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O’Shea J, Zucker J, Stampfer S, Cash-Goldwasser S, Minhaj FS, Dretler A, Cheeley J, Chaudhuri S, Gallitano SM, Gunaratne S, Parkinson M, Epling B, Morcock DR, Sereti I, Deleage C. Prolonged Mpox Disease in People With Advanced HIV: Characterization of Mpox Skin Lesions. J Infect Dis 2024; 229:S243-S248. [PMID: 38019806 PMCID: PMC10965209 DOI: 10.1093/infdis/jiad532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023] Open
Abstract
We report 3 complicated and prolonged cases of mpox in people with advanced human immunodeficiency virus (HIV) not on antiretroviral therapy (ART) at mpox diagnosis. Multiple medical countermeasures were used, including prolonged tecovirimat treatment and immune optimization with ART initiation. Immunofluorescence of skin biopsies demonstrated a dense immune infiltrate of predominantly myeloid and CD8+ T cells, with a strong type I interferon local response. RNAscope detected abundant replication of monkeypox virus (MPXV) in epithelial cells and dendritic cells. These data suggest that prolonged mpox in people with advanced HIV may be due to ongoing MPXV replication, warranting aggressive medical countermeasures and immune optimization.
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Affiliation(s)
- Jesse O’Shea
- Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jason Zucker
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York
| | - Samuel Stampfer
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Shama Cash-Goldwasser
- Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Faisal S Minhaj
- Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alexandra Dretler
- Division of Infectious Diseases, Atlanta and Emory Decatur Hospital, Decatur, Georgia
| | - Justin Cheeley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Shaoli Chaudhuri
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York
| | - Stephanie M Gallitano
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Shauna Gunaratne
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York
| | - Melissa Parkinson
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York
| | - Brian Epling
- HIV Pathogenesis Section, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - David R Morcock
- AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Irini Sereti
- HIV Pathogenesis Section, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Claire Deleage
- AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, Maryland
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Zucker J, McLean J, Huang S, DeLaurentis C, Gunaratne S, Stoeckle K, Glesby MJ, Wilkin TJ, Fischer W, Damon I, Brooks JT. Development and Pilot of an Mpox Severity Scoring System. J Infect Dis 2024; 229:S229-S233. [PMID: 37956401 DOI: 10.1093/infdis/jiad492] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 11/15/2023] Open
Abstract
Clinical severity scores facilitate comparisons to understand risk factors for severe illness. For the 2022 multinational monkeypox clade IIb virus outbreak, we developed a 7-item Mpox Severity Scoring System (MPOX-SSS) with initial variables refined by data availability and parameter correlation. Application of MPOX-SSS to the first 200 patients diagnosed with mpox revealed higher scores in those treated with tecovirimat, presenting >3 days after symptom onset, and with CD4 counts <200 cells/mm3. For individuals evaluated repeatedly, serial scores were concordant with clinical observations. The pilot MPOX-SSS demonstrated good discrimination, distinguished change over time, and identified higher scores in expected groups.
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Affiliation(s)
- Jason Zucker
- Division of Infectious Diseases, Vagelos College of Physicians and Surgeons, Columbia University, NewYork, New York
| | - Jacob McLean
- Division of Infectious Diseases, Vagelos College of Physicians and Surgeons, Columbia University, NewYork, New York
| | - Simian Huang
- Division of Infectious Diseases, Vagelos College of Physicians and Surgeons, Columbia University, NewYork, New York
| | - Clare DeLaurentis
- Division of Infectious Diseases, Vagelos College of Physicians and Surgeons, Columbia University, NewYork, New York
| | - Shauna Gunaratne
- Division of Infectious Diseases, Vagelos College of Physicians and Surgeons, Columbia University, NewYork, New York
| | - Kate Stoeckle
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY
| | - Marshall J Glesby
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY
| | - Timothy J Wilkin
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY
| | - William Fischer
- Institute of Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill
| | - Inger Damon
- Centers for Disease Control and Prevention, Atlanta, GA
| | - John T Brooks
- Centers for Disease Control and Prevention, Atlanta, GA
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McLean J, Gunaratne S, Zucker J. Update on Mpox: What the Primary Care Clinician Should Know. Med Clin North Am 2024; 108:355-371. [PMID: 38331485 PMCID: PMC10853636 DOI: 10.1016/j.mcna.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Mpox is a viral infection, which primarily caused sporadic outbreaks in West and Central Africa until causing a global epidemic in 2022. The disease has disproportionately affected people with human immunodeficiency virus and men who have sex with men. Transmission is through close physical contact, including sexual contact. Infection presents with a characteristic rash, with frequent anogenital involvement-polymerase chain reaction of skin lesions is diagnostic. Vaccination is available for primary prevention and postexposure prophylaxis. Treatment consists of supportive care, with antiviral medications available via clinical trials and/or for patients with severe disease.
