A plague passing over: Clinical features of the 2022 mpox outbreak in patients of color living with HIV

Abstract

IntroductionCompared 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.MethodsWe 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 ConclusionMen 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.

Comparison of clinical course of Mpox among HIV‐negative and HIV‐positive patients: A 2022 cohort of hospitalized patients in Central Europe

“…Notably, in a course of mpox we also observed rare (7.4%) cases of nonspecific exanthema, which has only been infrequently reported so far 13,14,17,31 . This was self‐limiting, resolved spontaneously and was probably caused by the viral infection itself.…”

“…12,14,30 Notably, in a course of mpox we also observed rare (7.4%) cases of nonspecific exanthema, which has only been infrequently reported so far. 13,14,17,31 This was self-limiting, resolved spontaneously and was probably caused by the viral infection itself. The incidence of lymphadenopathy, mostly inguinal, was comparable to historical data from Nigeria and the US, as well as in the current epidemic.…”