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Zhang M, Wang Y, Zhang Y, Wang Y, Chen J, Xu G, Zhang J, Hu F, Cai Y. Association of HIV infection, other sexually transmitted infections or their coexistence with mpox among men who have sex with men: A national questionnaire-based study in China using propensity score matching. J Infect Public Health 2025; 18:102737. [PMID: 40081123 DOI: 10.1016/j.jiph.2025.102737] [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: 11/17/2024] [Revised: 02/26/2025] [Accepted: 03/04/2025] [Indexed: 03/15/2025] Open
Abstract
BACKGROUND A marked increase in mpox cases was observed in May 2022 in previously non-endemic regions. The men who have sex with men (MSM) population exhibited a disproportionately higher rate of infection. OBJECTIVES This study aimed to investigate the coexistence of HIV infection and other sexually transmitted infections (STIs) and their association with mpox among MSM, with validatiton conducted through a case-control study utilizing propensity score matching (PSM). METHODS A total of 2403 eligible MSM participants were recruited for a cross-sectional study conducted across six geographically representative regions of China from October 2023 to March 2024. Data were collected via an anonymous online questionnaire. Univariable and multivariable logistic regression analyses were performed to evaluate the association between status of HIV infection and other STIs and risk of mpox. Validatiton was conducted through a case-control study employing PSM. RESULTS Among the total 2403 participants, 56 (2.33 %) reported diagnosis of mpox. Taking participants negative for both HIV infection and other STIs (group 1) as reference, the adjusted ORs (95 % CIs) (p value) for mpox were 2.00 (0.60-6.65) (p = 0.256), 6.26 (2.97-13.16) (p < 0.001), and 8.72 (3.45-22.00) (p < 0.001) for those who were only positive for HIV infection (group 2), only positive for other STIs (group 3) and positive for both (group 4), respectively. In the case-control study, 53 participants from the mpox group were matched to 149 participants from the non-infection group at a ratio of 1:3. The positive association between status of HIV infection and other STIs and mpox persisted, with adjusted ORs (95 % CIs) (p value) of 1.53 (0.38-6.11) (p = 0.547), 7.01 (3.00-16.38) (p < 0.001), and 6.20 (2.21-17.43) (p < 0.001) for group 2 to group 4, respectively. CONCLUSIONS This study demonstrated a significant association between other STIs and the risk of mpox among MSM. HIV infection alone didn't significantly increase the risk of mpox, while other STIs were found to be strong and robust risk factors for mpox.
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Affiliation(s)
- Meihui Zhang
- Public Health Research Center, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No.1111, Xianxia Road, Shanghai 200336, China; School of Public Health, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai 200025, China
| | - Yuxuan Wang
- Public Health Research Center, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No.1111, Xianxia Road, Shanghai 200336, China; School of Public Health, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai 200025, China
| | - Yinghuan Zhang
- Public Health Research Center, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No.1111, Xianxia Road, Shanghai 200336, China; School of Public Health, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai 200025, China
| | - Ying Wang
- Public Health Research Center, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No.1111, Xianxia Road, Shanghai 200336, China
| | - Jianyu Chen
- College of Public Health, Shanghai University of Medicine & Health Sciences, No.279, Zhouzhu Highway, Shanghai 201318, China
| | - Gang Xu
- School of Public Health, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai 200025, China
| | - Jiechen Zhang
- Dermatology Department, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No.1111, Xianxia Road, Shanghai 200336, China.
| | - Fan Hu
- Public Health Research Center, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No.1111, Xianxia Road, Shanghai 200336, China.
| | - Yong Cai
- Public Health Research Center, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No.1111, Xianxia Road, Shanghai 200336, China; Center for Community Health Care, China Hospital Development Institute, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai 200025, China.
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Andrieu J, Mège J, Mezouar S. Monkeypox Virus and Pregnancy. J Med Virol 2025; 97:e70337. [PMID: 40223710 PMCID: PMC11995370 DOI: 10.1002/jmv.70337] [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: 01/27/2025] [Revised: 03/17/2025] [Accepted: 03/27/2025] [Indexed: 04/15/2025]
Abstract
Human monkeypox (Mpox) is a zoonotic disease caused by monkeypox virus (MPXV) present in western Africa and exported sporadically worldwide. MPXV causes illness in individuals and pregnant women which constitute a population at risk with obstetrical and fetal complications including miscarriage, stillbirth and premature delivery. There are accumulated data suggesting a vertical transmission of MPXV from mother to fetus. This review provides an overview of the literature on MPXV infection in pregnant women with a specific focus on vertical transmission.
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Affiliation(s)
- Jonatane Andrieu
- Aix‐Marseille Univ, Centre National de la Recherche Scientifique, Établissement Français du Sang, Anthropologie bio‐culturelle, Droit, Éthique et SantéMarseilleFrance
| | - Jean‐louis Mège
- Aix‐Marseille Univ, Centre National de la Recherche Scientifique, Établissement Français du Sang, Anthropologie bio‐culturelle, Droit, Éthique et SantéMarseilleFrance
- Department of ImmunologyTimone HospitalMarseilleFrance
| | - Soraya Mezouar
- Aix‐Marseille Univ, Centre National de la Recherche Scientifique, Établissement Français du Sang, Anthropologie bio‐culturelle, Droit, Éthique et SantéMarseilleFrance
- Faculty of Medical and Paramedical SciencesAix‐Marseille University, HIPE Human LabMarseilleFrance
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Nilasari H, Miranda E, Marissa M, Ruspitawati A, Handayani DOTL, Salama N, Setiawan B, Supriadi, Aisyah TV, Inggariwati, Haq AS, Zuhroh S, Safitri EY, Pramono RA, Wisnuwardani I, Nelwan EJ, Sinto R, Susilo A, Saharman YR, Ratnoglik SL, Pitawati NLP, Fauzan M, Hasanah SSA, Sharasti M, Yunihastuti E. Epidemiology and Clinical Features of Mpox in Jakarta, Indonesia, August 2022-December 2023. Vaccines (Basel) 2025; 13:210. [PMID: 40266089 PMCID: PMC11945424 DOI: 10.3390/vaccines13030210] [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: 11/06/2024] [Revised: 01/10/2025] [Accepted: 01/11/2025] [Indexed: 04/24/2025] Open
Abstract
BACKGROUND/OBJECTIVE This study explores the epidemiology and clinical features of re-emerging mpox in Jakarta, Indonesia. METHODS This study used a retrospective study design to describe the epidemiological data, clinical features, and mortality of mpox patients from August 2022 to December 2023. In addition, this study also aims to identify the differences in both the epidemiology and clinical features of mpox in people living with HIV (PLHIV) and in non-HIV patients (non-PLHIV). RESULTS Our study shows that, as of the end of December 2023, 59 mpox cases were treated in Jakarta. All of the mpox cases in Jakarta were diagnosed in males, mainly found in MSM (91.5%), and PLHIV (78%). Most patients would manifest with fever, rash, and skin lesions. Syphilis was found as a concomitant infection in this group (22/59, 37.2%). Severe manifestations were found among PLHIV without antiretroviral therapy (ART). CONCLUSIONS Mpox cases in Jakarta were all found in males and most of them were PLHIV. There are various manifestations of mpox; however, since immunosuppressed patients could present differently, a strong surveillance and vaccine notification system, cautious management, and spreading vaccination awareness are needed to prevent and treat mpox.
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Affiliation(s)
- Hanny Nilasari
- Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (E.M.); (M.M.); (E.J.N.); (R.S.); (A.S.); (Y.R.S.); (S.L.R.); (E.Y.)
- Department of Dermatology and Venereology, University of Indonesia, Jakarta 10430, Indonesia
| | - Eliza Miranda
- Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (E.M.); (M.M.); (E.J.N.); (R.S.); (A.S.); (Y.R.S.); (S.L.R.); (E.Y.)
- Department of Dermatology and Venereology, University of Indonesia, Jakarta 10430, Indonesia
| | - Melani Marissa
- Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (E.M.); (M.M.); (E.J.N.); (R.S.); (A.S.); (Y.R.S.); (S.L.R.); (E.Y.)
- Department of Dermatology and Venereology, University of Indonesia, Jakarta 10430, Indonesia
| | - Ani Ruspitawati
- DKI Jakarta Health District, Jakarta 10160, Indonesia; (A.R.); (D.O.T.L.H.); (N.S.); (B.S.); (S.); (T.V.A.); (I.); (A.S.H.); (S.Z.); (E.Y.S.); (R.A.P.); (I.W.)
| | - Dwi O. T. L. Handayani
- DKI Jakarta Health District, Jakarta 10160, Indonesia; (A.R.); (D.O.T.L.H.); (N.S.); (B.S.); (S.); (T.V.A.); (I.); (A.S.H.); (S.Z.); (E.Y.S.); (R.A.P.); (I.W.)
| | - Ngabila Salama
- DKI Jakarta Health District, Jakarta 10160, Indonesia; (A.R.); (D.O.T.L.H.); (N.S.); (B.S.); (S.); (T.V.A.); (I.); (A.S.H.); (S.Z.); (E.Y.S.); (R.A.P.); (I.W.)
| | - Budi Setiawan
- DKI Jakarta Health District, Jakarta 10160, Indonesia; (A.R.); (D.O.T.L.H.); (N.S.); (B.S.); (S.); (T.V.A.); (I.); (A.S.H.); (S.Z.); (E.Y.S.); (R.A.P.); (I.W.)
| | - Supriadi
- DKI Jakarta Health District, Jakarta 10160, Indonesia; (A.R.); (D.O.T.L.H.); (N.S.); (B.S.); (S.); (T.V.A.); (I.); (A.S.H.); (S.Z.); (E.Y.S.); (R.A.P.); (I.W.)
| | - Tiranti V. Aisyah
- DKI Jakarta Health District, Jakarta 10160, Indonesia; (A.R.); (D.O.T.L.H.); (N.S.); (B.S.); (S.); (T.V.A.); (I.); (A.S.H.); (S.Z.); (E.Y.S.); (R.A.P.); (I.W.)
| | - Inggariwati
- DKI Jakarta Health District, Jakarta 10160, Indonesia; (A.R.); (D.O.T.L.H.); (N.S.); (B.S.); (S.); (T.V.A.); (I.); (A.S.H.); (S.Z.); (E.Y.S.); (R.A.P.); (I.W.)
| | - Arif S. Haq
- DKI Jakarta Health District, Jakarta 10160, Indonesia; (A.R.); (D.O.T.L.H.); (N.S.); (B.S.); (S.); (T.V.A.); (I.); (A.S.H.); (S.Z.); (E.Y.S.); (R.A.P.); (I.W.)
| | - Siti Zuhroh
- DKI Jakarta Health District, Jakarta 10160, Indonesia; (A.R.); (D.O.T.L.H.); (N.S.); (B.S.); (S.); (T.V.A.); (I.); (A.S.H.); (S.Z.); (E.Y.S.); (R.A.P.); (I.W.)
| | - Eka Y. Safitri
- DKI Jakarta Health District, Jakarta 10160, Indonesia; (A.R.); (D.O.T.L.H.); (N.S.); (B.S.); (S.); (T.V.A.); (I.); (A.S.H.); (S.Z.); (E.Y.S.); (R.A.P.); (I.W.)
| | - Rahmat A. Pramono
- DKI Jakarta Health District, Jakarta 10160, Indonesia; (A.R.); (D.O.T.L.H.); (N.S.); (B.S.); (S.); (T.V.A.); (I.); (A.S.H.); (S.Z.); (E.Y.S.); (R.A.P.); (I.W.)
| | - Inggrita Wisnuwardani
- DKI Jakarta Health District, Jakarta 10160, Indonesia; (A.R.); (D.O.T.L.H.); (N.S.); (B.S.); (S.); (T.V.A.); (I.); (A.S.H.); (S.Z.); (E.Y.S.); (R.A.P.); (I.W.)
| | - Erni J. Nelwan
- Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (E.M.); (M.M.); (E.J.N.); (R.S.); (A.S.); (Y.R.S.); (S.L.R.); (E.Y.)
- Department of Internal Medicine, University of Indonesia, Jakarta 10430, Indonesia
| | - Robert Sinto
- Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (E.M.); (M.M.); (E.J.N.); (R.S.); (A.S.); (Y.R.S.); (S.L.R.); (E.Y.)
- Department of Internal Medicine, University of Indonesia, Jakarta 10430, Indonesia
| | - Adityo Susilo
- Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (E.M.); (M.M.); (E.J.N.); (R.S.); (A.S.); (Y.R.S.); (S.L.R.); (E.Y.)
- Department of Internal Medicine, University of Indonesia, Jakarta 10430, Indonesia
| | - Yulia R. Saharman
- Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (E.M.); (M.M.); (E.J.N.); (R.S.); (A.S.); (Y.R.S.); (S.L.R.); (E.Y.)
- Department of Clinical Microbiology, University of Indonesia, Jakarta 10430, Indonesia
| | - Suratno L. Ratnoglik
- Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (E.M.); (M.M.); (E.J.N.); (R.S.); (A.S.); (Y.R.S.); (S.L.R.); (E.Y.)
- Department of Clinical Microbiology, University of Indonesia, Jakarta 10430, Indonesia
| | - Ni L. P. Pitawati
- National Infectious Disease Center Sulianti Saroso Hospital, Jakarta 14340, Indonesia; (N.L.P.P.); (M.F.)
| | - Muhammad Fauzan
- National Infectious Disease Center Sulianti Saroso Hospital, Jakarta 14340, Indonesia; (N.L.P.P.); (M.F.)
| | | | | | - Evy Yunihastuti
- Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (E.M.); (M.M.); (E.J.N.); (R.S.); (A.S.); (Y.R.S.); (S.L.R.); (E.Y.)
- Department of Internal Medicine, University of Indonesia, Jakarta 10430, Indonesia
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Shabil M, Gaidhane S, Roopashree R, Kaur M, Srivastava M, Barwal A, Siva Prasad GV, Rajput P, Syed R, Dev A, Kundra D, Yappalparvi A, Satapathy P, Zahiruddin QS, Kumar H, Sah R, Bushi G. Association of HIV infection and hospitalization among mpox cases: a systematic review and meta-analysis. BMC Infect Dis 2025; 25:102. [PMID: 39844097 PMCID: PMC11752846 DOI: 10.1186/s12879-025-10512-6] [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: 11/25/2024] [Accepted: 01/16/2025] [Indexed: 01/24/2025] Open
Abstract
BACKGROUND Mpox is a viral zoonotic disease that has seen a resurgence in recent years, with outbreaks reaching beyond its traditional endemic zones in Central and West Africa to parts of Europe and North America. The relationship between human immunodeficiency virus (HIV) infection and mpox outcomes, particularly hospitalization rates, remains underexplored despite the known immunosuppressive effects of HIV. This systematic review and meta-analysis aimed to clarify the association between HIV infection and the likelihood of hospitalization in mpox cases. METHODS A literature search was conducted through PubMed, Embase, Web of Science, Scopus, and the Cochrane Library up until August 10, 2024. The eligibility criteria focused on observational studies that evaluated hospitalization rates among mpox cases, distinguishing between HIV-positive and HIV-negative individuals. Newcastle-Ottawa Scale was used for evaluating study quality. The meta-analysis used a random-effects model to accommodate expected study heterogeneity using R software (V. 4.4). RESULTS The search yielded 686 records, with 14 studies meeting the inclusion and exclusion criteria after screenings and full-text assessments. The pooled analysis revealed a 56.6% increased risk of hospitalization among HIV-positive mpox cases compared to HIV-negative individuals (95% CI: 18.0-107.7%). Notable heterogeneity (I² = 76%) was observed, likely reflecting variations in study settings and methodologies. Sensitivity analysis confirmed the robustness of these findings, and no significant publication bias was detected (Egger's test p-value = 0.733). CONCLUSION HIV infection is associated with a statistically significant increased risk of hospitalization in mpox cases. There is a critical need for integrated care and enhanced surveillance, especially in populations with high HIV prevalence. Our findings emphasize the importance of ongoing research to better understand HIV and mpox co-infection and to refine management strategies for this vulnerable group. Future studies should focus on long-term outcomes and the effectiveness of various management strategies across different healthcare settings.
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Affiliation(s)
- Muhammed Shabil
- University Center for Research and Development, Chandigarh University, Mohali, Punjab, India
- Medical Laboratories Techniques Department, AL-Mustaqbal University, Hillah, Babil, 51001, Iraq
| | - Shilpa Gaidhane
- One Health Centre (COHERD), Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education, Wardha, India
| | - R Roopashree
- Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to be University), Bangalore, Karnataka, India
| | - Mandeep Kaur
- Department of Allied Healthcare and Sciences, Vivekananda Global University, Jaipur, Rajasthan, 303012, India
| | | | - Amit Barwal
- Chandigarh Pharmacy College, Chandigarh Group of College, Jhanjeri, Mohali1, Punjab, 140307, India
| | - G V Siva Prasad
- Department of Chemistry, Raghu Engineering College, Visakhapatnam, Andhra Pradesh, 531162, India
| | - Pranchal Rajput
- School of Applied and Life Sciences, Division of Research and Innovation, Uttaranchal University, Dehradun, India
| | - Rukshar Syed
- IES Institute of Pharmacy, IES University, Bhopal, Madhya Pradesh, 462044, India
| | - Anoop Dev
- Centre of Research Impact and Outcome, Chitkara University, Rajpura, Punjab, 140417, India
| | - Danish Kundra
- Chitkara Centre for Research and Development, Chitkara University, Solan, Himachal Pradesh, 174103, India
| | - Ambanna Yappalparvi
- Noida Institute of Engineering and Technology (Pharmacy Institute), Greater Noida, India
| | - Prakasini Satapathy
- Center for Global Health Research, Saveetha Institute of Medical and Technical Sciences, Saveetha Medical College and Hospital, Saveetha University, Chennai, India
- University of Cyberjaya, Persiaran Bestari, Cyber 11, Selangor Darul Ehsan, Cyberjaya, 63000, Malaysia
| | - Quazi Syed Zahiruddin
- South Asia Infant Feeding Research Network (SAIFRN), Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India.
| | - Harish Kumar
- New Delhi Institute of Management, Tughlakabad Institutional Area, New Delhi, India
| | - Renu Sah
- SR Sanjeevani Hospital, Kalyanpur, Siraha, 56517, Nepal.