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Affiliation(s)
- Jacob McLean
- Division of Infectious Diseases, Columbia University Medical Center, 630 W 168th Street, Suite 876, New York, NY 10032, USA.
| | - Shauna Gunaratne
- Division of Infectious Diseases, Columbia University Medical Center, 630 W 168th Street, Suite 876, New York, NY 10032, USA
| | - Jason Zucker
- Division of Infectious Diseases, Columbia University Medical Center, 630 W 168th Street, Suite 876, New York, NY 10032, USA
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Cotton JJ, Lang FM, Onyilofor C, Ritter A, Gunaratne S. Lemierre Syndrome Complicated by Emphysematous Osteomyelitis. Cureus 2023; 15:e43719. [PMID: 37724221 PMCID: PMC10505499 DOI: 10.7759/cureus.43719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
Lemierre syndrome is characterized by severe pharyngitis, internal jugular vein thrombosis, and septic emboli. We present a case of emphysematous osteomyelitis secondary to Lemierre syndrome in a 27-year-old previously healthy man. Despite the high mortality associated with these conditions, full symptom resolution can be achieved with early diagnosis and aggressive management.
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Affiliation(s)
- Jesse J Cotton
- Infectious Disease, Columbia University College of Physicians and Surgeons, New York, USA
| | - Frederick M Lang
- Infectious Disease, Columbia University College of Physicians and Surgeons, New York, USA
| | | | - Abigail Ritter
- Internal Medicine, Columbia Irving Medical Center, New York, USA
| | - Shauna Gunaratne
- Infectious Disease, Columbia Irving Medical Center, New York, USA
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Anand P, Mukerji S, Gunaratne S, Thon J, Cho T, Venna N. 1406. Steroid-Sparing Agents to Control Inflammation in Complicated Neurocysticercosis: Three Cases. Open Forum Infect Dis 2019. [PMCID: PMC6809049 DOI: 10.1093/ofid/ofz360.1270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Clinical manifestations of neurocysticercosis (NCC) are primarily due to the inflammatory response against degenerating cysts of the Taenia solium tapeworm. Inflammation can occur when cysts lose their ability to evade the host immune response during their natural life cycle or result from antihelminthic therapy. A subset can develop chronic perilesional edema requiring immunosuppressive therapy. Although guidelines recommend methotrexate (MTX) as an alternative to long-term steroids, limited information is available regarding when to start a steroid-sparing agent (SSA) and alternative SSAs in case of MTX failure or intolerance. Methods Retrospective chart review. Results Three patients with complicated NCC followed at a single tertiary care center are described in this study: Patient 1 with subarachnoid NCC (age 64, female), patient 2 with subarachnoid and intraventricular NCC (age 48, male) and patient 3 with parenchymal NCC (age 43, male). Patients 1–3 were followed clinically and radiographically for 8, 1.5 and 3 years, respectively. Patient 1 was treated with antihelminthic therapy and steroids for 24 months. She was transitioned to MTX for 1 month, but developed ulcerative stomatitis, leukopenia and transaminitis. She completed a treatment course of steroids, complicated by osteoporosis. Patient 2 was treated with 12 months of antihelminthic therapy and steroids with resolution of a previously positive cysticercal antigen in spinal fluid. Imaging revealed persistent inflammation in spite of adequate antihelminthic therapy. He was started on MTX and has remained on this medication for 5 months. Patient 3 was treated with two courses of antihelminthic therapy. He developed perilesional edema despite treatment with steroids and MTX uptitrated to 20 mg weekly. Adalimumab was added to his regimen and he had a rapid radiographic resolution of edema and clinical improvement in seizures. His seizures returned during an interruption in his adalimumab treatment and again resolved with re-initiation of this medication. Conclusion SSAs are beneficial in the long-term treatment of patients with subarachnoid NCC or chronic perilesional edema. The formulation of guidelines that include multiple options for SSAs will be essential in guiding management of complicated NCC. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Pria Anand
