Clinical presentation of human monkeypox virus infection during the 2022 outbreak: descriptive case series from a large italian Research Hospital.
Journal
Virology journal
ISSN: 1743-422X
Titre abrégé: Virol J
Pays: England
ID NLM: 101231645
Informations de publication
Date de publication:
18 09 2023
18 09 2023
Historique:
received:
22
11
2022
accepted:
05
09
2023
medline:
20
9
2023
pubmed:
19
9
2023
entrez:
18
9
2023
Statut:
epublish
Résumé
In May 2022, a new case of Monkeypox Virus (MPX) was reported in a non-endemic area, the United Kingdom, and since then, the number of confirmed cases in Europe has been increasing until WHO, on May 10 2023, declared that MPOX is no longer a public health emergency of international concern. We aimed to describe the clinical and microbiological characteristics of sixteen patients with a confirmed diagnosis of MPX followed by a single Italian clinical centre, the Fondazione Policlinico Universitario Agostino Gemelli, between May 20 and August 30. A prospective observational study has been conducted, collecting microbiological samples during the time of the infection, as well as epidemiological and clinical data of the patients. All patients provided written informed consent. During clinical practice, 16 individuals presenting with consistent symptoms tested positive for MPX on a polymerase chain reaction. All patients were men having sex with men (MSM). The most frequent clinical presentation was a vesicular erythematous cutaneous rash, mainly distributed on the genital and perianal area, but also regarding limbs, face, neck, chest and back in some of the patients. Systemic symptoms, such as fever or lymphadenopathy, involved eight patients. The symptom most frequently reported by patients was pruritus in the area of the vesicles. Thirteen patients also reported pain. Nine patients were HIV-1 coinfected, but no significant differences have been observed compared to other cohort patients. The median time between the onset of symptoms and the healing was 19.5 days (IQR 14.0-20.3). Our cohort of patients presented a mild manifestation of the disease with no complications and no need for antiviral therapy nor hospitalization. This population seems different from the ones reported in the literature during the previous outbreaks in endemic areas in epidemiological data and clinical manifestations but also from a cohort of patients described in the literature from the 2022 outbreak, suggesting the importance for healthcare workers to keep in mind the possibility of an MPX infection in the differential diagnosis of patients presenting with consistent symptoms, even in non-endemic areas, to ensure efficient isolation of the patient for infection control purposes and effective management of the infection preventing the development of MPOX-related complications.
Sections du résumé
BACKGROUND
In May 2022, a new case of Monkeypox Virus (MPX) was reported in a non-endemic area, the United Kingdom, and since then, the number of confirmed cases in Europe has been increasing until WHO, on May 10 2023, declared that MPOX is no longer a public health emergency of international concern. We aimed to describe the clinical and microbiological characteristics of sixteen patients with a confirmed diagnosis of MPX followed by a single Italian clinical centre, the Fondazione Policlinico Universitario Agostino Gemelli, between May 20 and August 30.
MATERIALS AND METHODS
A prospective observational study has been conducted, collecting microbiological samples during the time of the infection, as well as epidemiological and clinical data of the patients. All patients provided written informed consent.
RESULTS
During clinical practice, 16 individuals presenting with consistent symptoms tested positive for MPX on a polymerase chain reaction. All patients were men having sex with men (MSM). The most frequent clinical presentation was a vesicular erythematous cutaneous rash, mainly distributed on the genital and perianal area, but also regarding limbs, face, neck, chest and back in some of the patients. Systemic symptoms, such as fever or lymphadenopathy, involved eight patients. The symptom most frequently reported by patients was pruritus in the area of the vesicles. Thirteen patients also reported pain. Nine patients were HIV-1 coinfected, but no significant differences have been observed compared to other cohort patients. The median time between the onset of symptoms and the healing was 19.5 days (IQR 14.0-20.3).
CONCLUSIONS
Our cohort of patients presented a mild manifestation of the disease with no complications and no need for antiviral therapy nor hospitalization. This population seems different from the ones reported in the literature during the previous outbreaks in endemic areas in epidemiological data and clinical manifestations but also from a cohort of patients described in the literature from the 2022 outbreak, suggesting the importance for healthcare workers to keep in mind the possibility of an MPX infection in the differential diagnosis of patients presenting with consistent symptoms, even in non-endemic areas, to ensure efficient isolation of the patient for infection control purposes and effective management of the infection preventing the development of MPOX-related complications.
