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Cole J, Choudry S, Kular S, Payne T, Akili S, Callaby H, Gordon NC, Ankcorn M, Martin A, Hobson E, Tunbridge AJ. Monkeypox encephalitis with transverse myelitis in a female patient. Lancet Infect Dis 2023; 23:e115-e120. [PMID: 36470282 PMCID: PMC9718539 DOI: 10.1016/s1473-3099(22)00741-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 12/05/2022]
Abstract
The 2022 monkeypox outbreak has affected 110 countries worldwide, outside of classic endemic areas (ie, west Africa and central Africa). On July 23, 2022, the outbreak was classified by WHO as a public health emergency of international concern. Clinical presentation varies from mild to life-changing symptoms; neurological complications are relatively uncommon and there are few therapeutic interventions for monkeypox disease. In this Grand Round, we present a case of monkeypox with encephalitis complicated by transverse myelitis in a previously healthy woman aged 35 years who made an almost complete recovery from her neurological symptoms after treatment with tecovirimat, cidofovir, steroids, and plasma exchange. We describe neurological complications associated with orthopoxvirus infections and laboratory diagnosis, the radiological features in this case, and discuss treatment options.
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Affiliation(s)
- Joby Cole
- Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Department of Infection, Immunity, and Cardiovascular Diseases, University of Sheffield, Sheffield, UK.
| | - Saher Choudry
- Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Saminderjit Kular
- Department of Neuroradiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Thomas Payne
- Academic Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Suha Akili
- Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Department of Virology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Helen Callaby
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, UK
| | - N Claire Gordon
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, UK
| | - Michael Ankcorn
- Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Department of Virology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Andrew Martin
- Department of Neuroradiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Esther Hobson
- Academic Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Anne J Tunbridge
- Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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2
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Ankcorn M, Said B, Morgan D, Elsharkawy AM, Maggs J, Ryder S, Valliani T, Gordon F, Abeysekera K, Suri D, McPherson S, Galliford J, Smith B, Pelosi E, Bansal S, Bethune C, Sheridan D, Vine L, Tedder RS, Ijaz S, Zuckerman M, Dalton H, Healy B, Donati M, Bicknell K, Evans C, Poller B, Smit E, Halsema C, Williams E, Raza M, McGann H, Irving W, Douthwaite S, Ch'ng CL, McCaughey C, Irish D. Persistent Hepatitis E virus infection across England and Wales 2009-2017: Demography, virology and outcomes. J Viral Hepat 2021; 28:420-430. [PMID: 33073452 DOI: 10.1111/jvh.13424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/20/2020] [Accepted: 10/02/2020] [Indexed: 01/11/2023]
Abstract
The first clinical case of persistent HEV infection in England was reported in 2009. We describe the demography, virology and outcomes of patients identified with persistent HEV infection in England and Wales between 2009 and 2017. A series of 94 patients with persistent HEV infection, defined by HEV viraemia of more than 12 weeks, was identified through routine reference laboratory testing. Virology, serology and clinical data were recorded through an approved PHE Enhanced Surveillance System. Sixty-six cases (70.2%) were transplant recipients, 16 (17.0%) had an underlying haematological malignancy without stem cell transplantation, six (6.4%) had advanced HIV infection, five (5.3%) were otherwise immunosuppressed, and one patient (1.1%) had no identified immunosuppression. Retrospective analysis of 46 patients demonstrated a median 38 weeks of viraemia before diagnostic HEV testing. At initial diagnosis, 16 patients (17.0%) had no detectable anti-HEV serological response. Of 65 patients treated with ribavirin monotherapy, 11 (16.9%) suffered virological relapse despite undetectable RNA in plasma or stool at treatment cessation. Persistent HEV infection remains a rare diagnosis, but we demonstrate that a broad range of immunocompromised patients are susceptible. Both lack of awareness and the pauci-symptomatic nature of persistent HEV infection likely contribute to significant delays in diagnosis. Diagnosis should rely on molecular testing since anti-HEV serology is insufficient to exclude persistent HEV infection. Finally, despite treatment with ribavirin, relapses occur even after cessation of detectable faecal shedding of HEV RNA, further emphasising the requirement to demonstrate sustained virological responses to treatment.