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Jesse Thon
- University of Pennsylvania, Philadelphia, Pennsylvania
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Anand P, Mukerji SS, Thon J, Gunaratne S, Cho TA, Venna N. Steroid-sparing agents for the treatment of inflammation in complicated neurocysticercosis. Neurol Neuroimmunol Neuroinflamm 2019; 6:6/6/e606. [PMID: 31454762 PMCID: PMC6745724 DOI: 10.1212/nxi.0000000000000606] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/05/2019] [Indexed: 12/03/2022]
Affiliation(s)
- Pria Anand
- From the Division of Neuroimmunology and Neuro-Infectious Diseases (P.A., S.S.M., N.V.), Department of Neurology, Massachusetts General Hospital, Boston; Department of Neurology (J.T.), University of Pennsylvania, Philadelphia; Division of Infectious Diseases (S.G.), Massachusetts General Hospital, Boston; and Division of Neuroimmunology (T.A.C.), Department of Neurology, University of Iowa.
| | - Shibani S Mukerji
- From the Division of Neuroimmunology and Neuro-Infectious Diseases (P.A., S.S.M., N.V.), Department of Neurology, Massachusetts General Hospital, Boston; Department of Neurology (J.T.), University of Pennsylvania, Philadelphia; Division of Infectious Diseases (S.G.), Massachusetts General Hospital, Boston; and Division of Neuroimmunology (T.A.C.), Department of Neurology, University of Iowa
| | - Jesse Thon
- From the Division of Neuroimmunology and Neuro-Infectious Diseases (P.A., S.S.M., N.V.), Department of Neurology, Massachusetts General Hospital, Boston; Department of Neurology (J.T.), University of Pennsylvania, Philadelphia; Division of Infectious Diseases (S.G.), Massachusetts General Hospital, Boston; and Division of Neuroimmunology (T.A.C.), Department of Neurology, University of Iowa
| | - Shauna Gunaratne
- From the Division of Neuroimmunology and Neuro-Infectious Diseases (P.A., S.S.M., N.V.), Department of Neurology, Massachusetts General Hospital, Boston; Department of Neurology (J.T.), University of Pennsylvania, Philadelphia; Division of Infectious Diseases (S.G.), Massachusetts General Hospital, Boston; and Division of Neuroimmunology (T.A.C.), Department of Neurology, University of Iowa
| | - Tracey A Cho
- From the Division of Neuroimmunology and Neuro-Infectious Diseases (P.A., S.S.M., N.V.), Department of Neurology, Massachusetts General Hospital, Boston; Department of Neurology (J.T.), University of Pennsylvania, Philadelphia; Division of Infectious Diseases (S.G.), Massachusetts General Hospital, Boston; and Division of Neuroimmunology (T.A.C.), Department of Neurology, University of Iowa
| | - Nagagopal Venna
- From the Division of Neuroimmunology and Neuro-Infectious Diseases (P.A., S.S.M., N.V.), Department of Neurology, Massachusetts General Hospital, Boston; Department of Neurology (J.T.), University of Pennsylvania, Philadelphia; Division of Infectious Diseases (S.G.), Massachusetts General Hospital, Boston; and Division of Neuroimmunology (T.A.C.), Department of Neurology, University of Iowa
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Gunaratne S, Masinter L, Kolak M, Feinglass J. Change in Population Characteristics and Teen Birth Rates in 77 Community Areas: Chicago, Illinois, 1999-2009. Public Health Rep 2015; 130:372-9. [PMID: 26345288 DOI: 10.1177/003335491513000416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We analyzed community area differences in teen births in Chicago, Illinois, from 1999 to 2009. We analyzed the association between changes in teen birth rates and concurrent measures of community area socioeconomic and demographic change. METHODS Mean annual changes in teen birth rates in 77 Chicago community areas were correlated with concurrent census-based population changes during the decade. Census measures included changes in race/ethnicity, adult high school dropouts, poverty or higher-income households, crowded housing, unemployment, English proficiency, foreign-born residents, or residents who moved in the last five years. We