- Department of Paediatrics, Hospital and Research Centre, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, 411018, India.
| | - Ganesh Bushi
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
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He S, Zhao J, Chen J, Liang J, Hu X, Zhang X, Zeng H, Sun G. Urogenital Manifestations in Mpox (Monkeypox) Infection: A Comprehensive Review of Epidemiology, Pathogenesis, and Therapeutic Approaches. Infect Drug Resist 2025; 18:209-226. [PMID: 39816240 PMCID: PMC11733167 DOI: 10.2147/idr.s504280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Accepted: 12/23/2024] [Indexed: 01/18/2025] Open
Abstract
Monkeypox (mpox), caused by mpox virus (MPXV) infection, reemerged in 2022 and still raises concerns globally. Abundant clinical data indicate that mpox is a sexually transmitted infection and that the urogenital system is the most frequently involved system in mpox, which deserves more attention. Penile lesions are the most common presentation, followed by urethritis. Acute urine retention and acute kidney injury are relatively rare but also highly crucial. Currently, the majority of the urogenital lesions are considered complications secondary to MPXV infection and the common immunosuppression in mpox patients. However, such viewpoints should be treated carefully due to the lack of understanding of the basic mpox pathology. Here, we briefly and comprehensively review the current evidence concerning urogenital lesions caused by mpox, including epidemiology, clinical features, pathogenesis, and therapeutic approaches to provide a preliminary reference for clinicians in future clinical practice.
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Affiliation(s)
- Sike He
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Jinge Zhao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Junru Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Jiayu Liang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Xu Hu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Xingming Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Hao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Guangxi Sun
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
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Hall R, Patel K, Poullis A, Pollok R, Honap S. Separating Infectious Proctitis from Inflammatory Bowel Disease-A Common Clinical Conundrum. Microorganisms 2024; 12:2395. [PMID: 39770599 PMCID: PMC11678827 DOI: 10.3390/microorganisms12122395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 11/19/2024] [Accepted: 11/20/2024] [Indexed: 01/11/2025] Open
Abstract
Proctitis refers to inflammation in the rectum and may result in rectal bleeding, discharge, urgency, tenesmus, and lower abdominal pain. It is a common presentation, particularly in genitourinary medicine and gastroenterology, as the two most common causes are sexually transmitted infections and inflammatory bowel disease. The incidence of infective proctitis is rising, particularly amongst high-risk groups, including men who have sex with men, those with HIV seropositive status, and those participating in high-risk sexual behaviours. The most commonly isolated organisms are Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema palladium, herpes simplex virus, and Mycoplasma genitalium. Recently, proctitis was also identified as a common feature during the Mpox outbreak. Distinguishing infective proctitis from inflammatory bowel disease remains a significant clinical challenge as there is significant overlap in the clinical presentation and their endoscopic and histological features. This review compares and highlights the distinguishing hallmarks of both inflammatory and infective causes of proctitis. It provides a practical guide to describe the key features that clinicians should focus on in both clinical and key diagnostic investigations to avoid potential misdiagnosis.
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Affiliation(s)
- Richard Hall
- Department of Gastroenterology, St George’s University Hospital, London SW17 0QT, UK; (R.H.)
| | - Kamal Patel
- Department of Gastroenterology, St George’s University Hospital, London SW17 0QT, UK; (R.H.)
| | - Andrew Poullis
- Department of Gastroenterology, St George’s University Hospital, London SW17 0QT, UK; (R.H.)
| | - Richard Pollok
- Department of Gastroenterology, St George’s University Hospital, London SW17 0QT, UK; (R.H.)
- Institute of Infection and Immunity, St George’s University, London SW17 0RE, UK
| | - Sailish Honap
- Department of Gastroenterology, St George’s University Hospital, London SW17 0QT, UK; (R.H.)
- School of Immunology and Microbial Sciences, King’s College London, London SE1 9NH, UK
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7
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Grüner E, Grossegesse M, Stern D, Ober V, Eser TM, Reiling G, Stirner R, Ibarra G, Postel N, Conca R, Dächert C, Grifoni A, Sette A, Bogner J, Seybold U, Roider J. Mpox-Specific Immune Responses Elicited by Vaccination or Infection in People With HIV. J Infect Dis 2024; 230:1110-1119. [PMID: 38478746 DOI: 10.1093/infdis/jiae138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/07/2024] [Indexed: 11/16/2024] Open
Abstract
In the recent mpox outbreak, people with human immunodeficiency virus (PWH) were at high risk both for contracting infection and for a more severe disease course. We studied cellular and humoral immune responses elicited by mpox infection (n = 5; n = 3 PWH) or smallpox vaccination (n = 17; all PWH) in a cohort of men who have sex with men. All PWH were successfully treated, with stable CD4 counts and undetectable HIV viral loads. Eleven of 17 vaccinated individuals had received childhood smallpox vaccination. In this group of individuals, both 2-dose modified vaccinia Ankara (MVA) vaccination and natural infection evoked mpox-specific immune responses mediated by B cells as well as CD4 and CD8 T cells. This study improves our understanding of smallpox vaccination-mediated cross-reactivity to other orthopox viruses, and long-lasting durability of childhood smallpox vaccination-mediated immune responses, including in PWH.
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Affiliation(s)
- Eva Grüner
- Department of Infectious Diseases, Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Marica Grossegesse
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses (ZBS 1), Berlin, Germany
| | - Daniel Stern
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens, Biological Toxins (ZBS 3), Berlin, Germany
| | - Veronica Ober
- Department of Infectious Diseases, Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Tabea M Eser
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology, Infection and Pandemic Research, Munich, Germany
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Gabriele Reiling
- Department of Infectious Diseases, Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Renate Stirner
- Department of Infectious Diseases, Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Gerardo Ibarra
- Department of Infectious Diseases, Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | | | - Raffaele Conca
- Department of Pediatrics, Dr von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christopher Dächert
- Max von Pettenkofer Institute, Virology, National Reference Center for Retroviruses, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Alba Grifoni
- Center for Vaccine Innovation, La Jolla Institute for Immunology (LJI), La Jolla, California, USA
| | - Alessandro Sette
- Center for Vaccine Innovation, La Jolla Institute for Immunology (LJI), La Jolla, California, USA
- Department of Pathology, University of California, San Diego, La Jolla, California, USA
| | - Johannes Bogner
- Department of Infectious Diseases, Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Ulrich Seybold
- Department of Infectious Diseases, Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Julia Roider
- Department of Infectious Diseases, Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
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8
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Taylor H, Humphreys C, Verlander NQ, Bhattacharya A, Vivancos R, Paranthaman K. Emergency department attendances and inpatient admissions due to mpox infection, England, 2022. Sex Transm Infect 2024; 100:423-429. [PMID: 38849207 DOI: 10.1136/sextrans-2024-056200] [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: 05/01/2024] [Accepted: 05/25/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVES In 2022, a global outbreak of mpox was reported. In the UK, it predominantly affected gay, bisexual and men who have sex with men (GBMSM). The study objectives were to describe the impact of the mpox outbreak on healthcare service usage in England in 2022, particularly emergency department (ED) attendance, inpatient admission and a number of bed days. Additionally, we wanted to explore whether pre-exposure prophylaxis (PrEP) usage, as a marker of condomless anal intercourse, which increases the risk of sexually transmitted infections associated with compromised skin integrity, was associated with higher ED attendance or hospital attendance. METHODS Data on adult males with laboratory-confirmed mpox were linked with hospital records and described. Using routinely collected data and self-reported exposure data (including PrEP usage) from surveillance questionnaires, multinomial regression was used to estimate adjusted relative risk ratios (aRRRs) with 95% CIs for ED attendance and hospital admission compared with those not admitted. RESULTS Among 3542 adult males with mpox during May to December 2022, 544 (15.4%) attended ED and 202 (5.7%) were admitted to the hospital. London had the most cases (2393, 68.7%), ED attendances (391, 71.9%) and hospital admissions (121, 59.9%). In multinomial regression, we found strong evidence that compared with people living with HIV, the aRRR for hospital admissions was higher in those not using PrEP (6.9 (95% CI 2.3 to 20.6) vs 4.9 (95% CI 1.7 to 14.1)). The aRRR for ED attendance was 0.63 (95% CI 0.36 to 1.1) for those not using PrEP versus 0.49 (95% CI 0.31 to 0.79). CONCLUSIONS This outbreak had a considerable impact on health services, particularly in high-incidence areas. Commissioners of sexual and healthcare services should review plans for healthcare provision for similar sexually transmitted infection or novel outbreaks among GBMSM or naïve populations in the future. Further studies are needed to confirm and identify reasons for the higher likelihood of hospital admission seen for GBMSM without HIV infection.
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Affiliation(s)
- Hannah Taylor
- SE HPT and UKFETP, UKHSA, Chilton, UK
- Public Health, Army Medical Service, Camberley, UK
| | - Clare Humphreys
- SE HPT, UKHSA, Oxford, UK
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV (BSHSH), UK Health Security Agency, London, UK
| | | | | | - Roberto Vivancos
- Field Service, UKHSA, London, UK
- Health Protection Unit in Emerging and Zoonotic Infections & in GI Infections, NIHR, London, UK
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9
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Chakravarty N, Hemani D, Paravastu R, Ahmad Z, Palani SN, Arumugaswami V, Kumar A. Mpox Virus and its ocular surface manifestations. Ocul Surf 2024; 34:108-121. [PMID: 38972544 PMCID: PMC11625629 DOI: 10.1016/j.jtos.2024.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/28/2024] [Accepted: 07/04/2024] [Indexed: 07/09/2024]
Abstract
The Mpox virus (MPXV) is the causative agent of human Mpox disease - a debilitating rash illness similar to smallpox. Although Clade I MPXV has remained endemic to West and Central Africa, Clade II MPXV has been responsible for many outbreaks worldwide. The most recent outbreak in 2022 resulted from the rapid spread of a new clade of MPXV, classified into Clade IIb - a distinct lineage from the previously circulating viral strains. The rapid spread and increased severity of Mpox disease by the Clade IIb strain have raised the serious public health imperative of better understanding the host and viral determinants during MPXV infection. In addition to typical skin rashes, including in the periorbital area, MPXV causes moderate to severe ophthalmic manifestations - most commonly, ocular surface complications (e.g., keratitis, conjunctivitis, blepharitis). While ocular manifestations of Clade I Mpox within the Congo basin have been well-reported, global incidence trends of ocular Mpox cases by Clade IIb are still emerging. Given the demonstrated ability of all MPXV strains to auto-inoculate ocular tissue, alongside the enhanced transmissibility of the Clade IIb virus, there is an urgent need to elucidate the mechanisms by which MPXV causes ocular anomalies. In this review, we discuss the viral and genomic structures of MPXV, the epidemiology, and pathology of systemic and ocular Mpox, as well as potential prophylactic and therapeutic interventions.
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Affiliation(s)
- Nikhil Chakravarty
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA, USA; School of Medicine, California University of Science and Medicine, Colton, CA, USA
| | - Darshi Hemani
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, Detroit, MI, USA
| | - Ramya Paravastu
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Zeeshan Ahmad
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, Detroit, MI, USA
| | - Sankara Naynar Palani
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Vaithilingaraja Arumugaswami
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA, USA; Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, Los Angeles, CA, USA; California NanoSystems Institute, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Ashok Kumar
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, Detroit, MI, USA.
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10
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De Vos E, Van Gestel L, Brosius I, Kenyon C, Vuylsteke B, De Baetselier I, Mariën J, Bangwen E, Couvreur S, Lecompte A, Van Beckhoven D, Hoorelbeke B, Verstrepen BE, Zaeck LM, de Vries RD, Geurts van Kessel CH, Hens N, Ariën KK, Vercauteren K, Van Esbroek M, Van Dijck C, Liesenborghs L. Potential determinants of the decline in mpox cases in Belgium: A behavioral, epidemiological and seroprevalence study. Int J Infect Dis 2024; 146:107132. [PMID: 38942168 DOI: 10.1016/j.ijid.2024.107132] [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: 01/20/2024] [Revised: 06/06/2024] [Accepted: 06/06/2024] [Indexed: 06/30/2024] Open
Abstract
OBJECTIVES The 2022 mpox epidemic reached a peak in Belgium and the rest of Europe in July 2022, after which it unexpectedly subsided. This study investigates epidemiological, behavioral, and immunological factors behind the waning of the epidemic in Belgium. METHODS We investigated temporal evolutions in the characteristics and behavior of mpox patients using national surveillance data and data from a prospective registry of mpox patients in the Institute of Tropical Medicine (Antwerp). We studied behavioral changes in the population at risk using a survey among HIV-preexposure prophylaxis (PrEP) users. We determined the seroprevalence of anti-orthopoxvirus antibodies among HIV-PrEP users across four-time points in 2022. RESULTS Mpox patients diagnosed at the end of the epidemic had less sexual risk behavior compared to those diagnosed earlier: they engaged less in sex at mass events, had fewer sexual partners, and were less likely to belong to the sexual network's central group. Among HIV-PrEP users there were no notable changes in sexual behavior. Anti-orthopoxvirus seroprevalence did not notably increase before the start of national vaccination campaigns. CONCLUSION The observed changes in group immunity and behavior in the population at greater risk of exposure to mpox seem unable to explain the waning of the mpox epidemic. A change in the profile of mpox patients might have contributed to the decline in cases.
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Affiliation(s)
- Elise De Vos
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Liesbeth Van Gestel
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Isabel Brosius
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Chris Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Irith De Baetselier
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joachim Mariën
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Biology, University of Antwerp, Antwerp, Belgium
| | - Eugene Bangwen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Simon Couvreur
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Amaryl Lecompte
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | | | - Bart Hoorelbeke
- Public Health Emergencies Department, Federal Public Service - Health, Food Chain Safety and Environment, Brussels, Belgium
| | - Babs E Verstrepen
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Luca M Zaeck
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Rory D de Vries
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Niel Hens
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Kevin K Ariën
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Koen Vercauteren
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marjan Van Esbroek
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Christophe Van Dijck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | - Laurens Liesenborghs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, Leuven, Belgium
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11
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Derhab N. Human monkeypox virus: A systematic critical review during the pandemic peak. Indian J Med Microbiol 2024; 51:100704. [PMID: 39134221 DOI: 10.1016/j.ijmmb.2024.100704] [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: 05/03/2024] [Revised: 08/05/2024] [Accepted: 08/10/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND In July 2022, the world health organization (WHO) announced the monkeypox virus (MPXV) as a public health emergency of international concern, due to the unprecedented global transmission of the disease beyond previously endemic countries in Africa. METHODS For this systematic review, the author searched the "web of science" (WoS) database, which retrieves 138 articles on MPXV, published between 01-04-2022 and 22-09-2022. This period witnessed the maximum cases of infection as confirmed by the WHO. Seventy articles were used for in-depth analysis, after excluding papers not highly relevant to the topic. RESULTS AND CONCLUSIONS The current review demonstrates different types of MPXV identification analysis, transmission of MPXV, clinical features, immune responses against MPXV, the mutations, and phylogenetic analysis. It also identifies the patients with high-risk complications and determines the other diseases related to MPXV. This paper provides suggestions for the suitable usage of vaccines or antiviral drugs as a procedure to control the outbreak and preventive strategies related to the humans. This research discusses significant implications and recommendations to contribute in reducing the spread of MPXV and presents avenues for upcoming MPXV research.
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Affiliation(s)
- Neama Derhab
- Department of Botany and Microbiology, Faculty of Science, Damanhour University, Damanhour, Egypt.
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12
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Nakamura H, Yamamoto K. Mpox in people with HIV: A narrative review. HIV Med 2024; 25:910-918. [PMID: 38745559 DOI: 10.1111/hiv.13661] [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: 01/10/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The 2022 global mpox outbreak disproportionately impacted people living with HIV. This review explores recent evidence on mpox in this group, focusing on clinical presentation, complications, treatment modalities and vaccine strategies. RECENT FINDINGS Recent studies have suggested that people with HIV diagnosed with mpox have a greater risk of proctitis and hospitalization compared with people without HIV. In addition, those with advanced immunosuppression face an elevated risk of severe mpox infection, which can lead to mortality. Comprehensive and prompt supportive care using antiretrovirals and mpox antivirals is crucial in this group. Although results from randomized clinical trials are still forthcoming, recent studies suggest that early initiation of tecovirimat can prevent disease progression in people with HIV. The non-replicative attenuated smallpox vaccine is well tolerated and effective in preventing monkeypox virus infections in people with HIV. Further studies are needed regarding long-term vaccine effectiveness for this population. CONCLUSION Evaluating the risk of severe mpox in people living with HIV requires assessing the level of immune suppression and viral control. Universal access to vaccination is imperative to prevent the resurgence of future outbreaks.
