapienza University of Rome, Polo Pontino, Fiorini Hospital, 04019 Terracina, Italy
| | - Ersilia Tolino
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit “Daniele Innocenzi”, Sapienza University of Rome, Polo Pontino, Fiorini Hospital, 04019 Terracina, Italy
| | - Agnieszka Ewa Dybala
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit “Daniele Innocenzi”, Sapienza University of Rome, Polo Pontino, Fiorini Hospital, 04019 Terracina, Italy
| | - Antonio Di Guardo
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit “Daniele Innocenzi”, Sapienza University of Rome, Polo Pontino, Fiorini Hospital, 04019 Terracina, Italy
| | - Alessandra Rallo
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit “Daniele Innocenzi”, Sapienza University of Rome, Polo Pontino, Fiorini Hospital, 04019 Terracina, Italy
| | - Marco Di Fraia
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit “Daniele Innocenzi”, Sapienza University of Rome, Polo Pontino, Fiorini Hospital, 04019 Terracina, Italy
| | - Maria Francesca Rossi
- Department of Health Science and Public Health, Catholic University of the Sacred Heart, 00168 Roma, Italy
| | - Martina Vitiello
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit “Daniele Innocenzi”, Sapienza University of Rome, Polo Pontino, Fiorini Hospital, 04019 Terracina, Italy
| | - Umberto Moscato
- Department of Health Science and Public Health, Catholic University of the Sacred Heart, 00168 Roma, Italy
| | - Giovanni Pellacani
- Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Miriam Lichtner
- Department of Neurosciences Public Health and Organs of Sense, Infectious Diseases Unit, Sapienza University of Rome, Santa Maria Goretti Hospital, 04100 Latina, Italy
| | - Concetta Potenza
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit “Daniele Innocenzi”, Sapienza University of Rome, Polo Pontino, Fiorini Hospital, 04019 Terracina, Italy
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28
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Betancort-Plata C, Lopez-Delgado L, Jaén-Sanchez N, Tosco-Nuñez T, Suarez-Hormiga L, Lavilla-Salgado C, Pisos-Álamo E, Hernández-Betancor A, Hernández-Cabrera M, Carranza-Rodríguez C, Briega-Molina M, Pérez-Arellano JL. Monkeypox and HIV in the Canary Islands: A Different Pattern in a Mobile Population. Trop Med Infect Dis 2022; 7:318. [PMID: 36288059 PMCID: PMC9608065 DOI: 10.3390/tropicalmed7100318] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The clinical and epidemiological data of the recent outbreak of monkeypox (MPX) differ from previous reports. One difference is the epidemiological profile; the disease mainly affects a subgroup of MSM (men who have sex with men) with high-risk sexual behaviors, frequently persons living with human immunodeficiency virus (PLHIV). METHODS In this observational analysis, all patients with PCR (polymerase chain reaction)-confirmed MPX attending an Infectious Diseases and Tropical Medicine Unit in Gran Canaria (Spain) between May and July 2022 were considered. RESULTS In total, 42 men were included; 88% were identified as MSM, with a median age of 40 years. Only 43% were born in Spain. All the patients had systemic symptoms and skin lesions. The distribution of lesions was more frequent in the genital/anal region, and the involvement of hands and feet was less common. Fever and lymphadenopathies were less frequent than in other series. Other unusual manifestations were proctitis, pharyngitis and penile-scrotal edema. Half of the patients had other associated infections (mainly STIs, sexually transmitted infections), and 60% of the monkeypox patients had PLHIV (People Living with HIV). When comparing the clinical characteristics between HIV-positive and -negative patients, we found three main differences: (i) a higher frequency of perioral lesions, (ii) a higher frequency of pharyngitis and (iii) a higher number of sexually transmitted infections in HIV-positive patients. CONCLUSIONS The clinical findings in this outbreak of MPX had great variability in presentation. Several clinical differences were found in PLHIV-coinfected patients.