Identifiants
pubmed: 37723564
doi: 10.1186/s12985-023-02178-w
pii: 10.1186/s12985-023-02178-w
pmc: PMC10506307
doi:
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
214Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
McCollum AM, Damon IK. Human monkeypox. Clin Infect Dis. 2014;58:260–7.
doi: 10.1093/cid/cit703
pubmed: 24158414
Pastula DM, Tyler KL. An overview of monkeypox virus and its neuroinvasive potential. Ann Neurol. 2022;92:527–31.
doi: 10.1002/ana.26473
pubmed: 35932225
World Health Organization. Multi-country monkeypox outbreak in non-endemic countries: Update (2022). Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON388 .
World Health Organization. Monkeypox—United Kingdom of Great Britain and Northern Ireland (2022). Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON381 .
Vivancos R, Anderson C, Blomquist P, et al. Community transmission of monkeypox in the United Kingdom, April to May 2022. Eurosurveillance. 2022;27(22):pii.
doi: 10.2807/1560-7917.ES.2022.27.22.2200422
European Centre for Disease Prevention and Control. Risk Assessment: monkeypox multi-country outbreak (2022). Available at: https://www.who.int/director-general/speeches/detail/who-director-general-s-statement-on-the-press-conference-following-IHR-emergency-committee-regarding-the-multi--country-outbreak-of-monkeypox--23-july-2022 .
Ministero della Salute della Rebubblica Italiana. Mpox- Bolletino. 2023. Available at: https://www.salute.gov.it/portale/vaioloScimmie/dettaglioContenutiVaioloScimmie jsp?lingua=italiano&id=5943&area=vaioloScimmie&menu=vuoto.
World Health Organization (WHO). Fifth Meeting of the International Health Regulations. (2005) (IHR) Emergency Committee on the Multi-Country Outbreak of mpox (monkeypox). 2023. Available at: https://www.who.int/news/item/11-05-2023-fifth-meeting-of-the-international-health-regulations-(2005)-(ihr)-emergency-committee-on-the-multi-country-outbreak-of-monkeypox-(mpox)?gclid=CjwKCAjwt52mBhB5EiwA 05YKoznkpsKbDQVz7tyUjgXYh4Bl000x7CjAdVQ0YUn8mOI6U9qGfLvaqBoCy5sQAvD_BwE.
Brown K, Leggat PA. Human monkeypox: current state of knowledge and implications for the future. Trop Med Infect Dis. 2016;1(1):8.
doi: 10.3390/tropicalmed1010008
pubmed: 30270859
pmcid: 6082047
Beer EM, Rao VB. A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy. PLoS Negl Trop Dis. 2019;13(10):e0007791.
doi: 10.1371/journal.pntd.0007791
pubmed: 31618206
pmcid: 6816577
Reed KD, Melski JW, Graham MB, et al. The detection of monkeypox in humans in the western emisphere. N Engl J Med. 2004;350:342–50.
doi: 10.1056/NEJMoa032299
pubmed: 14736926
Adler H, Gould S, Hine P, et al. Clinical features and management of human monkeypox: a retrospective observational study in the UK. Lancet Infec Dis. 2022;22(8):1153–62. https://doi.org/10.1016/S1473-3099(22)00228-6 .
doi: 10.1016/S1473-3099(22)00228-6
Yinka-Ogunleye A, Aruna O, Dalat M, et al. Outbreak of human monkeypox in Nigeria in 2017–18: a clinical epidemiological report. Lancet Infec Dis. 2019;19(8):872–9. https://doi.org/10.1016/S1473-3099(19)30294-4 .
doi: 10.1016/S1473-3099(19)30294-4
Benites-Zapata VA, Ulloque-Badaracco JR, et al. Clinical features, hospitalisation and deaths associated with monkeypox: a systematic review and meta-analysis. Ann Clin Microbiol Antimicrob. 2022;21(1):36.
doi: 10.1186/s12941-022-00527-1
pubmed: 35948973
pmcid: 9364300
Perez Duque M, Ribeiro S, et al. Ongoing monkeypox virus outbreak, Portugal, 29 April to 23 May 2022. Eurosurveillance. 2022;27(22):2200424.
doi: 10.2807/1560-7917.ES.2022.27.22.2200424
pubmed: 35656830
pmcid: 9164676
Girometti N, Byrne R, et al. Demographic and clinical characteristics of confirmed human monkeypox virus cases in individuals attending a sexual health centre in London, UK: an observational analysis. Lancet Infect Dis. 2022;22(9):1321–8.
doi: 10.1016/S1473-3099(22)00411-X
pubmed: 35785793
pmcid: 9534773
Selb R, Werber D, et al. A shift from travel-associated cases to autochthonous transmission with Berlin as epicentre of the monkeypox outbreak in Germany, May to June 2022. Eurosurveillance. 2022;27(27):22004499.
doi: 10.2807/1560-7917.ES.2022.27.27.2200499