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Affiliation(s)
- Hideta Nakamura
- First Department of International Medicine, Division of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus Graduate School of Medicine, Nishihara-cho, Japan
| | - Kazuko Yamamoto
- First Department of International Medicine, Division of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus Graduate School of Medicine, Nishihara-cho, Japan
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13
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Yang S, Xia C, Zhang Y, Shen Y, Xia C, Lu Y, Su S, Deng C, Harypursat V, Wang J, Yuan J, Chen Y. Clinical features and viral load variations of Mpox: a retrospective study in Chongqing, China. BMC Infect Dis 2024; 24:641. [PMID: 38926635 PMCID: PMC11202379 DOI: 10.1186/s12879-024-09537-0] [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: 02/26/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024] Open
Abstract
PURPOSE Since May 2022, Mpox has spread extensively outside of Africa, posing a serious threat to the health of people globally, and particularly to the men who have sex with men (MSM) population. Chongqing, a province in Southwest China, has relatively large MSM and people living with HIV (PLWH) populations, presenting conditions conducive to the wide dissemination of Mpox. In this study, we investigated the clinical characteristics of Mpox patients among MSM and PLWH in Chongqing, aiming to inform the development of targeted prevention, control, and treatment strategies for Mpox. METHOD We evaluated the clinical characteristics, travel history, time of onset, distribution and number of skin lesions of Mpox patients admitted to the Chongqing Public Health Medical Center between September 2022 and October 2023. Meanwhile, a series of clinical samples were collected and the pathogen of interest was identified as Mpox virus using quantitative polymerase chain reaction (qPCR). The results were presented in the form of cycle thresholds (Ct), which help to approximate the quantification of viral load. RESULTS As of October 11, 2023, the Chongqing Public Health Medical Center reported a total of nine Mpox virus infections. All the patients identified were male and belonged to the MSM population, among whom seven (77.8%) were living with HIV, and maintained a preserved immune system while achieving viral suppression via effective ART. We observed no discernible clinical differences between MSM with Mpox with or without HIV, and no fatalities were recorded. Viral loads were observed to be higher in samples taken from the skin than those from the throat, nasopharynx, blood, or semen. CONCLUSION In this retrospective study, the clinical manifestations of MPXV infection appeared consistent among MSM patients, regardless of HIV status. Elevated MPXV viral loads in the skin and mucosal tissues, particularly at genital and anal sites, indicate that transmission is more likely to occur via direct physical contact as opposed to respiratory pathways or through exposure to bodily fluids.
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Affiliation(s)
- Sen Yang
- Biobank, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Chao Xia
- Biobank, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Yuxin Zhang
- Biobank, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Yan Shen
- Biobank, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Chengshuang Xia
- Biobank, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Yanqiu Lu
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Shifang Su
- Department of Disease Prevention, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Changgang Deng
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Vijay Harypursat
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Jing Wang
- Department of Medical Laboratory, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Jing Yuan
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, 400036, China.
| | - Yemiao Chen
- Biobank, Chongqing Public Health Medical Center, Chongqing, 400036, China.
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14
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Koppe U, Jansen K, Schmidt AJ, Weber C, Schulze H, Kulis-Horn RK, Tiemann C, Marcus U. Clinically inapparent mpox virus (MPXV) infections among clients of three anonymous Community Based Voluntary Counselling and Testing centres in Berlin, Germany, 2022-2023. BMC Infect Dis 2024; 24:613. [PMID: 38902610 PMCID: PMC11191340 DOI: 10.1186/s12879-024-09510-x] [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: 04/18/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION Since the mpox outbreak in 2022, it was unclear if and how often infections with mpox virus (MPXV) were clinically inapparent, i.e. not presenting to clinical care with mpox symptoms. Moreover, it was hypothesized that MPXV circulated in the affected communities before the outbreak was officially detected. METHODS We retrospectively tested rectal and urethral swabs, and pooled samples for presence of MPXV. Samples were obtained from routine STI testing of three anonymous Community Based Voluntary Counselling and Testing (CBVCT) centres in Berlin, in 2022 and 2023. Testing results were linked to anonymously provided behavioural data. RESULTS Overall, 9,053 samples from 6,600 client visits were included. Clinically inapparent MPXV infections were detectable in 1.1% of the samples. We did not find MPXV infections in the month before the first cases appeared in Berlin or between October 2022 and January 2023 when case numbers were low in Germany. However, during the outbreak period in 2022, we found clinically inapparent MPXV infections among 2.2% of the clients and during summer/autumn 2023 among 0.3%. The number of condomless anal/vaginal intercourse partners within the previous 6 months and PrEP use were identified as predictors of clinically inapparent MPXV infection. CONCLUSION Clinically inapparent MPXV infections occurred during the mpox outbreak in Berlin in 2022 and post-outbreak in summer/autumn 2023. Unrecognized MPXV circulation in Berlin before the recognition of the outbreak in May 2022 appears unlikely. However, low-level sustained circulation of clinically inapparent MPXV infections need to be acknowledged in mpox prevention strategies.
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Affiliation(s)
- Uwe Koppe
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
| | - Klaus Jansen
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Axel Jeremias Schmidt
- Deutsche Aidshilfe, Berlin, Germany
- Sigma Research, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Heike Schulze
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | | | - Ulrich Marcus
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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15
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Azzam A, Khaled H, Salem H, Ahmed A, Heniedy AM, Hassan HS, Hassan A, El-Mahdy TS. The impact of immunosuppression on the mortality and hospitalization of Monkeypox: a systematic review and meta-analysis of the 2022 outbreak. Virol J 2024; 21:130. [PMID: 38840177 PMCID: PMC11155170 DOI: 10.1186/s12985-024-02392-0] [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: 02/09/2024] [Accepted: 05/17/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Limited data is available regarding the severity and mortality of Mpox in individuals with immunocompromised conditions. Therefore, we performed this meta-analysis to understand the impact of HIV- or non-HIV-associated immunosuppression on the severity of Mpox requiring hospitalization and mortality. METHODS A thorough literature search was performed from 2022 up to January 2024. The results were presented as odds ratios (ORs). We only included patients who required hospitalization for severity rather than isolation. RESULTS A total of 34 studies were included in this analysis. Our analysis did not find a significant difference in the hospitalization risk between HIV-positive individuals and those who were HIV-negative (OR = 1.03; P = 0.85; 7 studies; CD4 count of fewer than 200 cells/µL was less than 0.5% across all studies). Patients with a CD4 count lower than 200 cells/µL or an unsuppressed RNA viral load (> 200 copies/ml) had a significantly higher hospitalization risk (OR = 5.3, P < 0.001) and (OR = 3, P < 0.001), respectively. Most of the reported deaths were reported in patients with HIV with CD4 counts below 200 cells/µL, with some fatal cases occurring in non-HIV immunosuppressed patients, particularly organ transplant recipients. Based on the autopsy findings, Mpox was confirmed in multiple organs, particularly the digestive tract, lung, and testes. Furthermore, some studies documented cases of death that were suspected to be related to hemophagocytic lymphohistiocytosis (HLH) and immune reconstitution inflammatory syndrome (IRIS). Most of the death reports showed concomitant non-Mpox infections at the time of hospitalization and death CONCLUSIONS: Our finding shows that Mpox acts as an opportunistic pathogen in immunocompromised individuals. These individuals should be prioritized for early care and closely monitored for signs of deteriorating clinical conditions. Clinical manifestations and autopsy findings strongly suggest Mpox dissemination to multiple organs, particularly the digestive tract, and lungs. However, the presence of concomitant non-Mpox infections complicates the assessment of the attribution of Mpox to death. Caution should be exercised when interpreting data suggesting poorer outcomes in individuals with non-HIV immunosuppression, as current evidence is scarce and further research is needed.
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Affiliation(s)
- Ahmed Azzam
- Department of Microbiology and Immunology, Faculty of Pharmacy, Helwan University, Cairo, Egypt.
| | - Heba Khaled
- Department of Biochemistry, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Haitham Salem
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ameer Ahmed
- Faculty of Medicine, Minia University, Minya, Egypt
| | - Amira M Heniedy
- Department of Epidemiology, El-Beheira Veterinary Administration, Egyptian Ministry of Agriculture and Land Reclamation, El-Beheira, Egypt
| | | | - Ahmed Hassan
- Dermatology resident physician, Qeft Teaching Hospital, Qena, Egypt
| | - Taghrid S El-Mahdy
- Department of Microbiology and Immunology, Faculty of Pharmacy, Helwan University, Cairo, Egypt
- Department of Microbiology and Immunology, Faculty of Pharmacy, Modern University for Technology and Information (MTI), Cairo, Egypt
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16
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Okoli GN, Van Caeseele P, Askin N, Abou-Setta AM. A global systematic evidence review with meta-analysis of the epidemiological characteristics of the 2022 Mpox outbreaks. Infection 2024; 52:901-921. [PMID: 38051425 DOI: 10.1007/s15010-023-02133-5] [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: 10/11/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND In 2022, there were outbreaks of Mpox where the disease is not endemic. We summarized published full-text epidemiological data from the outbreaks. METHODS A global evidence review (protocol: osf.io/j3kb7) with systematic literature search up to February 09, 2023. We focused on experimental/observational studies of laboratory confirmed Mpox, excluding case reports and case series of < 5 cases. Epidemiological data were pooled using an inverse variance, random-effects model, and pooled estimates presented with associated 95% confidence intervals. RESULTS We included 66 studies. Mean incubation period was 7.8 days (6.6-9.0 days, 8 studies: 560 cases), reproductive number 1.8 (1.7-1.9, 6 studies), mean duration from symptom onset to diagnosis 5.8 days (4.8-6.8 days, 4 studies: 982 cases), mean symptom duration 17.5 days (14.7-20.2 days, 3 studies: 292 cases), mean serial interval 8.5 days (7.3-9.9 days, 1 study), hospitalisation 6% (4-9%, 26 studies: 5339 cases), and vaccine effectiveness 78% (65-91%, 3 studies: 953 cases). Highly relevant clinical manifestations were pleomorphic skin lesions 82% (68-94%, 26 studies: 4093 cases), anogenital lesions 64% (51-77%, 9 studies: 10,398 cases), fever 54% (50-57%, 52 studies: 25,992 cases), and lymphadenopathy 51% (46-57%, 42 studies: 17,803 cases), with cases mostly men who have sex with men (MSM). Possibly relevant manifestations were perianal lesions, fatigue, asthenia, myalgia, and headache. CONCLUSIONS The 2022 Mpox outbreaks presented with sex-related clinical manifestations and were mostly reported among MSM.
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Affiliation(s)
- George N Okoli
- George & Fay Yee Centre for Healthcare Innovation, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0T6, Canada.
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Paul Van Caeseele
- Department of Medical Microbiology & Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Cadham Provincial Laboratory, Winnipeg, MB, Canada
| | - Nicole Askin
- Neil John Maclean Library, University of Manitoba, Winnipeg, MB, Canada
| | - Ahmed M Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0T6, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Liu BM, Rakhmanina NY, Yang Z, Bukrinsky MI. Mpox (Monkeypox) Virus and Its Co-Infection with HIV, Sexually Transmitted Infections, or Bacterial Superinfections: Double Whammy or a New Prime Culprit? Viruses 2024; 16:784. [PMID: 38793665 PMCID: PMC11125633 DOI: 10.3390/v16050784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Epidemiologic studies have established that mpox (formerly known as monkeypox) outbreaks worldwide in 2022-2023, due to Clade IIb mpox virus (MPXV), disproportionately affected gay, bisexual, and other men who have sex with men. More than 35% and 40% of the mpox cases suffer from co-infection with HIV and sexually transmitted infections (STIs) (e.g., Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, and herpes simplex virus), respectively. Bacterial superinfection can also occur. Co-infection of MPXV and other infectious agents may enhance disease severity, deteriorate outcomes, elongate the recovery process, and potentially contribute to the morbidity and mortality of the ensuing diseases. However, the interplays between MPXV and HIV, bacteria, other STI pathogens and host cells are poorly studied. There are many open questions regarding the impact of co-infections with HIV, STIs, or bacterial superinfections on the diagnosis and treatment of MPXV infections, including clinical and laboratory-confirmed mpox diagnosis, suboptimal treatment effectiveness, and induction of antiviral drug resistance. In this review article, we will discuss the progress and knowledge gaps in MPXV biology, antiviral therapy, pathogenesis of human MPXV and its co-infection with HIV, STIs, or bacterial superinfections, and the impact of the co-infections on the diagnosis and treatment of mpox disease. This review not only sheds light on the MPXV infection and co-infection of other etiologies but also calls for more research on MPXV life cycles and the molecular mechanisms of pathogenesis of co-infection of MPXV and other infectious agents, as well as research and development of a novel multiplex molecular testing panel for the detection of MPXV and other STI co-infections.
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Affiliation(s)
- Benjamin M. Liu
- Division of Pathology and Laboratory Medicine, Children’s National Hospital, Washington, DC 20010, USA
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC 20010, USA;
- Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA
- Department of Microbiology, Immunology & Tropical Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA;
- Children’s National Research Institute, Washington, DC 20012, USA
- The District of Columbia Center for AIDS Research, Washington, DC 20052, USA
| | - Natella Y. Rakhmanina
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC 20010, USA;
- The District of Columbia Center for AIDS Research, Washington, DC 20052, USA
- Division of Infectious Diseases, Children’s National Hospital, Washington, DC 20010, USA
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC 20005, USA
| | - Zhilong Yang
- Department of Veterinary Pathobiology, School of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA;
| | - Michael I. Bukrinsky
- Department of Microbiology, Immunology & Tropical Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA;
- The District of Columbia Center for AIDS Research, Washington, DC 20052, USA
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Sun Y, Nie W, Tian D, Ye Q. Human monkeypox virus: Epidemiologic review and research progress in diagnosis and treatment. J Clin Virol 2024; 171:105662. [PMID: 38432097 DOI: 10.1016/j.jcv.2024.105662] [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: 12/22/2023] [Revised: 02/22/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
Monkeypox virus (MPXV) is responsible for causing a zoonotic disease called monkeypox (mpox), which sporadically infects humans in West and Central Africa. It first infected humans in 1970 and, along with the variola virus, belongs to the genus Orthopoxvirus in the poxvirus family. Since the World Health Organization declared the MPXV outbreak a "Public Health Emergency of International Concern" on July 23, 2022, the number of infected patients has increased dramatically. To control this epidemic and address this previously neglected disease, MPXV needs to be better understood and reevaluated. In this review, we cover recent research on MPXV, including its genomic and pathogenic characteristics, transmission, mutations and mechanisms, clinical characteristics, epidemiology, laboratory diagnosis, and treatment measures, as well as prevention of MPXV infection in light of the 2022 and 2023 global outbreaks. The 2022 MPXV outbreak has been primarily associated with close intimate contact, including sexual activity, with most cases diagnosed among men who have sex with men. The incubation period of MPXV infection usually lasts from 6 to 13 days, and symptoms include fever, muscle pains, headache, swollen lymph nodes, and a characteristic painful rash, including several stages, such as macules, papules, blisters, pustules, scabs, and scab shedding involving the genitals and anus. Polymerase chain reaction (PCR) is usually used to detect MPXV in skin lesion material. Treatment includes supportive care, antivirals, and intravenous vaccinia immune globulin. Smallpox vaccines have been designed with four givens emergency approval for use against MPXV infection.
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Affiliation(s)
- Yanhong Sun
- Department of Clinical Laboratory, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Wenjian Nie
- Department of Clinical Laboratory, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Dandan Tian
- Department of Clinical Laboratory, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Qing Ye
- Department of Clinical Laboratory, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China.
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Ashley CN, Broni E, Wood CM, Okuneye T, Ojukwu MPT, Dong Q, Gallagher C, Miller WA. Identifying potential monkeypox virus inhibitors: an in silico study targeting the A42R protein. Front Cell Infect Microbiol 2024; 14:1351737. [PMID: 38500508 PMCID: PMC10945028 DOI: 10.3389/fcimb.2024.1351737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
Monkeypox (now Mpox), a zoonotic disease caused by the monkeypox virus (MPXV) is an emerging threat to global health. In the time span of only six months, from May to October 2022, the number of MPXV cases breached 80,000 and many of the outbreaks occurred in locations that had never previously reported MPXV. Currently there are no FDA-approved MPXV-specific vaccines or treatments, therefore, finding drugs to combat MPXV is of utmost importance. The A42R profilin-like protein of the MPXV is involved in cell development and motility making it a critical drug target. A42R protein is highly conserved across orthopoxviruses, thus A42R inhibitors may work for other family members. This study sought to identify potential A42R inhibitors for MPXV treatment using computational approaches. The energy minimized 3D structure of the A42R profilin-like protein (PDB ID: 4QWO) underwent virtual screening using a library of 36,366 compounds from Traditional Chinese Medicine (TCM), AfroDb, and PubChem databases as well as known inhibitor tecovirimat via AutoDock Vina. A total of seven compounds comprising PubChem CID: 11371962, ZINC000000899909, ZINC000001632866, ZINC000015151344, ZINC000013378519, ZINC000000086470, and ZINC000095486204, predicted to have favorable binding were shortlisted. Molecular docking suggested that all seven proposed compounds have higher binding affinities to A42R (-7.2 to -8.3 kcal/mol) than tecovirimat (-6.7 kcal/mol). This was corroborated by MM/PBSA calculations, with tecovirimat demonstrating the highest binding free energy of -68.694 kJ/mol (lowest binding affinity) compared to the seven shortlisted compounds that ranged from -73.252 to -97.140 kJ/mol. Furthermore, the 7 compounds in complex with A42R demonstrated higher stability than the A42R-tecovirimat complex when subjected to 100 ns molecular dynamics simulations. The protein-ligand interaction maps generated using LigPlot+ suggested that residues Met1, Glu3, Trp4, Ile7, Arg127, Val128, Thr131, and Asn133 are important for binding. These seven compounds were adequately profiled to be potential antivirals via PASS predictions and structural similarity searches. All seven potential lead compounds were scored Pa > Pi for antiviral activity while ZINC000001632866 and ZINC000015151344 were predicted as poxvirus inhibitors with Pa values of 0.315 and 0.215, and Pi values of 0.052 and 0.136, respectively. Further experimental validations of the identified lead compounds are required to corroborate their predicted activity. These seven identified compounds represent solid footing for development of antivirals against MPXV and other orthopoxviruses.