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Affiliation(s)
- Christian Betancort-Plata
- Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Laura Lopez-Delgado
- Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Nieves Jaén-Sanchez
- Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Tomás Tosco-Nuñez
- Servicio de Microbiología y Parasitología, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Laura Suarez-Hormiga
- Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Carmen Lavilla-Salgado
- Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Elena Pisos-Álamo
- Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
- Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Araceli Hernández-Betancor
- Servicio de Microbiología y Parasitología, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Michele Hernández-Cabrera
- Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
- Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Cristina Carranza-Rodríguez
- Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
- Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Marta Briega-Molina
- Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - José-Luis Pérez-Arellano
- Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
- Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
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Patauner F, Gallo R, Durante-Mangoni E. Monkeypox infection: An update for the practicing physician. Eur J Intern Med 2022; 104:1-6. [PMID: 35999095 PMCID: PMC9528240 DOI: 10.1016/j.ejim.2022.08.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 01/09/2023]
Abstract
As of August 5, 2022, >26,000 cases of monkeypox have been diagnosed worldwide and the steep increase of cases has spurred renewed concern about the risk for another viral pandemic. In this narrative review, we address etiology, epidemiology and virology of monkeypox, describing routes of transmission and modes of spread. We also describe the current clinical presentation of monkeypox, focusing on circumstances where the disease should be suspected, and the methods to diagnose it. Finally, we briefly describe available treatments and strategies for active immune prophylaxis.
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Affiliation(s)
- Fabian Patauner
- Department of Precision Medicine, University fo Campania 'Luigi Vanvitelli' & Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | - Raffaella Gallo
- Department of Precision Medicine, University fo Campania 'Luigi Vanvitelli' & Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University fo Campania 'Luigi Vanvitelli' & Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy.
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30
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León-Figueroa DA, Barboza JJ, Garcia-Vasquez EA, Bonilla-Aldana DK, Diaz-Torres M, Saldaña-Cumpa HM, Diaz-Murillo MT, Cruz OCS, Rodriguez-Morales AJ. Epidemiological Situation of Monkeypox Transmission by Possible Sexual Contact: A Systematic Review. Trop Med Infect Dis 2022; 7:267. [PMID: 36288008 PMCID: PMC9607952 DOI: 10.3390/tropicalmed7100267] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022] Open
Abstract
Monkeypox (MPX), a zoonotic infection caused by the monkeypox virus (MPXV), has re-emerged worldwide with numerous confirmed cases with person-to-person transmission through close contacts, including in sexual networks. Therefore, this study aimed to determine the epidemiological situation of monkeypox transmission by possible sexual contact. A systematic literature review was conducted using PubMed, Scopus, Web of Science, and Embase databases until 18 August 2022. The key search terms used were "monkeypox", "sexual contact", "sexual intercourse" and "sexual transmission". A total of 1291 articles were retrieved using the search strategy. After eliminating duplicates (n = 738) and examining by title, abstract, and full text, 28 studies reporting case reports of monkeypox with a detailed description of clinical features, sexually transmitted diseases, method of diagnosis, location and course of skin lesions, and treatment were included. A total of 4222 confirmed cases of monkeypox have been reported, of which 3876 monkeypox cases are the result of transmission by sexual contact distributed in twelve countries: 4152 cases were male with a mean age of 36 years. All confirmed cases of monkeypox were diagnosed by reverse transcriptase-polymerase chain reaction (RT-PCR). The most frequent clinical manifestations were fever, lymphadenopathy, headache, malaise, and painful perianal and genital lesions. The most frequent locations of the lesions were perianal, genital, oral, trunk, upper and lower extremities. Patients were in good clinical condition, with treatment based on analgesics and antipyretics to relieve some symptoms of monkeypox. A high proportion of STIs and frequent anogenital symptoms were found, suggesting transmissibility through local inoculation during close skin-to-skin or mucosal contact during sexual activity. The highest risk of monkeypox transmission occurs in men who have sex with men, and MPXV DNA could be recovered in seminal fluid. It is essential to establish health policies for the early detection and management of patients with monkeypox.
