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Lima ELD, Barra LAC, Borges LMS, Medeiros LA, Tomishige MYS, Santos LDSLA, Silva AJDD, Rodrigues CCM, Azevedo LCFD, Villas-Boas LS, Silva CAMD, Coletti TM, Manuli ER, Claro IM, Romano CM, Ramundo MS, Moutinho T, Sabino EC, Lindoso JAL, Figueiredo-Mello C. First case report of monkeypox in Brazil: clinical manifestations and differential diagnosis with sexually transmitted infections. Rev Inst Med Trop Sao Paulo 2022; 64:e54. [PMID: 36074449 PMCID: PMC9448252 DOI: 10.1590/s1678-9946202264054] [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] [Received: 07/08/2022] [Accepted: 08/15/2022] [Indexed: 11/22/2022] Open
Abstract
In 2022, an outbreak of monkeypox is being reported in non-endemic areas, with unusual clinical manifestations. The detailed clinical description of the first patient that received the diagnosis of monkeypox in Brazil is reported here, whose clinical manifestations can easily lead to misdiagnosis of sexually transmitted infections. A 41 years old male presented to an emergency room with a vesicular rash with eight days of evolution. He had traveled to Portugal and Spain and reported non-penetrative sexual involvement with three different male individuals. On the third day of symptoms, he sought medical care and received empirical treatment directed to sexually transmitted infections. As the symptoms did not improve, he sought medical attention at an infectious disease referral center presenting, on admission, an ulcerated penile lesion with central necrotic crusts, a disseminated pleomorphic skin rash and an oropharyngeal ulcer. The monkeypox diagnosis was suspected due to the characteristics of the lesions and the history of intimate contact with casual partners, and it was later confirmed by sequencing the almost complete monkeypox genome. The patient was hospitalized for pain control, which required opiate administration. He developed a secondary bacterial infection on the penile lesions, which were treated with oral antibiotics. He was discharged after 14 days, with lesions in process of re-epithelialization. Given the current outbreak, we must consider the possibility of monkeypox in patients with suggestive lesions, anywhere on the body (including the genitals), added to an epidemiological link or history of intimate contact with strangers or casual partners.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Lucy Santos Villas-Boas
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Camila Alves Maia da Silva
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Thaís Moura Coletti
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Erika R Manuli
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Ingra Morales Claro
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil.,Imperial College London, MRC Centre for Global Infectious Disease Analysis, London, United Kingdom
| | - Camila Malta Romano
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Mariana Severo Ramundo
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Tomas Moutinho
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
| | - Ester Cerdeira Sabino
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - José Angelo Lauletta Lindoso
- Instituto de Infectologia Emílio Ribas, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, Laboratório de Protozoologia, São Paulo, São Paulo, Brazil
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Claro IM, Romano CM, Candido DDS, de Lima EL, Lindoso JAL, Ramundo MS, Moreira FRR, Barra LAC, Borges LMS, Medeiros LA, Tomishige MYS, Moutinho T, da Silva AJD, Rodrigues CCM, de Azevedo LCF, Villas-Boas LS, da Silva CAM, Coletti TM, Manuli ER, O’Toole A, Quick J, Loman N, Rambaut A, Faria NR, Figueiredo-Mello C, Sabino EC. Shotgun metagenomic sequencing of the first case of monkeypox virus in Brazil, 2022. Rev Inst Med Trop Sao Paulo 2022; 64:e48. [PMID: 35749419 PMCID: PMC9217064 DOI: 10.1590/s1678-9946202264048] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/21/2022] Open
Abstract
Monkeypox virus (MPXV), a zoonotic virus endemic to the African continent, has been reported in 33 non-endemic countries since May 2022. We report an almost complete genome of the first confirmed case of MPXV in Brazil. Shotgun metagenomic sequencing was completed in 18 hours, from DNA extraction to consensus sequence generation.
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Affiliation(s)
- Ingra Morales Claro
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
- Imperial College London, MRC Centre for Global Infectious Disease Analysis, London, United Kingdom
| | - Camila Malta Romano
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Darlan da Silva Candido
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
- Imperial College London, MRC Centre for Global Infectious Disease Analysis, London, United Kingdom
- University of Oxford, Department of Zoology, Oxford, United Kingdom
| | | | - José Angelo Lauletta Lindoso
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
- Instituto de Infectologia Emílio Ribas, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
| | - Mariana Severo Ramundo
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Filipe Romero Rebello Moreira
- Imperial College London, MRC Centre for Global Infectious Disease Analysis, London, United Kingdom
- Universidade Federal do Rio de Janeiro, Instituto de Biologia, Departamento de Genética, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | - Tomas Moutinho
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
| | | | | | | | - Lucy Santos Villas-Boas
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Camila Alves Maia da Silva
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Thaís Moura Coletti
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Erika R. Manuli
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Aine O’Toole
- University of Edinburgh, Institute of Ecology and Evolution, Edinburgh, United Kingdom
| | - Joshua Quick
- University of Birmingham, School of Biosciences, Birmingham, United Kingdom
| | - Nicholas Loman
- University of Birmingham, School of Biosciences, Birmingham, United Kingdom
| | - Andrew Rambaut
- University of Edinburgh, Institute of Ecology and Evolution, Edinburgh, United Kingdom
| | - Nuno R. Faria
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
- Imperial College London, MRC Centre for Global Infectious Disease Analysis, London, United Kingdom
- University of Oxford, Department of Zoology, Oxford, United Kingdom
| | | | - Ester Cerdeira Sabino
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
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