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Affiliation(s)
- Carolyn N. Ashley
- Department of Medicine, Loyola University Medical Center, Loyola University Chicago, Maywood, IL, United States
| | - Emmanuel Broni
- Department of Medicine, Loyola University Medical Center, Loyola University Chicago, Maywood, IL, United States
| | - Chanyah M. Wood
- Department of Medicine, Loyola University Medical Center, Loyola University Chicago, Maywood, IL, United States
- Department of Chemistry and Physics, Lincoln University, Lincoln, PA, United States
| | - Tunmise Okuneye
- Department of Medicine, Loyola University Medical Center, Loyola University Chicago, Maywood, IL, United States
- Department of Biology, Lincoln University, Lincoln, PA, United States
| | - Mary-Pearl T. Ojukwu
- Department of Medicine, Loyola University Medical Center, Loyola University Chicago, Maywood, IL, United States
- Department of Chemistry and Physics, Lincoln University, Lincoln, PA, United States
- College of Pharmacy, University of Florida, Orlando, FL, United States
| | - Qunfeng Dong
- Department of Medicine, Loyola University Medical Center, Loyola University Chicago, Maywood, IL, United States
- Center for Biomedical Informatics, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Carla Gallagher
- Department of Chemistry and Physics, Lincoln University, Lincoln, PA, United States
| | - Whelton A. Miller
- Department of Medicine, Loyola University Medical Center, Loyola University Chicago, Maywood, IL, United States
- Department of Molecular Pharmacology & Neuroscience, Loyola University Medical Center, Loyola University Chicago, Maywood, IL, United States
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Corma-Gómez A, Cabello A, Orviz E, Morante-Ruiz M, Ayerdi O, Al-Hayani A, Muñoz-Gómez A, Santos IDL, Gómez-Ayerbe C, Rodrigo D, Riestra SDLR, Reus-Bañuls S, Silva-Klug A, Galindo MJ, Santos M, Serrano-Fuentes M, Faro-Míguez N, Pérez-Camacho I, Corona-Mata D, Morano L, López-Ruz MÁ, Montero M, Anaya-Baz B, Merino D, Castillo-Navarro A, Pineda JA, Macías J. Long or complicated mpox in patients with uncontrolled HIV infection. J Med Virol 2024; 96:e29511. [PMID: 38469884 DOI: 10.1002/jmv.29511] [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: 02/12/2024] [Revised: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 03/13/2024]
Abstract
To date, former research about the impact of HIV infection on mpox poor outcomes is still limited and controversial. Therefore, the aim of this study was to assess the impact of HIV on the clinical course of mpox, in a large population of patients from Spain. Nationwide case-series study. Patients from 18 Spanish hospitals, with PCR-confirmed mpox from April 27, 2022 to June 30, 2023 were included in this study. The main outcome was the development of long or complicated (LC) mpox, defined as: (i) duration of the clinical course ≥ 28 days, or; (ii) disseminated disease, or: (iii) emergence of severe complications. One thousand eight hundred twenty-three individuals were included. Seven hundred eighty-six (43%) were people living with HIV (PLWH), of whom 11 (1%) had a CD4 cell count < 200 cells/mm3 and 33 (3%) <350 cells/mm3 . HIV viral load ≥ 1000 cp/mL was found in 27 (3%) PLWH, none of them were on effective ART. Fifteen (60%) PLWH with HIV-RNA ≥ 1000 cp/mL showed LC versus 182 (29%) PLWH with plasma HIV-RNA load < 1000 copies/mL and 192 (24%) individuals without HIV infection (p < 0.001). In multivariate analysis, adjusted by age, sex, CD4 cell counts and HIV viral load at the time of mpox, only plasma HIV-RNA ≥ 1000 cp/mL was associated with a greater risk of developing LC mpox [adjusted OR = 4.06 (95% confidence interval 1.57-10.51), p = 0.004]. PLWH with uncontrolled HIV infection, due to lack of ART, are at a greater risk of developing LC mpox. Efforts should be made to ensure HIV testing is carried out in patients with mpox and to start ART without delay in those tested positive.
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Affiliation(s)
- Anaïs Corma-Gómez
- Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain
- Grupo de Virología Clínica e ITS, Hospital Universitario Virgen de Valme, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Alfonso Cabello
- Unit of Infectious Diseases, Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | - Eva Orviz
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid
| | - Miguel Morante-Ruiz
- Unit of Infectious Diseases, Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | - Oskar Ayerdi
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid
| | - Aws Al-Hayani
- Unit of Infectious Diseases, Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | - Ana Muñoz-Gómez
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid
| | - Ignacio De Los Santos
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Servicio de Medicina Interna-Enfermedades Infecciosas, Hospital Universitario de la Princesa, Madrid, Spain
| | - Cristina Gómez-Ayerbe
- Unit of Infectious Diseases, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - David Rodrigo
- Unit of Infectious Diseases, Consorcio Hospital General de Valencia, Valencia, Spain
| | - Sandra De la Rosa Riestra
- Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena, Valencia, Spain
- Department of Medicine, School of Medicine, University of Sevilla, Sevilla, Spain
| | - Sergio Reus-Bañuls
- Unit of Infectious Diseases, Hospital General Universitario de Alicante, Sevilla, Spain
| | - Ana Silva-Klug
- Unit of Infectious Diseases, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Sevilla, Spain
| | - María José Galindo
- Unit of Infectious Diseases, Hospital Clínico Universitario de Valencia, Sevilla, Spain
| | - Marta Santos
- Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain
- Grupo de Virología Clínica e ITS, Hospital Universitario Virgen de Valme, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Miriam Serrano-Fuentes
- Servicio de Medicina Interna, Hospital de Gran Canaria Dr Negrín, Las Palmas De Gran Canaria, Spain
| | - Naya Faro-Míguez
- Unit of Infectious Diseases, Hospital Universitario San Cecilio, Granada, Spain
| | - Inés Pérez-Camacho
- Unit of Infectious Diseases· Hospital Regional Universitario Málaga, Sevilla, Spain
| | - Diana Corona-Mata
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Infectious Diseases Unit, Reina Sofía University Hospital of Córdoba, Spain
- Maimonides Institute of Biomedical Research of Córdoba (Instituto Maimónides de Investigación Biomédica de Córdoba IMIBIC), Cordoba, Spain
- Department of Medicine, University of Córdoba, Cordoba, Spain
| | - Luis Morano
- Unit of Infectious Diseases, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | - Miguel Ángel López-Ruz
- Unit of infectious Diseases, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Marta Montero
- Unit of infectious Diseases, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Blanca Anaya-Baz
- Unit of Infectious diseases, Hospital Universitario Puerto Real, Spain
| | - Dolores Merino
- Unit of Infectious Diseases, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | | | - Juan A Pineda
- Department of Medicine, School of Medicine, University of Sevilla, Sevilla, Spain
| | - Juan Macías
- Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain
- Grupo de Virología Clínica e ITS, Hospital Universitario Virgen de Valme, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Department of Medicine, School of Medicine, University of Sevilla, Sevilla, Spain
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21
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Costa AF, Rocha SQ, Fonsi M, Nogueira RS, Kalichman AO, Madruga JVR, Gianna MC, Souza RDA, Rodrigues R, Tayra A, Ramos LR, da Silva RJC, Sartori AMC, Prado WDA, Abbud A, Tancredi MV, Mpox-CRT working group #. Clinical and epidemiological features of mpox in a Brazilian reference center for HIV and sexually transmitted infections: A cross-sectional study. IJID REGIONS 2024; 10:114-122. [PMID: 38269305 PMCID: PMC10805638 DOI: 10.1016/j.ijregi.2023.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/18/2023] [Accepted: 11/22/2023] [Indexed: 01/26/2024]
Abstract
Background The 2022 mpox outbreak has affected disproportionately people living with HIV (PLWH) and pre-exposure prophylaxis (PrEP) users. Methods We conducted a cross-sectional study to evaluate factors associated with laboratory diagnosis of mpox among suspected cases, and access differences between PrEP users and PLWH with confirmed diagnostic. Results 394 mpox suspected cases were analyzed, 309 (78.4%) confirmed. Most patients with mpox were PLWH (54.4%) and 99 (32%) PrEP users. Mpox cases were likely to be between 25 and 39 years old (aOR=2.8; p=0.042), men who have sex with men/bisexual or transgender women (aOR=17.2; p< 0.001) and to have fever (aOR=4.7; p< 0.001), adenomegaly (aOR=7.2; p< 0.001) and multiple vesicular lesions (aOR=4.2; p< 0.001). Comparing PrEP users to PLWH with confirmed mpox, PrEP users had lesions predominantly with exclusive genital involvement (p=0.016); while PLWH had higher extragenital involvement (p=0.018). Conclusions PrEP users and PLWHA were the main epidemiological groups in our cohort. Recognizing the differences between vulnerable populations can contribute to the development public policies to control mpox in settings with reduced access to vaccines.
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Affiliation(s)
| | | | - Mylva Fonsi
- Centro de Referência e Treinamento DTS/Aids, São Paulo (SP), Brazil
| | | | | | | | | | | | | | - Angela Tayra
- Centro de Referência e Treinamento DTS/Aids, São Paulo (SP), Brazil
| | | | | | - Ana Marli Christovam Sartori
- Departamento de Moléstias Infecciosas do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo (SP), Brazil
| | - Walkiria Delnero Almeida Prado
- Centro de Informações Estratégicas em Vigilância em Saúde do Centro de Vigilância Epidemiológica de São Paulo, São Paulo (SP), Brazil
| | | | | | - Mpox-CRT working group#
- Centro de Referência e Treinamento DTS/Aids, São Paulo (SP), Brazil
- Departamento de Moléstias Infecciosas do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo (SP), Brazil
- Centro de Informações Estratégicas em Vigilância em Saúde do Centro de Vigilância Epidemiológica de São Paulo, São Paulo (SP), Brazil
- Instituto Adolfo Lutz, São Paulo (SP), Brazil
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Fontán-Vela M, Hernando V, Olmedo C, Coma E, Martínez M, Moreno-Perez D, Lorusso N, Vázquez Torres M, Barbas del Buey JF, Roig-Sena J, Pastor E, Galmés Truyols A, Artigues Serra F, Sancho Martínez RM, Latasa Zamalloa P, Pérez Martínez O, Vázquez Estepa A, García Rojas AJ, Barreno Estévez AI, Sánchez-Migallón Naranjo A, Pérez Martín JJ, Peces Jiménez P, Morales Romero R, Castilla J, García Cenoz M, Huerta Huerta M, Boone ALD, Macías Ortiz MJ, Álvarez Río V, Rodríguez Recio MJ, Merino Díaz M, Berradre Sáenz B, Villegas-Moreno MT, Limia A, Diaz A, Monge S. Effectiveness of Modified Vaccinia Ankara-Bavaria Nordic Vaccination in a Population at High Risk of Mpox: A Spanish Cohort Study. Clin Infect Dis 2024; 78:476-483. [PMID: 37864849 PMCID: PMC10874271 DOI: 10.1093/cid/ciad645] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/04/2023] [Accepted: 10/18/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND With more than 7500 cases reported since April 2022, Spain has experienced the highest incidence of mpox in Europe. From 12 July onward, the modified vaccinia Ankara-Bavaria Nordic (MVA-BN) smallpox vaccine was offered as pre-exposure prophylaxis for those receiving pre-exposure prophylaxis for human immunodeficiency virus (HIV-PrEP). Our aim was to assess the effectiveness of 1 dose of MVA-BN vaccine as pre-exposure prophylaxis against mpox virus (MPXV) infection in persons on HIV-PrEP. METHODS National retrospective cohort study between 12 July and 12 December 2022. Individuals aged ≥18 years receiving HIV-PrEP as of 12 July with no previous MPXV infection or vaccination were eligible. Each day, we matched individuals receiving a first dose of vaccine and unvaccinated controls of the same age and region. We used a Kaplan-Meier estimator, calculated risk ratios (RR) and vaccine effectiveness (VE = [1 - RR]x100). RESULTS We included 5660 matched pairs, with a median follow-up of 62 days (interquartile range, 24-97). Mpox cumulative incidence was 5.6 per 1000 (25 cases) in unvaccinated and 3.5 per 1000 (18 cases) in vaccinated. No effect was found during days 0-6 post-vaccination (VE, -38.3; 95% confidence interval [CI], -332.7 to 46.4), but VE was 65% at ≥7 days (95% CI, 22.9 to 88.0) and 79% at ≥14 days (95% CI, 33.3 to 100.0) post-vaccination. CONCLUSIONS One dose of MVA-BN vaccine offered protection against mpox in most-at-risk population shortly after the vaccination. Further studies need to assess the VE of a second dose and the duration of protection over time.
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Affiliation(s)
- Mario Fontán-Vela
- National Centre of Epidemiology, Institute of Health Carlos III, Community of Madrid, Spain
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Community of Madrid, Spain
| | - Victoria Hernando
- National Centre of Epidemiology, Institute of Health Carlos III, Community of Madrid, Spain
- CIBER on Infectious Diseases, Madrid, Spain
| | - Carmen Olmedo
- Vaccination Programme, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Ermengol Coma
- Primary Healthcare Information Systems, Health Institute of Catalonia, Catalonia, Spain
| | - Montse Martínez
- Preventive Medicine Service, General Sub-directorate for Health Promotion, Health Department, Secretariat of Public Health,Catalonia, Spain
| | - David Moreno-Perez
- Health and Consumption Department, General Directorate of Public Health and Pharmaceutical Management, Andalusia, Spain
| | - Nicola Lorusso
- Health and Consumption Department, General Directorate of Public Health and Pharmaceutical Management, Andalusia, Spain
| | - María Vázquez Torres
- Healthcare Department, General Sub-directorate of Health Prevention and Promotion, General Directorate of Public Health, Community of Madrid, Spain
| | - José Francisco Barbas del Buey
- General Sub-directorate of Public Health Surveillance, General Directorate of Public Health, Madrid, Community of Madrid, Spain
| | - Javier Roig-Sena
- Department of Universal Healthcare and Public Health, Epidemiological Surveillance Service, Valencian Community, Spain
| | - Eliseo Pastor
- Universal Healthcare and Public Health Department, Health Promotion and Prevention Programs Service, Valencian Community, Spain
| | - Antònia Galmés Truyols
- Disease Prevention Service, Health and Consumption Department, General Directorate of Public Health and Participation, Balearic Islands, Spain
| | - Francisca Artigues Serra
- Disease Prevention Service, Health and Consumption Department, General Directorate of Public Health and Participation, Balearic Islands, Spain
| | - Rosa María Sancho Martínez
- Epidemiology Unit, General Sub-directorate of Public Health and Addictions of Gipuzkoa, Basque Country, Spain
| | - Pello Latasa Zamalloa
- Epidemiology and Vaccination Service, General Directorate of Public Health, Basque Country, Spain
| | - Olaia Pérez Martínez
- Epidemiology Service, Health Department, General Directorate of Public Health, Galicia, Spain
| | - Ana Vázquez Estepa
- Epidemiology Service, Health Department, General Directorate of Public Health, Galicia, Spain
| | - Amós José García Rojas
- Prevention and Epidemiology Service, General Directorate of Public Health, Canarian Health Service, Canary Islands, Spain
| | - Ana Isabel Barreno Estévez
- Prevention and Epidemiology Service, General Directorate of Public Health, Canarian Health Service, Canary Islands, Spain
| | | | - Jaime Jesús Pérez Martín
- Vaccination Progamme, Prevention and Health Protection Service, Health Department, General Directorate of Public Health and Addictions, Murcia Region, Spain
| | - Pilar Peces Jiménez
- Epidemiology Service, Healthcare Department, General Directorate of Public Health, Castilla-La Mancha, Spain
| | - Raquel Morales Romero
- Epidemiology Service, Healthcare Department, General Directorate of Public Health, Castilla-La Mancha, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra – IdiSNA – CIBERESP, Pamplona, Spain
| | | | - Marta Huerta Huerta
- Vaccination Programme, Health Department, Epidemiological Surveillance Service, Principado de Asturias, Spain
| | - An Lieve Dirk Boone
- Vaccination Programme, Health Department, Epidemiological Surveillance Service, Principado de Asturias, Spain
| | - María José Macías Ortiz
- Vaccination Program, General Directorate of PublicHealth, Healthcare Service of Extremadura, Spain
| | - Virginia Álvarez Río
- Epidemiology Service, Healthcare Department, General Directorate of Public Health, Castilla y León, Spain
| | | | - María Merino Díaz
- Epidemiology and Healthcare Prevention Service, Health Department, General Directorate of Public Health, Consumption and Nursing, La Rioja, Spain
| | - Belén Berradre Sáenz
- Epidemiology and Healthcare Prevention Service, Health Department, General Directorate of Public Health, Consumption and Nursing, La Rioja, Spain
| | | | - Aurora Limia
- Vaccination Programme, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Asuncion Diaz
- National Centre of Epidemiology, Institute of Health Carlos III, Community of Madrid, Spain
- CIBER on Infectious Diseases, Madrid, Spain
| | - Susana Monge
- National Centre of Epidemiology, Institute of Health Carlos III, Community of Madrid, Spain
- CIBER on Infectious Diseases, Madrid, Spain
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Jia L, Jia H, Fang Y, Yan B, Zhang M, Zhang Y, Wang W, Guo C, Huang X, Zhang T, Jiang T. A Case of Acute HIV-1 and Monkeypox Coinfection After Condomless Insertive Anal Sex in the Previous 69 Days - Beijing Municipality, China, August-October, 2023. China CDC Wkly 2024; 6:126-130. [PMID: 38405600 PMCID: PMC10883321 DOI: 10.46234/ccdcw2024.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/29/2024] [Indexed: 02/27/2024] Open
Abstract
What is already known about this topic? The prevalence of monkeypox (mpox) infections is primarily observed among young men who engage in sexual activities with other men, and there is a possibility of sexual transmission. Co-occurring sexually transmitted infections have also been documented. What is added by this report? In this report, we present a case of a patient in China who was simultaneously diagnosed with mpox, and acute human immunodeficiency virus (HIV) infection. The patient exhibited symptoms of fever and widespread papules on the trunk, face, and genital area. What are the implications for public health practice? It is crucial for health agencies to prioritize HIV testing when mpox is suspected or diagnosed in individuals with recent engagement in high-risk sexual behavior.