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Affiliation(s)
- Darwin A. León-Figueroa
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 15011, Peru
- Centro de Investigación en Atención Primaria en Salud, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
- Sociedad Científica de Estudiantes de Medicina Veritas (SCIEMVE), Chiclayo, Peru
| | - Joshuan J. Barboza
- Vicerrectorado de Investigación, Universidad Norbert Wiener, Lima 15046, Peru
| | - Edwin A. Garcia-Vasquez
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 15011, Peru
- Sociedad Científica de Estudiantes de Medicina Veritas (SCIEMVE), Chiclayo, Peru
| | - D. Katterine Bonilla-Aldana
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundacion Universitaria Autonoma de Las Americas, Pereira 660001, Risaralda, Colombia
- Latin American Network of MOnkeypox VIrus Research (LAMOVI), Pereira, Risaralda, Colombia
| | - Milagros Diaz-Torres
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 15011, Peru
- Sociedad Científica de Estudiantes de Medicina Veritas (SCIEMVE), Chiclayo, Peru
| | - Hortencia M. Saldaña-Cumpa
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 15011, Peru
- Sociedad Científica de Estudiantes de Medicina Veritas (SCIEMVE), Chiclayo, Peru
| | - Melissa T. Diaz-Murillo
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 15011, Peru
- Sociedad Científica de Estudiantes de Medicina Veritas (SCIEMVE), Chiclayo, Peru
| | - Olga Campos-Santa Cruz
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 15011, Peru
- Sociedad Científica de Estudiantes de Medicina Veritas (SCIEMVE), Chiclayo, Peru
| | - Alfonso J. Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundacion Universitaria Autonoma de Las Americas, Pereira 660001, Risaralda, Colombia
- Latin American Network of MOnkeypox VIrus Research (LAMOVI), Pereira, Risaralda, Colombia
- Master of Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur, Lima 15067, Peru
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Ramoni S, Maronese CA, Morini N, Avallone G, Quattri E, Carrera CG, Boggio FL, Marzano AV. Syphilis and monkeypox co-infection: Coincidence, synergy or asymptomatic carriage? Travel Med Infect Dis 2022; 50:102447. [PMID: 36067937 DOI: 10.1016/j.tmaid.2022.102447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Stefano Ramoni
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Nicole Morini
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Gianluca Avallone
- Department of Medical Sciences, University of Turin, Dermatology Clinic, Turin, Italy
| | - Eleonora Quattri
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Carlo Giovanni Carrera
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy.
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Quattri E, Avallone G, Maronese CA, Cusini M, Carrera CG, Marzano AV, Ramoni S. Unilesional monkeypox: A report of two cases from Italy. Travel Med Infect Dis 2022; 49:102424. [PMID: 35961491 PMCID: PMC9533888 DOI: 10.1016/j.tmaid.2022.102424] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 11/02/2022]
Affiliation(s)
- Eleonora Quattri
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
| | - Gianluca Avallone
- Department of Medical Sciences, University of Turin, Dermatology Clinic, Turin, Italy
| | - Carlo A Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Marco Cusini
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo G Carrera
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Stefano Ramoni
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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See KC. Vaccination for Monkeypox Virus Infection in Humans: A Review of Key Considerations. Vaccines (Basel) 2022; 10:vaccines10081342. [PMID: 36016230 PMCID: PMC9413102 DOI: 10.3390/vaccines10081342] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 01/08/2023] Open
Abstract
Monkeypox virus infection in humans (MVIH) is currently an evolving public health concern given that >3000 MVIH cases have been reported in >50 countries globally, and the World Health Organization declared monkeypox a global health emergency on 23 July 2022. Adults (≥16 years old) usually have mild disease in contemporary studies, with a pooled case fatality rate of 0.03% (1/2941 cases). In comparison, poorer outcomes have been reported in children <16 years old (pooled case fatality rate 19% (4/21 cases)), immunocompromised patients, and pregnant women, with high rates of fetal demise in this group. Monkeypox-specific treatments include oral or intravenous tecovirimat, intravenous or topical cidofovir, oral brincidofovir, and vaccinia immunoglobulin, but the overall risk−benefit balance of monkeypox-specific treatment is unclear. Two effective vaccines exist for the prevention of MVIH: modified vaccinia Ankara and ACAM2000. Most probably, vaccination will be a key strategy for mitigating MVIH given the current rapid global spread of monkeypox, the existence of efficacious vaccines, and the uncertain risk−benefit profile of current antivirals. Priority groups for vaccination should include healthcare workers at high risk for occupational exposure, immunocompromised patients, and children. Vaccination strategies include pre-exposure vaccination, post-exposure prophylaxis, and ring vaccination of close contacts.
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Affiliation(s)
- Kay Choong See
- Division of Respiratory & Critical Care Medicine, Department of Medicine, National University Hospital, Singapore 119228, Singapore
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