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Affiliation(s)
- Michael Ankcorn
- Blood Borne Virus Unit, Virus Reference Department, National Infection Service, Public Health England, London, UK.,Transfusion Microbiology, National Health Service Blood and Transplant, London, UK
| | - Bengü Said
- Emerging Infections and Zoonoses, National Infection Service, Public Health England, London, UK
| | - Dilys Morgan
- Emerging Infections and Zoonoses, National Infection Service, Public Health England, London, UK
| | | | - James Maggs
- Department of Gastroenterology, Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
| | - Stephen Ryder
- Department of Hepatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Talal Valliani
- North Bristol Liver Unit, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Fiona Gordon
- Department of Hepatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Kushala Abeysekera
- Department of Hepatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Deepak Suri
- Department of Hepatology, University College London Hospitals, London, UK
| | - Stuart McPherson
- Liver Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, & Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - Jack Galliford
- Department of Nephrology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Belinda Smith
- Department of Hepatology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Emanuela Pelosi
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sanjay Bansal
- Department of Paediatric Hepatology, Gastroenterology & Nutrition Center, King's College Hospital NHS Foundation Trust, London, UK
| | - Claire Bethune
- Department of Immunology and Allergy, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - David Sheridan
- South West Liver Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Louisa Vine
- South West Liver Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Richard S Tedder
- Blood Borne Virus Unit, Virus Reference Department, National Infection Service, Public Health England, London, UK.,Transfusion Microbiology, National Health Service Blood and Transplant, London, UK.,Department of Medicine, Imperial College London, London, UK
| | - Samreen Ijaz
- Blood Borne Virus Unit, Virus Reference Department, National Infection Service, Public Health England, London, UK
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3
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Colton H, Ankcorn M, Yavuz M, Tovey L, Cope A, Raza M, Keeley AJ, State A, Poller B, Parker M, de Silva TI, Evans C. Improved sensitivity using a dual target, E and RdRp assay for the diagnosis of SARS-CoV-2 infection: Experience at a large NHS Foundation Trust in the UK. J Infect 2020; 82:159-198. [PMID: 32474037 PMCID: PMC7255707 DOI: 10.1016/j.jinf.2020.05.061] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Hayley Colton
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Michael Ankcorn
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
| | - Mehmet Yavuz
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Leeanne Tovey
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Alison Cope
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Mohammad Raza
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Alexander J Keeley
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Amy State
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Bozena Poller
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Matthew Parker
- Sheffield Biomedical Research Centre, Sheffield Bioinformatics Core, The Medical School, The University of Sheffield, United Kingdom
| | - Thushan I de Silva
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The Department of Infection, Immunity and Cardiovascular Disease, The Medical School, The University of Sheffield, United Kingdom
| | - Cariad Evans
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
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Keeley AJ, Evans C, Colton H, Ankcorn M, Cope A, State A, Bennett T, Giri P, de Silva TI, Raza M. Roll-out of SARS-CoV-2 testing for healthcare workers at a large NHS Foundation Trust in the United Kingdom, March 2020. ACTA ACUST UNITED AC 2020; 25. [PMID: 32290904 PMCID: PMC7160437 DOI: 10.2807/1560-7917.es.2020.25.14.2000433] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Healthcare workers (HCW) are potentially at increased risk of infection with coronavirus disease (COVID-19) and may transmit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to vulnerable patients. We present results from staff testing at Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom. Between 16 and 29 March 2020, 1,533 symptomatic HCW were tested, of whom 282 (18%) were positive for SARS-CoV-2. Testing HCW is a crucial strategy to optimise staffing levels during this outbreak.