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Affiliation(s)
- Lin Jia
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Han Jia
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yuan Fang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Benyong Yan
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Mei Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yang Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wen Wang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Caiping Guo
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xiaojie Huang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Tong Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Taiyi Jiang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
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24
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Zhu Z, Pan X. Preventing stigma against the gay community to curb mpox transmission in the Western Pacific region. J Glob Health 2024; 14:03012. [PMID: 38330199 PMCID: PMC10852531 DOI: 10.7189/jogh.14.03012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Affiliation(s)
- Zhenggang Zhu
- School of Nursing, Hunan University of Chinese Medicine, Yuelu District, Changsha, Hunan, China
- School of Nursing, Wenzhou Medicine University, Chashan Town, Ouhai District, Wenzhou, Zhejiang, China
- School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Xiaoyan Pan
- School of Nursing, Hunan University of Chinese Medicine, Yuelu District, Changsha, Hunan, China
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25
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Abstract
Mpox, previously known as monkeypox, is caused by an Orthopoxvirus related to the variola virus that causes smallpox. Prior to 2022, mpox was considered a zoonotic disease endemic to central and west Africa. Since May 2022, more than 86,000 cases of mpox from 110 countries have been identified across the world, predominantly in men who have sex with men, most often acquired through close physical contact or during sexual activity. The classical clinical presentation of mpox is a prodrome including fever, lethargy, and lymphadenopathy followed by a characteristic vesiculopustular rash. The recent 2022 outbreak included novel presentations of mpox with a predominance of anogenital lesions, mucosal lesions, and other features such as anorectal pain, proctitis, oropharyngeal lesions, tonsillitis, and multiphasic skin lesions. We describe the demographics and clinical spectrum of classical and novel mpox, outlining the potential complications and management.
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Affiliation(s)
- J P Thornhill
- SHARE Research Collaborative, The Blizard Institute, Queen Mary University of London, London, United Kingdom;
| | - M Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - C Orkin
- SHARE Research Collaborative, The Blizard Institute, Queen Mary University of London, London, United Kingdom;
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26
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Jia L, Yan B, Fang Y, Yang X, Jia H, Zhang M, Li S, Zhang Y, Wang W, Guo C, Zhang T, Huang X, Jiang T. Cases of Monkeypox show highly-overlapping co-infection with HIV and syphilis. Front Public Health 2024; 11:1276821. [PMID: 38249378 PMCID: PMC10797090 DOI: 10.3389/fpubh.2023.1276821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/05/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose Ongoing Monkeypox (MPX) outbreaks in countries outside Africa have unique characteristics. However, data on cohorts of confirmed cases in China is limited. The study provides important epidemiological, diagnostic, and clinical information about this disease in China. Methods We report a series of Chinese individuals with confirmed MPX infections identified at Beijing Youan Hospital (China) from June 10 to July 15, 2023. Samples were taken from the skin, anus, throat, and blood. An epidemiological questionnaire was used to collect demographic and clinical data. Further, we compared the MPX viral (MPXV) loads across different anatomical sites. Results 66 samples were collected from 20 patients, all of whom were cisgender men. Median patient age was 29 years. Notably, 19 (95%) patients reported unprotected sexual encounters with men in the preceding month, and 13 (65%) were human immunodeficiency virus (HIV)-positive. Among those with HIV, 12 (92%) were receiving antiretroviral therapy, and 11 (85%) had well-controlled infections (HIV viral load <40/mL). The median CD4+ T cell count was 667 cells/mm3. In the HIV-negative group, three (43%) patients were taking preexposure prophylaxis. Fifteen patients (75%) had concurrent sexually transmitted infections (50% had syphilis and 65% had HIV) and eight (40%) had HIV and syphilis co-infection. MPXV loads were significantly higher in samples from the skin (cycle threshold value [Ct value]: 19·0) and anus (Ct value: 23.0) compared to samples from the throat (Ct value: 31.0) or blood (Ct value: 34.5). All patients had skin lesions (85% of whom presented with anogenital lesions). Common systemic symptoms included fever (85%) and lymphadenopathy (55%). The median incubation period was 8 d [interquartile range (IQR): 6-16 d]. The median time from the onset of skin lesions to scab removal was 14 d (IQR: 10-16 d). No deaths or severe cases were reported. Conclusion MPXV primarily affects young homosexual men. The high MPXV viral loads in skin and anal lesions indicate that transmission most likely occurs through direct and close body contact. This study also reports high rates of HIV and syphilis co-infection. Therefore, preventive efforts should focus on homosexual men.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Xiaojie Huang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Taiyi Jiang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
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27
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Grabmeier-Pfistershammer K, Skorepa C, Breuer M, Masood M, Chromy D, Strassl R. No evidence of asymptomatic monkeypox infection in a highly sexually active MSM population in Austria. HIV Med 2024; 25:150-153. [PMID: 37652894 DOI: 10.1111/hiv.13535] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/06/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND The 2022 outbreak of monkeypox virus (MPXV) revealed new transmission routes. Incidence declined sharply in September 2022, and it remains unclear whether MPXV is circulating in asymptomatic individuals because of increased immunity. OBJECTIVES Our study aimed to assesss the number of asymtomatic MPXV carriers in individuals at high risk for STI. METHODS We analysed anal samples from asymptomatic highly sexually active men who have sex with men for the presence of MPXV. RESULTS We detected a high number of concomitant sexually transmitted infections but did not find a single sample with MPXV. CONCLUSIONS Our results indicate that the general recommendation to implement screening for MPXV is not currently justified.
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Affiliation(s)
| | - Christopher Skorepa
- Division of Clinical Virology, Department of Laboratory Medicine, Medical University Vienna, Vienna, Austria
| | - Monika Breuer
- Division of Clinical Virology, Department of Laboratory Medicine, Medical University Vienna, Vienna, Austria
| | - Maheen Masood
- Division of Clinical Virology, Department of Laboratory Medicine, Medical University Vienna, Vienna, Austria
| | - David Chromy
- Department of Dermatology, Medical University Vienna, Vienna, Austria
| | - Robert Strassl
- Division of Clinical Virology, Department of Laboratory Medicine, Medical University Vienna, Vienna, Austria
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28
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Pinnetti C, Mondi A, Mazzotta V, Vita S, Carletti F, Aguglia C, Beccacece A, Vergori A, Gagliardini R, Specchiarello E, Ascoli Bartoli T, Baldini F, Giancola ML, Valli MB, D'Abramo A, Gebremeskel Teklè S, Fontana C, Garbuglia AR, Girardi E, Maggi F, Vaia F, Nicastri E, Antinori A. Pharyngo-tonsillar involvement of Mpox in a cohort of men who have sex with men (MSM): A serious risk of missing diagnosis. J Infect Public Health 2024; 17:130-136. [PMID: 38000313 DOI: 10.1016/j.jiph.2023.11.015] [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: 06/26/2023] [Revised: 09/15/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
During the 2022-outbreak, peculiar clinical presentations of Mpox have been described, some of which can make the diagnosis of the disease extremely challenging. Here we report a case series of fourteen patients with Mpox pharynogotonsillar involvement (PTI) seen at National Institute for Infectious Diseases, "Lazzaro Spallanzani", in Rome, Italy from May to September 2022. All included patients were men who have sex with men (median age 38 years) reporting unprotected sex within three weeks from symptoms onset. Seven out of fourteen patients needed hospitalization due to uncontrolled pain, reduced airspace and difficulty swallowing, of whom five were effectively treated with tecovirimat or cidofovir. The remaining two patients were treated with symptomatic drugs. The typical Mpox muco-cutaneous manifestations were not observed simultaneously with PTI in three patients, two of whom developed the lesions after several days, while one never manifested them. Polymerase Chain Reaction (PCR) for Mpox virus was positive in oropharyngeal swab, saliva and serum. Although PTI occurs in only a small percentage of Mpox cases, its diagnosis is of utmost importance. In fact, this localization, if not identified, could lead to serious complications in the absence of early antiviral treatment and to missed diagnosis with an increased risk of disease transmission.
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Affiliation(s)
- Carmela Pinnetti
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Annalisa Mondi
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy.
| | - Valentina Mazzotta
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Serena Vita
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Carletti
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Camilla Aguglia
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessia Beccacece
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Vergori
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Roberta Gagliardini
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Eliana Specchiarello
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Tommaso Ascoli Bartoli
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Baldini
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Letizia Giancola
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Beatrice Valli
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra D'Abramo
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Saba Gebremeskel Teklè
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Carla Fontana
- Laboratory of Microbiology and Biological Bank, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Anna Rosa Garbuglia
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Maggi
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Vaia
- General Direction, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuele Nicastri
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Antinori
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
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29
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Cho W, Park S, Kim HJ, Lee M, Choi YS, Yeo SG, Lee J, Koyanagi A, Jacob L, Smith L, Rahmati M, Ahmad S, Fond G, Boyer L, Rhee SY, Lee SW, Shin JI, Woo HG, Yon DK. Clinical characteristics and outcomes of patients with mpox during the 2022 mpox outbreak compared with those before the outbreak: A systematic review and meta-analysis. Rev Med Virol 2024; 34:e2508. [PMID: 38282393 DOI: 10.1002/rmv.2508] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/12/2023] [Accepted: 12/17/2023] [Indexed: 01/30/2024]
Abstract
On 23 July 2022, the World Health Organization declared the global mpox outbreak as a public health emergency of international significance. The mpox virus (MPXV) that caused the outbreak was classified as clade IIb, which belongs to the West African clade. However, the relationship between MPXV clades and symptoms, as well as the severity of mpox outcomes, is not fully understood. Thus, we aimed to investigate the global mpox prevalence and the differences in clinical manifestations and outcomes among patients with mpox between pre-outbreak (2003-2021) and the current mpox outbreak. In this systematic review and meta-analysis, PubMed/MEDLINE, Web of Science, Embase, Cumulative Index to Nursing and Allied Health Literature, and Google Scholar were searched using the keyword "monkeypox" and "mpox" up to 13 October 2022. A random effects model was used to obtain the pooled prevalence and 95% confidence intervals. This study included 27 articles, and 5698 patients with mpox with 19 distinctive features from 19 countries across five continents were assessed. Patients with mpox during the 2022 mpox outbreak showed mild clinical manifestations and outcomes compared with those before the 2022 mpox outbreak: mild rash (relative ratio [RR]: 5.09, 95% confidence interval [CI]: 1.52-17.08), fever (0.68, 0.49-0.94), pruritus (0.25, 0.19-0.32), myalgia (0.50, 0.31-0.81), headache (0.56, 0.35-0.88), skin ulcer (0.32, 0.17-0.59), abdominal symptom (0.29, 0.20-0.42), pharyngitis (0.32, 0.18-0.58), nausea or vomiting (0.15, 0.02-0.93), conjunctivitis (0.11, 0.03-0.38), concomitant infection with HIV (1.70, 0.95-3 0.04), and death (0.02, 0.001-0.31). MPXV clade IIb exhibited higher infectivity but may cause mild disease symptoms and low mortality rate. It is important to consider MPXV infection in patients with mpox-related features and/or a history of sexual transmission to prevent the spread of the disease and recognise the current pandemic threat.
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Affiliation(s)
- Wonyoung Cho
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Sangil Park
- Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyeon Jin Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Myeongcheol Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Yong Sung Choi
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Seung Geun Yeo
- Department of Otolaryngology - Head & Neck Surgery, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Jinseok Lee
- Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Louis Jacob
- Epidemiology of Ageing and Neurodegenerative Diseases, Université Paris-Cité, Paris, France
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Suhana Ahmad
- Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Guillaume Fond
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Aix-Marseille University, Health Service Research and Quality of Life Center, Marseille, France
- FondaMental Foundation, Creteil, France
| | - Laurent Boyer
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Aix-Marseille University, Health Service Research and Quality of Life Center, Marseille, France
- FondaMental Foundation, Creteil, France
| | - Sang Youl Rhee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Endocrinology and Metabolism, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, South Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
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30
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Silva MST, Coutinho C, Torres TS, Peixoto EM, Bastos MO, Mesquita MB, Tavares ICF, Andrade HB, Reges PPS, Martins PS, Echeverría-Guevara A, Moreira RI, Lessa FCS, Hoagland B, Nunes EP, Cardoso SW, Veloso VG, Grinsztejn B. Mpox severity and associated hospitalizations among people with HIV and related immunosuppression in Brazil. AIDS 2024; 38:105-113. [PMID: 37812389 PMCID: PMC10715691 DOI: 10.1097/qad.0000000000003748] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES This study aimed to analyze characteristics of mpox hospitalization in a Brazilian cohort, further exploring the impact of HIV on mpox-related outcomes and hospitalization. DESIGN We conducted a descriptive analysis, comparing characteristics of individuals diagnosed with mpox according to hospitalization and HIV status, and described the mpox cases among those living with HIV. METHODS This was a single-center, prospective cohort study conducted at a major infectious diseases referral center in Rio de Janeiro, Brazil, that enrolled participants older than 18 years of age diagnosed with mpox. Information was collected on standardized forms, including data on sociodemographic, behavioral, clinical and laboratory characteristics. For comparisons, we used chi-squared, Fisher's exact and the Moods median tests whenever appropriate. RESULTS From June to December, 2022, we enrolled 418 individuals diagnosed with mpox, of whom 52% were people with HIV (PWH). PWH presented more frequently with fever, anogenital lesions and proctitis. The overall hospitalization rate was 10.5% ( n = 43), especially for pain control. Among hospitalized participants, PWH had more proctitis and required invasive support. Mpox severity was related to poor HIV continuum of care outcomes and low CD4 + cell counts. All deaths ( n = 2) occurred in PWH with CD4 + less than 50 cells/μl. CONCLUSION HIV-related immunosuppression likely impacts mpox clinical outcomes. This is of special concern in settings of poor adherence and late presentation to care related to socioeconomic inequalities, such as Brazil. The HIV continuum of care must be taken into account when responding to the mpox outbreak.
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Affiliation(s)
- Mayara S T Silva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Manguinhos, Rio de Janeiro, Brazil
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31
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Ogoina D, Dalhat MM, Denue BA, Okowa M, Chika-Igwenyi NM, Yusuff HA, Christian UC, Adekanmbi O, Ojimba AO, Aremu JT, Habila KL, Oiwoh SO, Tobin EA, Johnson SM, Olaitan A, Onyeaghala C, Gomerep SS, Alasia D, Onukak AE, Mmerem J, Unigwe U, Falodun O, Kwaghe V, Awang SK, Sunday M, Maduka CJ, Na'uzo AM, Owhin SO, Mohammed AA, Adeiza MA. Clinical characteristics and predictors of human mpox outcome during the 2022 outbreak in Nigeria: a cohort study. THE LANCET. INFECTIOUS DISEASES 2023; 23:1418-1428. [PMID: 37625431 DOI: 10.1016/s1473-3099(23)00427-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Research from sub-Saharan Africa that contributes to our understanding of the 2022 mpox (formerly known as monkeypox) global outbreak is insufficient. Here, we describe the clinical presentation and predictors of severe disease among patients with mpox diagnosed between Feb 1, 2022, and Jan 30, 2023 in Nigeria. METHODS We did a cohort study among laboratory-confirmed and probable mpox cases seen in 22 mpox-treatment centres and outpatient clinics across Nigeria. All individuals with confirmed and probable mpox were eligible for inclusion. Exclusion criteria were individuals who could not be examined for clinical characterisation and those who had unknown mortality outcomes. Skin lesion swabs or crust samples were collected from each patient for mpox diagnosis by PCR. A structured questionnaire was used to document sociodemographic and clinical data, including HIV status, complications, and treatment outcomes from the time of diagnosis to discharge or death. Severe disease was defined as mpox associated with death or with a life-threatening complication. Two logistic regression models were used to identify clinical characteristics associated with severe disease and potential risk factors for severe disease. The primary outcome was the clinical characteristics of mpox and disease severity. FINDINGS We enrolled 160 people with mpox from 22 states in Nigeria, including 134 (84%) adults, 114 (71%) males, 46 (29%) females, and 25 (16%) people with HIV. Of the 160 patients, distinct febrile prodrome (n=94, 59%), rash count greater than 250 (90, 56%), concomitant varicella zoster virus infection (n=48, 30%), and hospital admission (n=70, 48%) were observed. Nine (6%) of the 160 patients died, including seven (78%) deaths attributable to sepsis. The clinical features independently associated with severe disease were a rash count greater than 10 000 (adjusted odds ratio 26·1, 95% CI 5·2-135·0, p<0·0001) and confluent or semi-confluent rash (6·7, 95% CI 1·9-23·9). Independent risk factors for severe disease were concomitant varicella zoster virus infection (3·6, 95% CI 1·1-11·5) and advanced HIV disease (35·9, 95% CI 4·1-252·9). INTERPRETATION During the 2022 global outbreak, mpox in Nigeria was more severe among those with advanced HIV disease and concomitant varicella zoster virus infection. Proactive screening, management of co-infections, the integration and strengthening of mpox and HIV surveillance, and preventive and treatment services should be prioritised in Nigeria and across Africa. FUNDING None.
