Clinical spectrum of human monkeypox: An Italian single‐centre case series

Aromolo, Italo Francesco; Maronese, Carlo Alberto; Avallone, Gianluca; Beretta, Andrea; Boggio, Francesca; Murgia, Giulia; Marletta, Dario A; Barei, Francesca; Carrera, Carlo Giovanni; Ramoni, Stefano; Benedetto, Alessandra Di; Marzano, Angelo Valerio

doi:10.1111/jdv.18612

Cited by 15 publications

(18 citation statements)

References 15 publications

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“…7,13 Even if the outcome was favorable for all patients, clinical resolution occurred with just one atrophic skin scarring in 19% of them, in line with another recent Italian study. 19 Dermoscopy, histopathology, and immunohistochemistry of the skin lesions in our series were comparable to the few data reported in other studies. 19,20 However, eosinophilic intracytoplasmic inclusion bodies referable to viral cytopathic changes of keratinocytes (spherical Guarnieri bodies), recently described 20 in agreement with data from the previous MPX outbreaks, 21,22 were not observed in our cases.…”

Section: Resultssupporting

confidence: 91%

“…However, none of our patients were admitted to an intensive care unit nor developed serious complications, like myocarditis or encephalitis, that were rarely described in other recent studies on MPX outbreaks 7,13 . Even if the outcome was favorable for all patients, clinical resolution occurred with just one atrophic skin scarring in 19% of them, in line with another recent Italian study 19 . Dermoscopy, histopathology, and immunohistochemistry of the skin lesions in our series were comparable to the few data reported in other studies 19,20 .…”

Section: Discussionsupporting

confidence: 88%

“…The clinical and social features observed in our study and similar reports on the 2022 MPX outbreak in non‐African countries 7,12,13,19,20 have several differences from those of the “old” human MPX outbreaks that occurred in Africa in the last two to ‐three decades 23–25 …”

Section: Discussionsupporting

confidence: 71%

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Monkeypox outbreak in Genoa, Italy: Clinical, laboratory, histopathologic features, management, and outcome of the infected patients

Ciccarese

Biagio

Bruzzone

et al. 2023

Journal of Medical Virology

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Since May 2022, multiple human Monkeypox cases were identified in nonendemic countries, mainly among men who have sex with men. We aimed to report the features, clinical course, management, and outcome of the Monkeypox cases diagnosed in the Dermatology and Infectious Disease Units of the San Martino Hospital, Genoa, Italy. We performed an observational study of the Monkeypox cases diagnosed from July 1 until August 31, 2022, collecting clinical, laboratory, and histological data. We studied 16 Monkeypox‐infected men (14 homosexual, 2 bisexual) with a median age of 37 years. Three were HIV‐infected. All patients reported multiple sexual partners and/or unprotected sex in the 2 weeks before the diagnosis. Most patients had prodromal signs/symptoms before the appearance of the skin/mucosal eruption, consisting of erythematous papules/vesicles/pustules in the anogenital area, which tended to erode evolving into crusts and ulcers. Lesions were often associated with local and/or systemic symptoms. Histopathology showed overlapping features in all cases: epidermal ulceration and dermal inflammatory infiltrate consisting of lymphocytes and neutrophils with an interstitial and perivascular/peri‐adnexal pattern and endothelial swelling. Concomitant sexually transmitted infections (STIs) (gonococcal/nongonococcal proctitis and anal high‐risk human papillomavirus [HR‐HPV] infection) were frequent. Four patients were hospitalized, and one received specific treatment. The overall outcome was good. At the follow‐up visit, three patients presented skin scars. Our series confirms the features of the current Monkeypox outbreak; however, different from other studies, we found a considerable rate of concomitant STIs, such as anal HR‐HPV infection, that should be kept in mind because this persistent infection is the main cause of anal cancers.

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Section: Resultssupporting

confidence: 91%

Section: Discussionsupporting

confidence: 88%

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Monkeypox outbreak in Genoa, Italy: Clinical, laboratory, histopathologic features, management, and outcome of the infected patients

Ciccarese

Biagio

Bruzzone

et al. 2023

Journal of Medical Virology

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“…We assessed the eligibility of the remaining 1349 studies by reading full-text papers: 1112 did not report clinical features and epidemiological characteristics of mpox; one reported duplicated cases (the one with more detailed information was included), and three reported cases before 6 May 2022 (cases confirmed in 2017–2021), one reported asymptomatic cases. Seventy-seven studies [ 4 , 8 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 ,…”