included non-collinear census measures with a p<0.1 bivariate association with change in teen births in a stepwise multiple linear regression model. RESULTS Teen birth rates in Chicago fell faster than the overall birth rates, from 85 births per 1,000 teens in 1999 to 57 births per 1,000 teens in 2009. There were strong positive associations between increases in the percentage of residents who were black and Hispanic, poor, without a high school diploma, and living in crowded housing, and a negative association with an increase in higher-income households. Population changes in poverty, Hispanic population, and high school dropouts were the only significant measures in the final model, explaining almost half of the variance in teen birth rate changes. CONCLUSION The study provides a model of census-based measures that can be used to evaluate predicted vs. observed rates of change in teen births across communities, offering the potential to more appropriately prioritize public health resources for preventing unintended teen pregnancy.
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Affiliation(s)
- Shauna Gunaratne
- Northwestern University Feinberg School of Medicine, Department of Medicine, Chicago, IL
| | - Lisa Masinter
- Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology and Center for Healthcare Studies, Chicago, IL
| | - Marynia Kolak
- Northwestern University Feinberg School of Medicine, Institute of Public Health and Medicine, Chicago, IL
| | - Joe Feinglass
- Northwestern University Feinberg School of Medicine, Division of General Internal Medicine and Geriatrics, Chicago, IL
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Abstract
BACKGROUND Carcinoma of the true vocal cord represents the earliest clinically recognizable invasive malignancy in the head and neck region and provides a unique model for studying possible prognostic genetic markers. The aim of this study was to determine whether p53 overexpression correlated with tumor recurrence in a homogenous population of patients with early stage glottic carcinoma treated with radiotherapy alone. METHODS One hundred and fourteen patients with T1N0M0 squamous cell carcinoma of the glottis were treated with curative radiotherapy between 1976 and 1990. With a median follow-up of 6 years, actuarial local control was 80% with 23 local recurrences. Laryngeal biopsy specimens obtained prior to radiation therapy were analyzed retrospectively in 22 patients. Forty-five patients with local control were used as a control group. p53 overexpression indicating a mutated p53 gene was analyzed by immunohistochemistry using the mouse monoclonal antibody D0-7. RESULTS Approximately 82% of carcinomas that recurred locally expressed p53 compared with only 29% of those with local control (P < 0.001). No significant relation was noted between p53 expression and histologic grade. Intensity of staining did not predict tumor recurrence. CONCLUSIONS The authors believe that this case-controlled study demonstrated the role of p53 as an independent prognostic factor in patients with early stage glottic carcinoma.
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MESH Headings
- Actuarial Analysis
- Aged
- Aged, 80 and over
- Animals
- Antibodies, Monoclonal
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Biopsy
- Carcinoma, Squamous Cell/genetics
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Case-Control Studies
- Coloring Agents
- Female
- Follow-Up Studies
- Gene Expression Regulation, Neoplastic
- Genes, p53/genetics
- Glottis/pathology
- Glottis/radiation effects
- Humans
- Immunohistochemistry
- Laryngeal Neoplasms/genetics
- Laryngeal Neoplasms/pathology
- Laryngeal Neoplasms/radiotherapy
- Male
- Mice
- Middle Aged
- Mutation/genetics
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/prevention & control
- Neoplasm Staging
- Prognosis
- Retrospective Studies
- Tumor Suppressor Protein p53/analysis
- Tumor Suppressor Protein p53/genetics
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Affiliation(s)
- A Narayana
- Department of Radiotherapy, Loyola University Medical Center, Maywood, Illinois, USA
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