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Affiliation(s)
- Dimie Ogoina
- Infectious Diseases Unit, Department of Internal Medicine, Niger Delta University Teaching Hospital, Niger Delta University, Yenagoa, Bayelsa, Nigeria.
| | | | | | - Mildred Okowa
- Department of Public Health, Ministry of Health, Asaba, Delta, Nigeria
| | - Nneka Marian Chika-Igwenyi
- Infectious Diseases Unit, Internal Medicine Department, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi , Nigeria
| | | | - Umenzekwe Chukwudi Christian
- Infectious Diseases and Tropical Medicine Unit, Department of Internal Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | | | - John Tunde Aremu
- Infectious Diseases Unit, Federal Teaching Hospital Gombe, Gombe, Nigeria
| | - Kambai Lalus Habila
- Kaduna State Emergency Medical Services and Ambulance System, Kaduna, Kaduna, Nigeria
| | | | - Ekaete Alice Tobin
- Institute of Viral Haemorrhagic Fever and Emerging Pathogens, Irrua Specialist Teaching Hospital, Irrua, Edo, Nigeria
| | - Simon Mafuka Johnson
- Department of Internal Medicine, Federal University Teaching Hospital, Owerri, Imo, Nigeria
| | - Abimbola Olaitan
- Department of Internal Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun, Nigeria
| | - Chizaram Onyeaghala
- Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria
| | - Simji Samuel Gomerep
- Infectious Diseases Unit, Jos University Teaching Hospital, and Medicine Department, University of Jos, Plateau, Nigeria
| | - Datonye Alasia
- Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria
| | - Asukwo E Onukak
- Department of Internal Medicine, University of Uyo, Uyo, Nigeria
| | - Juliet Mmerem
- Infectious Disease and Tropical Medicine Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Uche Unigwe
- Infectious Disease and Tropical Medicine Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Olanrewaju Falodun
- Department of Internal Medicine, National Hospital Abuja, Federal Capital Territory, Nigeria
| | - Vivian Kwaghe
- Department of Internal Medicine, University of Abuja Teaching Hospital, Gwagalada, Abuja, Federal Capital Territory, Nigeria
| | - Sati Klein Awang
- Infectious Diseases Unit, Department of Internal Medicine, Modibo Adama University Teaching Hospital, Yola, Adamawa, Nigeria
| | - Mogaji Sunday
- Department of Public Health, Federal Medical Centre, Ebute Metta, Lagos, Nigeria
| | | | - Aliyu Mamman Na'uzo
- Department of Paediatrics, Federal Medical Centre, Birnin Kebbi, Kebbi, Nigeria
| | - Sampson Omagbemi Owhin
- Department of Medicine, Clinical Haematology Unit, Federal Medical Center, Owo, Ondo, Nigeria
| | - Abdullahi Asara Mohammed
- Infectious Diseases and Tropical Medicine Unit, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Kaduna, Nigeria
| | - Mukhtar Abdulmajid Adeiza
- Infectious Diseases and Tropical Medicine Unit, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Kaduna, Nigeria
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Zucker J, Hazra A, Titanji BK. Mpox and HIV-Collision of Two Diseases. Curr HIV/AIDS Rep 2023; 20:440-450. [PMID: 37994953 DOI: 10.1007/s11904-023-00682-w] [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] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE OF REVIEW The global outbreak of mpox has brought renewed attention to a previously neglected disease which is particularly severe in people with underlying untreated HIV co-infection. For this population, the disease is progressive, severe, and often lethal. In this review, we examine the pathogenesis of mpox disease and its collision with co-existent HIV infection and discuss key considerations for management as well as emerging clinical dilemmas and areas for future research. RECENT FINDINGS Co-existent untreated HIV infection characterized by severe immunocompromise potentiates the nefarious effects of monkeypox virus infection leading to severe manifestations of mpox. Treating mpox in the context of HIV requires mpox-directed therapies, supportive care, and HIV-specific treatment to restore immune function. Preventative measures for PWH are like those in healthy individuals, but the effectiveness and durability of protection conferred by existing vaccines in PWH remain to be fully characterized. Mpox is an important opportunistic infection in PWH. Clinicians should be aware of the unique features of the disease in this population and approaches to care and management of mpox in PWH.
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Affiliation(s)
- Jason Zucker
- Department of Infectious Diseases, Columbia University, New York, NY, USA
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA
| | - Boghuma K Titanji
- Division of Infectious Diseases, Health Sciences Research Building I, Emory University School of Medicine, 1760 Haygood Drive NE, W300, Rm 327, Atlanta, GA, USA.
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Rajme-López S, Corral-Herrera EA, Tello-Mercado AC, Tepo-Ponce KM, Pérez-Meléndez RE, Rosales-Sotomayor Á, Figueroa-Ramos G, López-López K, Domínguez-Cherit JG, San-Martín-Morante O, Saeb-Lima M, Gamboa-Domínguez A, Ponce-de-León A, Crabtree-Ramírez B, Ramos-Cervantes P, Ruíz-Palacios GM. Clinical, molecular, and histological characteristics of severely necrotic and fatal mpox in HIV-infected patients. AIDS Res Ther 2023; 20:85. [PMID: 38012656 PMCID: PMC10683144 DOI: 10.1186/s12981-023-00580-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND This case series of 5 patients with severely necrotic mpox highlights the predominantly necrotic nature of lesions seen in cases of severe mpox as shown by skin and lung biopsy, as well as the extensive dissemination of the infection, as shown by polymerase chain reaction (PCR) assessment in different body sites. CASE PRESENTATIONS Patients were male, the median age was 37, all lived with HIV (2 previously undiagnosed), the median CD4+ cell count was 106 cells/mm3, and 2/5 were not receiving antiretroviral treatment. The most common complication was soft tissue infection. Skin and lung biopsies showed extensive areas of necrosis. Mpox PCR was positive in various sites, including skin, urine, serum, and cerebrospinal fluid. The initiation of antiretroviral treatment, worsened the disease, like that seen in immune reconstitution syndrome. Three patients died due to multiple organ failure, presumably associated with mpox since coinfections and opportunistic pathogens were ruled out. CONCLUSIONS Severely necrotic manifestations of mpox in people living with advanced and untreated HIV are related to adverse outcomes.
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Affiliation(s)
- Sandra Rajme-López
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán" Vasco de Quiroga #15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de México, 14080, México
| | - Ever A Corral-Herrera
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán" Vasco de Quiroga #15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de México, 14080, México
| | - Andrea C Tello-Mercado
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán" Vasco de Quiroga #15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de México, 14080, México
| | - Karen M Tepo-Ponce
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán" Vasco de Quiroga #15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de México, 14080, México
| | - Raúl E Pérez-Meléndez
- Internal Medicine Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Ángela Rosales-Sotomayor
- Dermatology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Grecia Figueroa-Ramos
- Dermatology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Karla López-López
- Dermatology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Judith G Domínguez-Cherit
- Dermatology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Oswaldo San-Martín-Morante
- Pathology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Marcela Saeb-Lima
- Pathology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Armando Gamboa-Domínguez
- Pathology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Alfredo Ponce-de-León
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán" Vasco de Quiroga #15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de México, 14080, México
| | - Brenda Crabtree-Ramírez
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán" Vasco de Quiroga #15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de México, 14080, México
| | - Pilar Ramos-Cervantes
- Virology and Molecular Biology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Guillermo M Ruíz-Palacios
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán" Vasco de Quiroga #15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de México, 14080, México.
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Triana-González S, Román-López C, Mauss S, Cano-Díaz AL, Mata-Marín JA, Pérez-Barragán E, Pompa-Mera E, Gaytán-Martínez JE. Risk factors for mortality and clinical presentation of monkeypox. AIDS 2023; 37:1979-1985. [PMID: 37294338 DOI: 10.1097/qad.0000000000003623] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To describe risk factors for mortality and clinical characteristics in patients with mpox infection at a reference hospital in Mexico. DESIGN A prospective cohort study was conducted from September to December 2022 at Hospital de Infectología La Raza National Medical Center. METHODS Study participants were patients that met operational definition of confirmed case of mpox according to WHO criteria. Information was obtained through a case report form that included epidemiological, clinical, and biochemical information. The follow-up period was from initial evaluation for hospitalization until discharge due to clinical improvement or death. Written informed consent was obtained from all participants. RESULTS Seventy-two patients were included in the analysis, 64 of 72 (88.9%) were people with HIV (PWH). Of the total of patients 71 of 72 (98.6%) were male, with a median age of 32 years old [95% confidence interval (CI), interquartile range (IQR) 27-37]. Coinfection with sexually transmitted infections was reported in 30 of 72 (41.7%). The overall mortality was five of 72 (6.9%). The incidence of mortality rate in PWH was 6.3%. Median days from onset of symptoms to death from any cause during hospitalization was 50 days (95% CI, IQR 38-62). Risk factors for mpox mortality in the bivariate analysis were CD4 + cells count ≤100 cells/μl at the time of assessment RR 20 (95% CI, IQR 6.6-60.2) ( P < 0.001), absence of antiretroviral therapy RR 6.6 (95% CI, IQR 3.6-12.1) ( P = 0.001) and ≥50 skin lesions at presentation RR 6.4 (95% CI, IQR 2.6-15.7) ( P = 0.011). CONCLUSIONS The clinical presentation between PWH and non-HIV patients was similar in this study, however, reported mortality was associated with advanced-HIV disease.
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Affiliation(s)
- Salma Triana-González
- Infectious Diseases Department, Hospital de Infectología 'Dr Daniel Méndez Hernández' La Raza National Medical Center
| | - Cristina Román-López
- Infectious Diseases Department, Hospital de Infectología 'Dr Daniel Méndez Hernández' La Raza National Medical Center
| | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Duesseldorf, Germany
| | - Ana Luz Cano-Díaz
- Infectious Diseases Department, Hospital de Infectología 'Dr Daniel Méndez Hernández' La Raza National Medical Center
| | - José Antonio Mata-Marín
- Infectious Diseases Department, Hospital de Infectología 'Dr Daniel Méndez Hernández' La Raza National Medical Center
| | - Edgar Pérez-Barragán
- Infectious Diseases Department, Hospital de Infectología 'Dr Daniel Méndez Hernández' La Raza National Medical Center
| | - Ericka Pompa-Mera
- Research Unit, Hospital de Infectología 'Dr Daniel Méndez Hernández' La Raza National Medical Center, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Jesús Enrique Gaytán-Martínez
- Infectious Diseases Department, Hospital de Infectología 'Dr Daniel Méndez Hernández' La Raza National Medical Center
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Sharif N, Dey SK. Epidemiology of mpox: Focus on men with HIV. Heliyon 2023; 9:e22129. [PMID: 38034744 PMCID: PMC10685360 DOI: 10.1016/j.heliyon.2023.e22129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/22/2023] [Accepted: 11/05/2023] [Indexed: 12/02/2023] Open
Abstract
The 2022 mpox outbreak is the first ever report of worldwide spread of cases. Integrated knowledge on the epidemiology and clinical characteristics of mpox are limited. This study was conducted to shed light on the epidemiology of 2022 mpox outbreak. We found that men were the most infected sex (90-100 % cases). The highest prevalence of mpox infection (70 %) was found among men aged between 30 and 40 years. Pre-existing HIV was reported among 24-100 % of mpox positive cases. About 90-100 % of the cases have been disproportionately found among group of men with specific sexual practice, namely, men who have sex with men (MSM). Case fatality rate of 2022 mpox outbreak varied between 1 and 10 %. Studies on the relationship of HIV with mpox outcomes are limited. This study will add knowledge on the epidemiology of 2022 mpox outbreak.
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Affiliation(s)
- Nadim Sharif
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka-1342, Bangladesh
| | - Shuvra Kanti Dey
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka-1342, Bangladesh
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Akpoigbe K, Yannick J, Culpepper-Morgan J. Near obstructing painful anorectal mass and facial rash in a man with monkeypox: A case report. World J Clin Cases 2023; 11:7418-7423. [PMID: 37969438 PMCID: PMC10643086 DOI: 10.12998/wjcc.v11.i30.7418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/21/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Monkeypox (MPX) is a zoonotic infection that is endemic in Western and Central Africa along the Congo River basin. It has a high case fatality rate especially in younger age groups. It belongs to the virus family orthopoxvirus like smallpox. It is transmitted from wild animals to humans but human to human transmission has been established. It is often a self-limited infection in endemic regions. Recently, attention has been given to MPX with the spread of infection to Europe and the United States of America (USA). There is currently sporadic infection of MPX in the USA especially amongst men who have sex with men (MSM). It is a serious life-threatening infection in human immunodeficiency virus/acquired immunodeficiency syndrome co-infected individuals especially those who are treatment naïve with severe immunosuppression. CASE SUMMARY We report a 38-year old man who presented with rectal pain, and anal, torso, and facial rash. Abdominal computed tomography scan showed a near obstructive rectal mass with peri-anal fistula. MPX was positive. He was started on tecovirimat (TPOXX) and HAART therapy. Additional treatment provided included vaccinia immunoglobulin following his clinical deterioration. CONCLUSION This case highlights a rare presentation of MPX with peri-anal fistula and near obstructive rectal mass, and the significance of MPX as a differential diagnosis in proctitis in MSM in addition to other sexually transmitted infection like gonorrhea and chlamydia.
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Affiliation(s)
- Kesiena Akpoigbe
- Department of Gastroenterology, Columbia University Medical Center Health + Hospitals/Harlem Affiliation, New York, NY 10037, United States
| | - Jones Yannick
- Department of Internal Medicine, Columbia University Medical Center Health + Hospitals/Harlem Affiliation, New York, NY 10037, United States
| | - Joan Culpepper-Morgan
- Department of Gastroenterology, Columbia University Medical Center Health + Hospitals/Harlem Affiliation, New York, NY 10037, United States
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Momin ZK, Lee A, Vandergriff TW, Bowling JE, Chamseddin B, Dominguez A, Hosler GA, Wang RC, Kitchell E. A plague passing over: Clinical features of the 2022 mpox outbreak in patients of color living with HIV. HIV Med 2023; 24:1056-1065. [PMID: 37336551 PMCID: PMC10592586 DOI: 10.1111/hiv.13517] [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: 02/06/2023] [Accepted: 05/12/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Compared with previous geographically localized outbreaks of monkeypox (MPOX), the scale of the 2022 global mpox outbreak has been unprecedented, yet the clinical features of this outbreak remain incompletely characterized. METHODS We identified patients diagnosed with mpox by polymerase chain reaction (PCR; n = 36) from July to September 2022 at a single, tertiary care institution in the USA. Demographics, clinical presentation, infection course, and histopathologic features were reviewed. RESULTS AND CONCLUSION Men who have sex with men (89%) and people living with HIV (97%) were disproportionately affected. While fever and chills (56%) were common, some patients (23%) denied any prodromal symptoms. Skin lesions showed a wide range of morphologies, including papules and pustules, and lesions showed localized, not generalized, spread. Erythema was also less appreciable in skin of colour patients (74%). Atypical clinical features and intercurrent skin diseases masked the clinical recognition of several cases, which were ultimately diagnosed by PCR. Biopsies showed viral cytopathic changes consistent with Orthopoxvirus infections. All patients in this case series recovered without complications, although six patients (17%) with severe symptoms were treated with tecovirimat without complication.
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Affiliation(s)
- Zoha K. Momin
- Department of Dermatology, UT Southwestern Medical Center, Dallas, TX, U.S.A
| | - Aleuna Lee
- Department of Dermatology, UT Southwestern Medical Center, Dallas, TX, U.S.A
| | - Travis W. Vandergriff
- Department of Dermatology, UT Southwestern Medical Center, Dallas, TX, U.S.A
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, U.S.A
| | - Jason E. Bowling
- Department of Internal Medicine, UT Health Science Center, San Antonio, TX, U.S.A
| | - Bahir Chamseddin
- Department of Dermatology, UT Southwestern Medical Center, Dallas, TX, U.S.A
| | - Arturo Dominguez
- Department of Dermatology, UT Southwestern Medical Center, Dallas, TX, U.S.A
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, U.S.A
| | - Gregory A. Hosler
- Department of Dermatology, UT Southwestern Medical Center, Dallas, TX, U.S.A
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, U.S.A
- ProPath Dermatopathology, Dallas, TX, U.S.A
| | - Richard C. Wang
- Department of Dermatology, UT Southwestern Medical Center, Dallas, TX, U.S.A
| | - Ellen Kitchell
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, U.S.A
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Sharif N, Sharif N, Alzahrani KJ, Halawani IF, Alzahrani FM, Díez IDLT, Lipari V, Flores MAL, Parvez AK, Dey SK. Molecular epidemiology, transmission and clinical features of 2022-mpox outbreak: A systematic review. Health Sci Rep 2023; 6:e1603. [PMID: 37808926 PMCID: PMC10556267 DOI: 10.1002/hsr2.1603] [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: 05/25/2023] [Revised: 09/08/2023] [Accepted: 09/15/2023] [Indexed: 10/10/2023] Open
Abstract
Background and Aims The 2022-mpox outbreak has spread worldwide in a short time. Integrated knowledge of the epidemiology, clinical characteristics, and transmission of mpox are limited. This systematic review of peer-reviewed articles and gray literature was conducted to shed light on the epidemiology, clinical features, and transmission of 2022-mpox outbreak. Methods We identified 45 peer-reviewed manuscripts for data analysis. The standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement and Cochrane Collaboration were followed for conducting the study. Results The case number of mpox has increased about 100 times worldwide. About 99% of the cases in 2022 outbreak was from non-endemic regions. Men (70%-98% cases) were mostly infected with homosexual and bisexual behavior (30%-60%). The ages of the infected people ranged between 30 and 40 years. The presence of HIV and sexually transmitted infections among 30%-60% of cases were reported. Human-to-human transmission via direct contact and different body fluids were involved in the majority of the cases (90%-100%). Lesions in genitals, perianal, and anogenital areas were more prevalent. Unusually, pharyngitis (15%-40%) and proctitis (20%-40%) were more common during 2022 outbreak than pre-2022 outbreaks. Brincidofovir is approved for the treatment of smallpox by FDA (USA). Two vaccines, including JYNNEOSTM and ACAM2000®, are approved and used for pre- and post-prophylaxis in cases. About 100% of the cases in non-endemic regions were associated with isolates of IIb clade with a divergence of 0.0018-0.0035. Isolates from B.1 lineage were the most predominant followed by B.1.2 and B.1.10. Conclusion This study will add integrated knowledge of the epidemiology, clinical features, and transmission of mpox.