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Affiliation(s)
- Alexander J Keeley
- The Department of Infection, Immunity and Cardiovascular Disease, The Medical School, The University of Sheffield, United Kingdom.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Cariad Evans
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Hayley Colton
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Michael Ankcorn
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Alison Cope
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Amy State
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Tracy Bennett
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Prosenjit Giri
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Thushan I de Silva
- The Department of Infection, Immunity and Cardiovascular Disease, The Medical School, The University of Sheffield, United Kingdom.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Mohammad Raza
- The Department of Infection, Immunity and Cardiovascular Disease, The Medical School, The University of Sheffield, United Kingdom.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
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5
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Ankcorn M, Gallacher J, Ijaz S, Taha Y, Harvala H, Maclennan S, Thomson EC, Davis C, Singer JB, da Silva Filipe A, Smollett K, Niebel M, Semple MG, Tedder RS, McPherson S. Convalescent plasma therapy for persistent hepatitis E virus infection. J Hepatol 2019; 71:434-438. [PMID: 31075322 PMCID: PMC7126959 DOI: 10.1016/j.jhep.2019.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/17/2019] [Accepted: 04/22/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Michael Ankcorn
- Blood Borne Virus Unit, Virus Reference Department, National Infection Service, Public Health England, Colindale, London, UK; Transfusion Microbiology, National Health Service Blood and Transplant, London, UK.
| | - Jennifer Gallacher
- Liver Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Samreen Ijaz
- Blood Borne Virus Unit, Virus Reference Department, National Infection Service, Public Health England, Colindale, London, UK
| | - Yusri Taha
- Departments of Virology and Infectious Diseases, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Heli Harvala
- Transfusion Microbiology, National Health Service Blood and Transplant, London, UK
| | - Sheila Maclennan
- Transfusion Medicine, National Health Service Blood and Transplant, Leeds, UK
| | - Emma C. Thomson
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Chris Davis
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Joshua B. Singer
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | | | | | - Marc Niebel
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Malcolm G. Semple
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Richard S. Tedder
- Blood Borne Virus Unit, Virus Reference Department, National Infection Service, Public Health England, Colindale, London, UK,Transfusion Microbiology, National Health Service Blood and Transplant, London, UK,Department of Medicine, Imperial College London, London, UK
| | - Stuart McPherson
- Liver Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, UK.
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Ankcorn M, Haywood B, Tedder R, Ijaz S. Response to: 'Chronic genotype 1 hepatitis E infection from immunosuppression for ileo-colonic Crohn's disease'. Oxf Med Case Reports 2019; 2019:omy125. [PMID: 30800323 PMCID: PMC6380527 DOI: 10.1093/omcr/omy125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/20/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Michael Ankcorn
- Virus Reference Department, Public Health England, London, UK.,Reference Microbiology, NHS Blood and Transport, London, UK
| | - Becky Haywood
- Virus Reference Department, Public Health England, London, UK
| | - Richard Tedder
- Virus Reference Department, Public Health England, London, UK.,Reference Microbiology, NHS Blood and Transport, London, UK.,Division of Infection and Immunity, University College London, London, UK
| | - Samreen Ijaz
- Virus Reference Department, Public Health England, London, UK
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7
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Soothill G, Hessey S, Erotocritou M, Griffiths P, Ijaz S, Thorburn D, Ankcorn M, Irish D. Diagnostic utility of hepatitis E virus antigen-specific ELISA versus PCR testing in a cohort of post liver transplant patients in a large university hospital. J Clin Virol 2018; 106:44-48. [DOI: 10.1016/j.jcv.2018.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/08/2018] [Accepted: 07/20/2018] [Indexed: 01/28/2023]
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8
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Ankcorn M, Evans C, Green ST. Acute painless hepatitis in pregnancy--a cause for concern? BMJ 2014; 349:g7686. [PMID: 25550169 DOI: 10.1136/bmj.g7686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Michael Ankcorn
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield S10 2JF, UK Northern General Hospital, Sheffield Teaching Hospitals, Sheffield S5 7AU, UK
| | - Cariad Evans
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield S10 2JF, UK Northern General Hospital, Sheffield Teaching Hospitals, Sheffield S5 7AU, UK
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9
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Chadwick D, Ankcorn M, Sarfo F, Phillips R, Fox Z, Garcia A, Appiah L, Bedu-Addo G, Geretti AM. Outcomes of starting first-line antiretroviral therapy in hepatitis B virus/HIV-coinfected patients in Ghana. J Antimicrob Chemother 2012; 67:2939-42. [DOI: 10.1093/jac/dks333] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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