Clinical Features and Management of Individuals Hospitalised with Monkeypox and Associated Complications in the UK: A Retrospective Analysis Across 16 Hospitals

Fink, Douglas; Callaby, Helen; Luintel, Akish; Beynon, W. M.; Bond, Helena; Lim, Eleanor; Gkrania‐Klotsas, Effrossyni; Heskin, Joseph; Bracchi, Margherita; Rathish, Balram; Milligan, Iain; O’Hara, Geraldine; Rimmer, Stephanie; Peters, Joanna; Payne, Lara; Mody, Nisha; Hodgson, Bethany; Lewthwaite, Penny; Lester, Rebecca E.; Wooley, Stephen; Sturdy, Ann; Whittington, Ashley; Johnson, Leann; Jacobs, Nathan; Quartey, John; Payne, Brendan; Crowe, Stewart; Elliott, Ivo; Harrison, Thomas; Beard, Kate; Cusack, Tomas-Paul; Jones, Imogen; Banerjee, Rishi; Rampling, Tommy; Dunning, Jake

doi:10.2139/ssrn.4276629

Cited by 23 publications

(31 citation statements)

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“…remains a lack of understanding. 111 Political efforts should be made to support research and ensure proper education on mpox. 123 For instance, rather than blaming MSM as the major cause of the epidemic, calling public attention to reducing the number of people with multiple sexual partners is urged.…”

Section: Policy Implicationsmentioning

confidence: 99%

“…Several preceding reviews focused on the clinical characteristics of mpox derived from cases in specific centers or regions. 111,112 An observational review from the United Kingdom spotted demographic and clinical characteristics of mpox patients that attend a sexual health center in London (n = 54). 113 All patients were identified as MSM and 13 patients (24%) were living with HIV.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

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Comparison of clinical manifestations in mpox patients living with HIV versus without HIV: A systematic review and meta‐analysis

Shin

Rahmati

et al. 2023

Journal of Medical Virology

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Currently, many cases of mpox patients living with the human immunodeficiency virus (HIV) have been reported. Immunocompromised mpox patients, including those living with HIV are noted for an increased risk for severe symptoms; however, existing studies did not focus on the statistical comparison of mpox outcomes associated with HIV. Thus, we conducted a systematic review and meta-analysis to evaluate and compare the clinical manifestations of mpox in people living with HIV (PLWH) and people without HIV. In this systematic review and meta-analysis, PubMed/MEDLINE, Embase, and Google Scholar were searched up to March 7, 2023. A random effects model was used to calculate the pooled prevalence along with the 95% confidence intervals (CI), and the odds ratio and its corresponding 95% CIs were calculated to elucidate the significance of each clinical feature for mpox patients with and without HIV. In this study, we included 99 published papers with 2413 patients with mpox (median age, 35.5 years; PLWH n = 1151) from 27 countries across six continents. The odds ratio of the mpox outcomes with PLWH in

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Section: Policy Implicationsmentioning

confidence: 99%

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Comparison of clinical manifestations in mpox patients living with HIV versus without HIV: A systematic review and meta‐analysis

Shin

Rahmati

et al. 2023

Journal of Medical Virology

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“…Despite this, mortality is low (<0.1%), and extensive (>100 lesions) and severe presentations (confluent lesions, sepsis, or the involvement of risky anatomic areas such as the eyes, anus, etc.) are rare [6,8] and have been associated with immunocompromised individuals. In a CDC weekly report, cases of 57 hospitalized patients with severe Mpox were reviewed, where there were 12 deaths (21%), and it was noted that 82.5% were persons living with HIV and 72.1% had a CD4 count < 50 cells/mm3 (97% < 200) [9].…”

Section: Discussionmentioning

confidence: 99%

“…In a CDC weekly report, cases of 57 hospitalized patients with severe Mpox were reviewed, where there were 12 deaths (21%), and it was noted that 82.5% were persons living with HIV and 72.1% had a CD4 count < 50 cells/mm3 (97% < 200) [9]. This contrasts with the mortality rates reported in studies of patients with CD4 counts averaging 462 cells/mm3 (0.17% mortality) 7 , 510 cells/mm3 (0.0% mortality) 8 , or 664 cells/mm3 (0.0% mortality) [10].…”

Section: Discussionmentioning

confidence: 99%

Prolonged, Atypical and Fulminant Mpox in an HIV/HBV Coinfected Patient: A Case Report

Hernandez¹,

Sanchez²,

Torres-Erazo³

et al. 2023

Preprint

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Mpox (monkeypox) is a zoonotic disease that has been endemic in African countries for decades, with a recent outbreak in several countries around the world. A 39-year-old male with HIV-HBV coinfection and poor adherence to antiretroviral treatment, who was severely immunocompromised and had a concurrent diagnosis of Mpox infection, presented to our hospital with disseminated dermatosis (over 350 lesions), perianal ulcers, odynophagia, oral intolerance, diarrhea, and soft-tissue bacterial superinfection of the lower extremities. Laboratory results were consistent with HBV infection, with an absolute CD4 cell count of 40 cells/uL and a positive PCR result for Mpox. An abdominopelvic CT scan showed evidence of severe proctitis and perineal soft-tissue infection. After 65 days of Mpox PCR, new lesions in the vesicular stage continued to appear, eventually developing hemodynamic instability and sepsis, resulting in a fatal outcome. Our case highlights the importance of intentionally looking for risk factors such as HIV/HBV coinfection and evaluating immune status (CD4 cell count) in patients with severe Mpox infection because it could be related to higher mortality.

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“…About 10% of patients require hospital treatment in the current global outbreak, mainly due to pain and bacterial superinfections 2,7–10 . This is in contrast to the disease severity observed in the endemic mpox areas in Africa, in which mpox outbreaks are associated with mortality rates of up to 12% 4,11,12 …”

Section: Introductionmentioning

confidence: 99%

Repurposing of the antibiotic nitroxoline for the treatment of mpox

Bojkova

Zöller

Tietgen

et al. 2023

Journal of Medical Virology

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The antiviral drugs tecovirimat, brincidofovir, and cidofovir are considered for mpox (monkeypox) treatment despite a lack of clinical evidence. Moreover, their use is affected by toxic side‐effects (brincidofovir, cidofovir), limited availability (tecovirimat), and potentially by resistance formation. Hence, additional, readily available drugs are needed. Here, therapeutic concentrations of nitroxoline, a hydroxyquinoline antibiotic with a favourable safety profile in humans, inhibited the replication of 12 mpox virus isolates from the current outbreak in primary cultures of human keratinocytes and fibroblasts and a skin explant model by interference with host cell signalling. Tecovirimat, but not nitroxoline, treatment resulted in rapid resistance development. Nitroxoline remained effective against the tecovirimat‐resistant strain and increased the anti‐mpox virus activity of tecovirimat and brincidofovir. Moreover, nitroxoline inhibited bacterial and viral pathogens that are often co‐transmitted with mpox. In conclusion, nitroxoline is a repurposing candidate for the treatment of mpox due to both antiviral and antimicrobial activity.

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Clinical Features and Management of Individuals Hospitalised with Monkeypox and Associated Complications in the UK: A Retrospective Analysis Across 16 Hospitals

Cited by 23 publications

References 0 publications

Comparison of clinical manifestations in mpox patients living with HIV versus without HIV: A systematic review and meta‐analysis

Comparison of clinical manifestations in mpox patients living with HIV versus without HIV: A systematic review and meta‐analysis

Prolonged, Atypical and Fulminant Mpox in an HIV/HBV Coinfected Patient: A Case Report

Repurposing of the antibiotic nitroxoline for the treatment of mpox

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