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Affiliation(s)
- Nadim Sharif
- Department of MicrobiologyJahangirnagar UniversitySavarDhakaBangladesh
| | - Nazmul Sharif
- Department of MathematicsRajshahi University of Engineering & TechnologyRajshahiBangladesh
| | - Khalid J. Alzahrani
- Department of Clinical Laboratories Sciences, College of Applied Medical SciencesTaif UniversityTaifSaudi Arabia
| | - Ibrahim F. Halawani
- Department of Clinical Laboratories Sciences, College of Applied Medical SciencesTaif UniversityTaifSaudi Arabia
| | - Fuad M. Alzahrani
- Department of Clinical Laboratories Sciences, College of Applied Medical SciencesTaif UniversityTaifSaudi Arabia
| | | | - Vivían Lipari
- Universidad Europea del AtlánticoSantanderSpain
- Universidad Internacional IberoamericanaAreciboPuerto RicoUSA
- Universidade Internacional do CuanzaCuitoBiéAngola
- Fundación Universitaria Internacional de ColombiaBogotáColombia
| | - Miguel Angel López Flores
- Universidad Europea del AtlánticoSantanderSpain
- Universidad Internacional IberoamericanaCampecheMéxico
- Instituto Politécnico NacionalUPIICSACiudad de MéxicoMéxico
| | - Anowar K. Parvez
- Department of MicrobiologyJahangirnagar UniversitySavarDhakaBangladesh
| | - Shuvra K. Dey
- Department of MicrobiologyJahangirnagar UniversitySavarDhakaBangladesh
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Abstract
PURPOSE OF REVIEW We reviewed the available literature on mpox in People with HIV (PWH). We highlight special considerations of mpox infection related to epidemiology, clinical presentation, diagnostic and treatment considerations, prevention, and public health messaging in PWH. RECENT FINDINGS During the 2022 mpox outbreak, PWH were disproportionally impacted worldwide. Recent reports suggest that the disease presentation, management, and prognosis of these patients, especially those with advanced HIV disease, can widely differ from those without HIV-associated immunodeficiency. Mpox can often be mild and resolve on its own in PWH with controlled viremia and higher CD4 counts. However, it can be severe, with necrotic skin lesions and protracted healing; anogenital, rectal, and other mucosal lesions; and disseminated organ systems involvement. Higher rates of healthcare utilization are seen in PWH. Supportive, symptomatic care and single or combination mpox-directed antiviral drugs are commonly used in PWH with severe mpox disease. Data from randomized clinical control trials on the efficacy of therapeutic and preventive tools against mpox among PWH are needed to better guide clinical decisions.
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Affiliation(s)
- Carlos S Saldana
- Division of Infectious Diseases, Emory University School of Medicine, Ponce de Leon Center, 341 Ponce de Leon Ave NE, Atlanta, GA, 30308, USA.
| | - Colleen F Kelley
- Division of Infectious Diseases, Emory University School of Medicine, Ponce de Leon Center, 341 Ponce de Leon Ave NE, Atlanta, GA, 30308, USA
| | - Bruce M Aldred
- Division of Infectious Diseases, Emory University School of Medicine, Ponce de Leon Center, 341 Ponce de Leon Ave NE, Atlanta, GA, 30308, USA
| | - Valeria D Cantos
- Division of Infectious Diseases, Emory University School of Medicine, Ponce de Leon Center, 341 Ponce de Leon Ave NE, Atlanta, GA, 30308, USA
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40
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Schwartz DA, Pittman PR. Mpox (Monkeypox) in Pregnancy: Viral Clade Differences and Their Associations with Varying Obstetrical and Fetal Outcomes. Viruses 2023; 15:1649. [PMID: 37631992 PMCID: PMC10458075 DOI: 10.3390/v15081649] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
In African countries where mpox (monkeypox) is endemic, infection is caused by two genetically related clades-Clade I (formerly Congo Basin), and Clade IIa (formerly West Africa), both of which are potentially life-threatening infections. Prior to the 2022-2023 global outbreak, mpox infections among pregnant women caused by Clade I were reported to have a 75% perinatal case fatality rate in the Democratic Republic of Congo, including the only documented case of placental infection and stillbirth from the Congenital Mpox Syndrome, and the Clade IIa mpox infection was associated with stillbirths in Nigeria. The 2022-2023 global mpox outbreak, caused by a genetically distinct strain, Clade IIb, has focused attention on the effects of mpox on pregnant women and fetal outcomes. There have been at least 58 cases of mpox infection occurring in pregnant women during the 2022-2023 outbreak. No confirmed cases of adverse perinatal outcome, including stillbirth, have been reported. The absence of perinatal morbidity and mortality from Clade IIb corresponds to the overall case fatality rate among non-pregnant women of <0.1%, as this clade has been demonstrated to produce a less-severe disease than the mpox Clade I or IIa variants. Thus, there are apparently important differences between mpox clades affecting pregnant women and perinatal outcomes.
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Affiliation(s)
| | - Phillip R. Pittman
- Division of Medicine, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, MD 21702, USA;
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Martínez-Fernández DE, Fernández-Quezada D, Casillas-Muñoz FAG, Carrillo-Ballesteros FJ, Ortega-Prieto AM, Jimenez-Guardeño JM, Regla-Nava JA. Human Monkeypox: A Comprehensive Overview of Epidemiology, Pathogenesis, Diagnosis, Treatment, and Prevention Strategies. Pathogens 2023; 12:947. [PMID: 37513794 PMCID: PMC10384102 DOI: 10.3390/pathogens12070947] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/16/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Monkeypox virus (MPXV) is an emerging zoonotic virus that belongs to the Orthopoxvirus genus and presents clinical symptoms similar to those of smallpox, such as fever and vesicular-pustular skin lesions. However, the differential diagnosis between smallpox and monkeypox is that smallpox does not cause lymphadenopathy but monkeypox generates swelling in the lymph nodes. Since the eradication of smallpox, MPXV has been identified as the most common Orthopoxvirus to cause human disease. Despite MPXV being endemic to certain regions of Africa, the current MPXV outbreak, which began in early 2022, has spread to numerous countries worldwide, raising global concern. As of the end of May 2023, over 87,545 cases and 141 deaths have been reported, with most cases identified in non-endemic countries, primarily due to human-to-human transmission. To better understand this emerging threat, this review presents an overview of key aspects of MPXV infection, including its animal reservoirs, modes of transmission, animal models, epidemiology, clinical and immunological features, diagnosis, treatments, vaccines, and prevention strategies. The material presented here provides a comprehensive understanding of MPXV as a disease, while emphasizing the significance and unique characteristics of the 2022 outbreak. This offers valuable information that can inform future research and aid in the development of effective interventions.
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Affiliation(s)
| | - David Fernández-Quezada
- Department of Neurosciences, University Center for Health Science (CUCS), University of Guadalajara, Guadalajara 44340, Mexico
| | | | | | - Ana Maria Ortega-Prieto
- Department of Microbiology, University of Málaga, 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
| | - Jose M Jimenez-Guardeño
- Department of Microbiology, University of Málaga, 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
| | - Jose Angel Regla-Nava
- Department of Microbiology and Pathology, University Center for Health Science (CUCS), University of Guadalajara, Guadalajara 44340, Mexico
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Rabaan AA, Alasiri NA, Aljeldah M, Alshukairiis AN, AlMusa Z, Alfouzan WA, Abuzaid AA, Alamri AA, Al-Afghani HM, Al-Baghli N, Alqahtani N, Al-Baghli N, Almoutawa MY, Mahmoud Alawi M, Alabdullah M, Bati NAA, Alsaleh AA, Tombuloglu H, Arteaga-Livias K, Al-Ahdal T, Garout M, Imran M. An Updated Review on Monkeypox Viral Disease: Emphasis on Genomic Diversity. Biomedicines 2023; 11:1832. [PMID: 37509470 PMCID: PMC10376458 DOI: 10.3390/biomedicines11071832] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
Monkeypox virus has remained the most virulent poxvirus since the elimination of smallpox approximately 41 years ago, with distribution mostly in Central and West Africa. Monkeypox (Mpox) in humans is a zoonotically transferred disease that results in a smallpox-like disease. It was first diagnosed in 1970 in the Democratic Republic of the Congo (DRC), and the disease has spread over West and Central Africa. The purpose of this review was to give an up-to-date, thorough, and timely overview on the genomic diversity and evolution of a re-emerging infectious disease. The genetic profile of Mpox may also be helpful in targeting new therapeutic options based on genes, mutations, and phylogeny. Mpox has become a major threat to global health security, necessitating a quick response by virologists, veterinarians, public health professionals, doctors, and researchers to create high-efficiency diagnostic tests, vaccinations, antivirals, and other infection control techniques. The emergence of epidemics outside of Africa emphasizes the disease's global significance. Increased monitoring and identification of Mpox cases are critical tools for obtaining a better knowledge of the ever-changing epidemiology of this disease.
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Affiliation(s)
- Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan
| | - Nada A Alasiri
- Monitoring and Risk Assessment Department, Saudi Food and Drug Authority, Riyadh 13513, Saudi Arabia
| | - Mohammed Aljeldah
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Hafr Al Batin, Hafr Al Batin 39831, Saudi Arabia
| | - Abeer N Alshukairiis
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah 21499, Saudi Arabia
| | - Zainab AlMusa
- Infectious Disease Section, Internal Medicine Department, King Fahad Specialist Hospital, Dammam 32253, Saudi Arabia
| | - Wadha A Alfouzan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat 13110, Kuwait
- Microbiology Unit, Department of Laboratories, Farwania Hospital, Farwania 85000, Kuwait
| | - Abdulmonem A Abuzaid
- Medical Microbiology Department, Security Forces Hospital Programme, Dammam 32314, Saudi Arabia
| | - Aref A Alamri
- Molecular Microbiology and Cytogenetics Department, Riyadh Regional Laboratory, Riyadh 11425, Saudi Arabia
| | - Hani M Al-Afghani
- Laboratory Department, Security Forces Hospital, Makkah 24269, Saudi Arabia
- iGene Center for Research and Training, Jeddah 2022, Saudi Arabia
| | - Nadira Al-Baghli
- Directorate of Public Health, Dammam Network, Eastern Health Cluster, Dammam 31444, Saudi Arabia
| | - Nawal Alqahtani
- Directorate of Public Health, Dammam Network, Eastern Health Cluster, Dammam 31444, Saudi Arabia
| | - Nadia Al-Baghli
- Directorate of Health Affairs, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 31982, Saudi Arabia
| | - Mashahed Y Almoutawa
- Primary Healthcare, Qatif Health Network, Eastern Health Cluster, Safwa 32833, Saudi Arabia
| | - Maha Mahmoud Alawi
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah 22254, Saudi Arabia
- Infection Control and Environmental Health Unit, King Abdulaziz University Hospital, Jeddah 22254, Saudi Arabia
| | - Mohammed Alabdullah
- Department of Infectious Diseases, Almoosa Specialist Hospital, Al Mubarraz 36342, Saudi Arabia
| | - Neda A Al Bati
- Medical and Clinical Affairs, Rural Health Network, Eastern Health Cluster, Dammam 31444, Saudi Arabia
| | - Abdulmonem A Alsaleh
- Clinical Laboratory Science Department, Mohammed Al-Mana College for Medical Sciences, Dammam 34222, Saudi Arabia
| | - Huseyin Tombuloglu
- Department of Genetics Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia
| | - Kovy Arteaga-Livias
- Escuela de Medicina-Filial Ica, Universidad Privada San Juan Bautista, Ica 11000, Peru
- Escuela de Medicina, Universidad Nacional Hermilio Valdizán, Huanuco 10000, Peru
| | - Tareq Al-Ahdal
- Research Associate, Institute of Global Health, Heidelberg University, Neuenheimerfeld130/3, 69120 Heidelberg, Germany
| | - Mohammed Garout
- Department of Community Medicine and Health Care for Pilgrims, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Mohd Imran
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Northern Border University, Rafha 91911, Saudi Arabia
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González-Díaz E, Rodríguez-Lugo CE, Quintero-Luce S, Esparza-Ahumada S, Pérez-Gómez HR, Morfín-Otero R, Kasten-Monges MDJ, Aguirre-Díaz SA, Vázquez-León M, Rodríguez-Noriega E. Mpox: Fifty-Nine Consecutive Cases from a Mexican Public Hospital; Just the Tip of the STIs Iceberg. Infect Dis Rep 2023; 15:319-326. [PMID: 37367191 DOI: 10.3390/idr15030032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
Monkeypox (Mpox) is a zoonotic viral infection endemic to Africa, which has caused a global outbreak since April 2022. The global Mpox outbreak is related to Clade IIb. The disease has primarily affected men who have sex with men. Skin lesions are concentrated in the genital area, with lymphadenopathy as well as concurrent sexually transmitted infections (STIs). This is an observational study of adult patients with a recent development of skin lesions and systemic symptoms, which could not be explained by other diseases present. Fifty-nine PCR-positive patients with prominent skin lesions in the genital area (77.9%), inguinal lymphadenopathy (49.1%), and fever (83.0%) were included. Twenty-five (42.3%) were known to be living with human immunodeficiency virus (HIV), and 14 of the HIV-naïve subjects (51.9%) were found to be positive during workup, totaling 39 (66.1%) patients with HIV. Eighteen patients (30.5%) had concurrent syphilis infections. It is worrisome that Mpox is present in large metropolitan areas of Mexico, but the underlying growth of cases of HIV infection and other STIs has not been well studied and should be evaluated in all at-risk adults and their contacts.
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Affiliation(s)
- Esteban González-Díaz
- Epidemiology Unit, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara 44280, Mexico
- Instituto de Patología Infecciosa y Experimental "Dr. Francisco Ruiz Sánchez", Centro Universitario Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Mexico
| | | | - Sergio Quintero-Luce
- Epidemiology Unit, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara 44280, Mexico
| | - Sergio Esparza-Ahumada
- Instituto de Patología Infecciosa y Experimental "Dr. Francisco Ruiz Sánchez", Centro Universitario Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Mexico
| | - Héctor Raúl Pérez-Gómez
- Instituto de Patología Infecciosa y Experimental "Dr. Francisco Ruiz Sánchez", Centro Universitario Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Mexico
| | - Rayo Morfín-Otero
- Instituto de Patología Infecciosa y Experimental "Dr. Francisco Ruiz Sánchez", Centro Universitario Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Mexico
| | | | - Sara A Aguirre-Díaz
- Infectious Disease Service, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara 44280, Mexico
| | - Marisela Vázquez-León
- Infectious Disease Service, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara 44280, Mexico
| | - Eduardo Rodríguez-Noriega
- Instituto de Patología Infecciosa y Experimental "Dr. Francisco Ruiz Sánchez", Centro Universitario Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Mexico
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Ramírez-Soto MC. Monkeypox Outbreak in Peru. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1096. [PMID: 37374300 DOI: 10.3390/medicina59061096] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/28/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
Monkeypox (Mpox) is a zoonotic disease caused by the Orthopoxvirus monkeypox virus (MPXV). Since 1970, outbreaks of MPXV have occurred in several Sub-Saharan African countries. However, from May 2022 to April 2023, recent outbreaks of Mpox occurred in several countries outside of Africa, and these cases quickly spread to over 100 non-endemic countries on all continents. Most of these cases were found in the region of the Americas and the Europe region. In Latin America, the highest all-age Mpox rates per million inhabitants were in Peru, Colombia, Chile, and Brazil. Given its global impact, Mpox was declared as an international Public Health Emergency by WHO in July 2022. MPXV infection disproportionately affects men who have sex with men and members of the HIV-infected population. Vaccination is the current strategy for controlling and preventing Mpox in high-risk groups. In this context, Peru has the fourth-highest number of Mpox cases in Latin America and faces significant challenges in disease control. Because of this, in this review, we discuss the epidemiology, public health indicators, and prevention of Mpox in the 2022 Peru outbreak so that health authorities can join forces to control MPXV transmission.
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Affiliation(s)
- Max Carlos Ramírez-Soto
- Centro de Investigación en Salud Pública, Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima 15011, Peru
- Facultad de Ciencias de la Salud, Universidad Tecnológica del Peru, Lima 15046, Peru
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Gamo Guerrero M, Simón Gozalbo A, Martín Díaz M, Díez Madueño K, Del Río Pena E, De la Cueva P, Talaván T, Jiménez E, Torres J, Valencia J, Cuevas G, Bibiano C, Ryan P. Interdisciplinary management of mpox-related local complications: report on a series of cases. Front Med (Lausanne) 2023; 10:1184924. [PMID: 37324126 PMCID: PMC10267306 DOI: 10.3389/fmed.2023.1184924] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/11/2023] [Indexed: 06/17/2023] Open
Abstract
Monkeypox (mpox) is a viral zoonosis, and human-to-human transmission can result from close contact with the respiratory secretions and mucocutaneous lesions of an infected person. The prodromal phase is followed by an eruptive phase, with skin and/or mucosal lesions that progress through several stages at different sites. In this study, we describe the importance of interdisciplinary care management and follow-up of patients with complicated mpox. A cross-sectional study was conducted from May 2022 until August 2022 at a secondary hospital in Madrid (Spain). Out of 100 patients with mpox seen at this institution, we selected and analyzed 11 with local complications. All the patients were male at birth, and the mean age was 32 (30-42) years. The clinical manifestations included skin rash or mucosal lesions, fever, myalgia and lymphadenopathies. The most frequent local complications were pharyngitis associated with dysphagia, penile edema, infection of the mucocutaneous lesions, and ulceration of the genital lesions. A multidisciplinary team was created for the care of patients with complications secondary to mpox. The team comprised dermatologists and specialists in infectious diseases, preventive medicine, and emergency medicine. This approach improved the ability to diagnose and treat early with supportive, topical, and systemic treatment. In our center most of the cases were self-limiting, and none were life-threatening. An interdisciplinary response to a public health alert enhances the management of complex patients and should be implemented in successive outbreaks of mpox.
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Affiliation(s)
| | | | | | | | | | - Pablo De la Cueva
- Dermatology Service, Infanta Leonor Hospital, Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Tamar Talaván
- Local Laboratory, Infanta Leonor Hospital, Madrid, Spain
| | - Eva Jiménez
- Preventive Medicine Service, Infanta Leonor Hospital, Madrid, Spain
| | - Juan Torres
- Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
- Internal Medicine Service, Infanta Leonor Hospital, Madrid, Spain
| | - Jorge Valencia
- Infectious Diseases Unit, Internal Medicine Service, Infanta Leonor Hospital, Madrid, Spain
| | - Guillermo Cuevas
- Internal Medicine Service, Infanta Leonor Hospital, Madrid, Spain
- Infectious Diseases Unit, Internal Medicine Service, Infanta Leonor Hospital, Madrid, Spain
| | - Carlos Bibiano
- Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
- Emergency Service, Infanta Leonor Hospital, Madrid, Spain
| | - Pablo Ryan
- Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
- Internal Medicine Service, Infanta Leonor Hospital, Madrid, Spain
- Infectious Diseases Unit, Internal Medicine Service, Infanta Leonor Hospital, Madrid, Spain
- Biomedical Network Research Centre on Infectious Diseases (CIBERINFECT), Madrid, Spain
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McLean J, Stoeckle K, Huang S, Berardi J, Gray B, Glesby MJ, Zucker J. Tecovirimat Treatment of People With HIV During the 2022 Mpox Outbreak : A Retrospective Cohort Study. Ann Intern Med 2023; 176:642-648. [PMID: 37126820 PMCID: PMC10344608 DOI: 10.7326/m22-3132] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The recent mpox outbreak has disproportionately affected people with HIV (PWH) and resulted in the first widespread use of the novel antiviral tecovirimat. Whether treatment outcomes differ between PWH and those without HIV is unknown. OBJECTIVE To compare the clinical presentation and treatment outcomes of PWH and HIV-negative persons with mpox virus (MPXV) infection treated with tecovirimat. DESIGN Retrospective cohort study of patients treated with tecovirimat for confirmed MPXV infection from June to August 2022. SETTING Two academic medical centers in New York City. PARTICIPANTS The study included 196 persons treated with tecovirimat from 20 June to 29 August 2022. Of 154 testing positive for MPXV, 72 were PWH and 4 had a CD4 count lower than 0.20 × 109 cells/L. MEASUREMENTS Patient demographic characteristics, clinical presentation, treatment outcomes, and safety data for tecovirimat. RESULTS Indications for tecovirimat treatment were similar between the PWH and HIV-negative groups. Four participants had serious adverse events; none were attributed to tecovirimat. Three of these 4 participants had HIV infection, and 2 had CD4 counts less than 0.20 × 109 cells/L. Twenty-two percent of participants had nonsevere adverse effects. Groups had similar rates of hospitalization, indications for treatment, and co-occurring infections, but PWH had fewer days from symptom onset to treatment (7.5 vs. 10). There was no difference in treatment outcomes, including days to improvement or rate of persistent symptoms. LIMITATION Patients with mpox who were not treated with tecovirimat were not followed routinely and therefore lacked comparable outcome data, limiting evaluation of efficacy. CONCLUSION In our cohort of patients treated with tecovirimat for severe mpox, HIV status did not seem to affect treatment outcomes. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Jacob McLean
- Division of Infectious Diseases, Columbia University Medical Center, New York, NY, USA
- New York-Presbyterian Hospital, New York, NY
| | - Kate Stoeckle
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
- New York-Presbyterian Hospital, New York, NY
| | - Simian Huang
- Division of Infectious Diseases, Columbia University Medical Center, New York, NY, USA
| | - Jonathan Berardi
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Brett Gray
- Division of Infectious Diseases, Columbia University Medical Center, New York, NY, USA
| | - Marshall J. Glesby
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
- New York-Presbyterian Hospital, New York, NY
| | - Jason Zucker
- Division of Infectious Diseases, Columbia University Medical Center, New York, NY, USA
- New York-Presbyterian Hospital, New York, NY
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Hatami H, Jamshidi P, Arbabi M, Safavi-Naini SAA, Farokh P, Izadi-Jorshari G, Mohammadzadeh B, Nasiri MJ, Zandi M, Nayebzade A, Sechi LA. Demographic, Epidemiologic, and Clinical Characteristics of Human Monkeypox Disease Pre- and Post-2022 Outbreaks: A Systematic Review and Meta-Analysis. Biomedicines 2023; 11:957. [PMID: 36979936 PMCID: PMC10045775 DOI: 10.3390/biomedicines11030957] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/28/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
(1) Background: In early May 2022, an increasing number of human monkeypox (mpox) cases were reported in non-endemic disparate regions of the world, which raised concerns. Here, we provide a systematic review and meta-analysis of mpox-confirmed patients presented in peer-reviewed publications over the 10 years before and during the 2022 outbreak from demographic, epidemiological, and clinical perspectives. (2) Methods: A systematic search was performed for relevant studies published in Pubmed/Medline, Embase, Scopus, and Google Scholar from 1 January 2012 up to 15 February 2023. Pooled frequencies with 95% confidence intervals (CIs) were assessed using the random or fixed effect model due to the estimated heterogeneity of the true effect sizes. (3) Results: Out of 10,163 articles, 67 met the inclusion criteria, and 31 cross-sectional studies were included for meta-analysis. Animal-to-human transmission was dominant in pre-2022 cases (61.64%), but almost all post-2022 reported cases had a history of human contact, especially sexual contact. The pooled frequency of MSM individuals was 93.5% (95% CI 91.0-95.4, I2: 86.60%) and was reported only in post-2022 included studies. The male gender was predominant in both pre- and post-2022 outbreaks, and the mean age of confirmed cases was 29.92 years (5.77-41, SD: 9.38). The most common clinical manifestations were rash, fever, lymphadenopathy, and malaise/fatigue. Proctalgia/proctitis (16.6%, 95% CI 10.3-25.6, I2: 97.76) and anal/perianal lesions (39.8%, 95% CI 30.4-49.9, I2: 98.10) were the unprecedented clinical manifestations during the 2022 outbreak, which were not described before. Genitalia involvement was more common in post-2022 mpox patients (55.6%, 95% CI 51.7-59.4, I2: 88.11). (4) Conclusions: There are speculations about the possibility of changes in the pathogenic properties of the virus. It seems that post-2022 mpox cases experience a milder disease with fewer rashes and lower mortality rates. Moreover, the vast majority of post-2022 cases are managed on an outpatient basis. Our study could serve as a basis for ongoing investigations to identify the different aspects of previous mpox outbreaks and compare them with the current ones.
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Affiliation(s)
- Hossein Hatami
- Department of Public Health, School of Public Health and Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran;
| | - Parnian Jamshidi
- Department of Public Health, School of Public Health and Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran;
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran; (M.A.); (P.F.); (B.M.); (M.J.N.)
| | - Mahta Arbabi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran; (M.A.); (P.F.); (B.M.); (M.J.N.)
| | - Seyed Amir Ahmad Safavi-Naini
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran;
| | - Parisa Farokh
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran; (M.A.); (P.F.); (B.M.); (M.J.N.)
| | - Ghazal Izadi-Jorshari
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran;
| | - Benyamin Mohammadzadeh
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran; (M.A.); (P.F.); (B.M.); (M.J.N.)
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran; (M.A.); (P.F.); (B.M.); (M.J.N.)
| | - Milad Zandi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran 1417613151, Iran;
| | - Amirhossein Nayebzade
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran;
| | - Leonardo A. Sechi
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
- SC Microbiologia e Virologia, Azienda Ospedaliera Universitaria, 07100 Sassari, Italy
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48
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Mitjà O, Alemany A, Marks M, Lezama Mora JI, Rodríguez-Aldama JC, Torres Silva MS, Corral Herrera EA, Crabtree-Ramirez B, Blanco JL, Girometti N, Mazzotta V, Hazra A, Silva M, Montenegro-Idrogo JJ, Gebo K, Ghosn J, Peña Vázquez MF, Matos Prado E, Unigwe U, Villar-García J, Wald-Dickler N, Zucker J, Paredes R, Calmy A, Waters L, Galvan-Casas C, Walmsley S, Orkin CM. Mpox in people with advanced HIV infection: a global case series. Lancet 2023; 401:939-949. [PMID: 36828001 DOI: 10.1016/s0140-6736(23)00273-8] [Citation(s) in RCA: 242] [Impact Index Per Article: 121.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND People living with HIV have accounted for 38-50% of those affected in the 2022 multicountry mpox outbreak. Most reported cases were in people who had high CD4 cell counts and similar outcomes to those without HIV. Emerging data suggest worse clinical outcomes and higher mortality in people with more advanced HIV. We describe the clinical characteristics and outcomes of mpox in a cohort of people with HIV and low CD4 cell counts (CD4 <350 cells per mm3). METHODS A network of clinicians from 19 countries provided data of confirmed mpox cases between May 11, 2022, and Jan 18, 2023, in people with HIV infection. Contributing centres completed deidentified structured case report sheets to include variables of interest relevant to people living with HIV and to capture more severe outcomes. We restricted this series to include only adults older than 18 years living with HIV and with a CD4 cell count of less than 350 cells per mm3 or, in settings where a CD4 count was not always routinely available, an HIV infection clinically classified as US Centers for Disease Control and Prevention stage C. We describe their clinical presentation, complications, and causes of death. Analyses were descriptive. FINDINGS We included data of 382 cases: 367 cisgender men, four cisgender women, and ten transgender women. The median age of individuals included was 35 (IQR 30-43) years. At mpox diagnosis, 349 (91%) individuals were known to be living with HIV; 228 (65%) of 349 adherent to antiretroviral therapy (ART); 32 (8%) of 382 had a concurrent opportunistic illness. The median CD4 cell count was 211 (IQR 117-291) cells per mm3, with 85 (22%) individuals with CD4 cell counts of less than 100 cells per mm3 and 94 (25%) with 100-200 cells per mm3. Overall, 193 (51%) of 382 had undetectable viral load. Severe complications were more common in people with a CD4 cell count of less than 100 cells per mm3 than in those with more than 300 cells per mm3, including necrotising skin lesions (54% vs 7%), lung involvement (29% vs 0%) occasionally with nodules, and secondary infections and sepsis (44% vs 9%). Overall, 107 (28%) of 382 were hospitalised, of whom 27 (25%) died. All deaths occurred in people with CD4 counts of less than 200 cells per mm3. Among people with CD4 counts of less than 200 cells per mm3, more deaths occurred in those with high HIV viral load. An immune reconstitution inflammatory syndrome to mpox was suspected in 21 (25%) of 85 people initiated or re-initiated on ART, of whom 12 (57%) of 21 died. 62 (16%) of 382 received tecovirimat and seven (2%) received cidofovir or brincidofovir. Three individuals had laboratory confirmation of tecovirimat resistance. INTERPRETATION A severe necrotising form of mpox in the context of advanced immunosuppression appears to behave like an AIDS-defining condition, with a high prevalence of fulminant dermatological and systemic manifestations and death. FUNDING None.
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Affiliation(s)
- Oriol Mitjà
- Skin Neglected Tropical diseases and Sexually Transmitted Infections section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Andrea Alemany
- Skin Neglected Tropical diseases and Sexually Transmitted Infections section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Michael Marks
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, and Division of Infection and Immunity, University College London Hospitals, London, UK
| | | | | | | | - Ever Arturo Corral Herrera
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, México City, México
| | - Brenda Crabtree-Ramirez
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, México City, México
| | - José Luis Blanco
- Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Institut d'Investigacions Mèdiques August Pi i Sunyer, Barcelona, Spain
| | - Nicolo Girometti
- Department of HIV and Genitourinary Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Valentina Mazzotta
- National Institute for Infectious Disease, Lazzaro Spallanzani, IRCCS, Rome, Italy
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA
| | - Macarena Silva
- Infectious Diseases Department, Hospital San Borja Arriarán, Santiago de Chile, Chile
| | - Juan José Montenegro-Idrogo
- Infectious Diseases Department, Hospital Nacional Dos de Mayo, Lima, Perú; Centro de Investigaciones Tecnológicas Biomédicas y Medioambientales, Lima, Perú
| | - Kelly Gebo
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jade Ghosn
- Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris Nord, Bichat University Hospital, Paris, France; Centre of Research in Epidemiology and Statistics, Université Paris Cité, INSERM UMR 1137 IAME, Paris, France
| | | | - Eduardo Matos Prado
- Infectious Diseases Department, Hospital Nacional Arzobispo Loayza, Lima, Perú
| | - Uche Unigwe
- Infectious Disease Unit Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Judit Villar-García
- Infectious Disease Unit, Hospital del Mar, Barcelona, Spain; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Infectious Diseases and Antibiotic Therapy Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Noah Wald-Dickler
- Los Angeles County and University of Southern California Medical Center, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jason Zucker
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | - Roger Paredes
- Infectious Disease Department, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Alexandra Calmy
- HIV/AIDS Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Laura Waters
- Central and North West London NHS Trust, London, UK
| | - Cristina Galvan-Casas
- Skin Neglected Tropical diseases and Sexually Transmitted Infections section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain; Dermatology Department, Hospital Universitario de Móstoles, Madrid, Spain
| | - Sharon Walmsley
- University Health Network, University of Toronto, Toronto, Canada
| | - Chloe M Orkin
- Blizard Institute and SHARE Collaborative, Queen Mary University of London, London, UK; Department of Infection and Immunity, Barts Health NHS Trust, London, UK.
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Mpox infection in people living with HIV. AIDS 2023; 37:701-703. [PMID: 36815525 DOI: 10.1097/qad.0000000000003495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Martinez AE, Frattaroli P, Vu CA, Paniagua L, Mintz J, Bravo-Gonzalez A, Zamudio P, Barco A, Rampersad A, Lichtenberger P, Gonzales-Zamora JA. Successful Outcome after Treatment with Cidofovir, Vaccinia, and Extended Course of Tecovirimat in a Newly-Diagnosed HIV Patient with Severe Mpox: A Case Report. Vaccines (Basel) 2023; 11:vaccines11030650. [PMID: 36992234 DOI: 10.3390/vaccines11030650] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/16/2023] Open
Abstract
Purpose: To report a case of severe mpox in a newly diagnosed HIV patient concerning for Immune Reconstitution Inflammatory Syndrome (IRIS) and/or tecovirimat resistance and to describe the management approach in the setting of refractory disease. Case: 49-year-old man presented with 2 weeks of perianal lesions. He tested positive for mpox PCR in the emergency room and was discharged home with quarantine instructions. Three weeks later, the patient returned with disseminated firm, nodular lesions in the face, neck, scalp, mouth, chest, back, legs, arms, and rectum, with worsening pain and purulent drainage from the rectum. The patient reported being on 3 days of tecovirimat treatment, which was prescribed by the Florida department of health (DOH). During this admission, he was found to be HIV positive. A pelvic CT scan revealed a 2.5 cm perirectal abscess. Treatment with tecovirimat was continued for 14 days, along with an empiric course of antibiotics for treatment of possible superimposed bacterial infection upon discharge. He was seen in the outpatient clinic and initiated antiretroviral therapy (ART) with TAF/emtricitabine/bictegravir. Two weeks after starting ART, the patient was readmitted for worsening mpox rash and rectal pain. Urine PCR also returned positive for chlamydia, for which the patient was prescribed doxycycline. He was discharged on a second course of tecovirimat and antibiotic therapy. Ten days later, the patient was readmitted for the second time due to worsening symptoms and blockage of the nasal airway from progressing lesions. At this point, there were concerns for tecovirimat resistance, and after discussion with CDC, tecovirimat was reinitiated for the third time, with the addition of Cidofovir and Vaccinia, and showed an improvement in his symptoms. He received three doses of cidofovir and two doses of Vaccinia, and the patient was then discharged to complete 30 days of tecovirimat. Outpatient follow-up showed favorable outcomes and near resolution. Conclusion: We reported a challenging case of worsening mpox after Tecovirimat treatment in the setting of new HIV and ART initiation concerning IRIS vs. Tecovirimat resistance. Clinicians should consider the risk of IRIS and weigh the pros and cons of initiating or delaying ART. In patients not responding to first-line treatment with tecovirimat, resistance testing should be performed, and alternative options should be considered. Future research is needed to establish guidance on the role of Cidofovir and Vaccinia immune globulin and the continuation of tecovirimat for refractory mpox.
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Affiliation(s)
- Andres E Martinez
- Division of Infectious Diseases, Department of Medicine, Jackson Memorial Hospital, Miami, FL 33136, USA
- Division of Infectious Diseases, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL 33146, USA
| | - Paola Frattaroli
- Division of Infectious Diseases, Department of Medicine, Jackson Memorial Hospital, Miami, FL 33136, USA
- Division of Infectious Diseases, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL 33146, USA
| | - Christine A Vu
- Department of Pharmacy, Jackson Memorial Hospital, Miami, FL 33136, USA
| | - Lizy Paniagua
- Division of Infectious Diseases, Department of Medicine, Jackson Memorial Hospital, Miami, FL 33136, USA
- Division of Infectious Diseases, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL 33146, USA
| | - Joel Mintz
- Department of Internal Medicine, University of Miami, Jackson Memorial Hospital, Miami, FL 33136, USA
| | | | - Paola Zamudio
- Universidad Anáhuac Querétaro, Querétaro 76246, Mexico
| | - Astrid Barco
- Universidad de Especialidades Espíritu Santo, Guayas 092301, Ecuador
| | - Aruna Rampersad
- Couva Hospital and Multi Training Facility, Couva 550214, Trinidad and Tobago
| | - Paola Lichtenberger
- Division of Infectious Diseases, Department of Medicine, Jackson Memorial Hospital, Miami, FL 33136, USA
- Division of Infectious Diseases, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL 33146, USA
| | - Jose A Gonzales-Zamora
- Division of Infectious Diseases, Department of Medicine, Jackson Memorial Hospital, Miami, FL 33136, USA
- Division of Infectious Diseases, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL 33146, USA
- Peruvian American Medical Society (PAMS), Albuquerque, NM 87111, USA
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