Section: Resultsmentioning

confidence: 99%

Clinical Characteristics of Human Mpox (Monkeypox) in 2022: A Systematic Review and Meta-Analysis

Liu

Wang

et al. 2023

Pathogens

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Since May 2022, large numbers of monkeypox (mpox) cases have been reported in non-endemic regions. We conducted a systematic review and meta-analysis to elucidate clinical characteristics of the current mpox outbreak. Our systematic review and meta-analysis were undertaken according to PRISMA and MOOSE guidelines. We searched PubMed, EMBASE, and Web of Science for publications between 1 January and 11 November 2022. Random-effects models were used to pool results. Heterogeneity was assessed using I2. This study is registered with PROSPERO, CRD42022355590. Skin lesions (95.2%, 95% CI [93.3–96.9%]), fever (58.4%, [54.9–61.8%]) and lymphadenopathy (53.0%, [48.7–57.3%]) were the most common symptoms. The most common dermatological manifestations were anogenital lesions (65.7%, [57.8–73.0%]), and the most common lymphadenopathy was inguinal (46.8%, [40.6–53.0%]). There were no differences in symptoms including malaise, fever, headache, and genital, anal, and oropharyngeal lesions according to HIV infection status. Median age of patients varied from 15 to 57.5 years (median, 35 years). The median proportion of men who had sex with men (MSM) was 100.0% (20.6–100.0%). The median proportion of patients who reported recent sexual exposure was 99.2% (14.3–100.0%). The median proportion of PLHIV was 42.2% (0.0–100.0%). Skin lesions, fever, inguinal lymphadenopathy, and anogenital lesions were the most common symptoms of mpox reported in the current outbreak. Existing guidelines should be updated to reflect these clinical manifestations and groups at highest risk of infection, MSM in particular.

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“…The chain of transmission includes terrestrial rodents to arboreal rodents, arboreal rodents to non-human primates, and non-human primates to terrestrial rodents or vice versa. Transmission from terrestrial rodents, arboreal rodents, and non-human primates to humans or vice versa was also found [ 3 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Association between Global Monkeypox Cases and Meteorological Factors

Islam

Sangkham

Tiwari

et al. 2022

IJERPH

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The emergence of an outbreak of Monkeypox disease (MPXD) is caused by a contagious zoonotic Monkeypox virus (MPXV) that has spread globally. Yet, there is no study investigating the effect of climatic changes on MPXV transmission. Thus, studies on the changing epidemiology, evolving nature of the virus, and ecological niche are highly paramount. Determination of the role of potential meteorological drivers including temperature, precipitation, relative humidity, dew point, wind speed, and surface pressure is beneficial to understand the MPXD outbreak. This study examines the changes in MPXV cases over time while assessing the meteorological characteristics that could impact these disparities from the onset of the global outbreak. To conduct this data-based research, several well-accepted statistical techniques including Simple Exponential Smoothing (SES), Auto-Regressive Integrated Moving Average (ARIMA), Automatic forecasting time-series model (Prophet), and Autoregressive Integrated Moving Average with Explanatory Variables (ARIMAX) were applied to delineate the correlation of the meteorological factors on global daily Monkeypox cases. Data on MPXV cases including affected countries spanning from May 6, 2022, to November 9, 2022, from global databases and meteorological data were used to evaluate the developed models. According to the ARIMAX model, the results showed that temperature, relative humidity, and surface pressure have a positive impact [(51.56, 95% confidence interval (CI): −274.55 to 377.68), (17.32, 95% CI: −83.71 to 118.35) and (23.42, 95% CI: −9.90 to 56.75), respectively] on MPXV cases. In addition, dew/frost point, precipitation, and wind speed show a significant negative impact on MPXD cases. The Prophet model showed a significant correlation with rising MPXD cases, although the trend predicts peak values while the overall trend increases. This underscores the importance of immediate and appropriate preventive measures (timely preparedness and proactive control strategies) with utmost priority against MPXD including awareness-raising programs, the discovery, and formulation of effective vaccine candidate(s), prophylaxis and therapeutic regimes, and management strategies.

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Clinical spectrum of human monkeypox: An Italian single‐centre case series

Cited by 15 publications

References 15 publications

Monkeypox outbreak in Genoa, Italy: Clinical, laboratory, histopathologic features, management, and outcome of the infected patients

Monkeypox outbreak in Genoa, Italy: Clinical, laboratory, histopathologic features, management, and outcome of the infected patients

Clinical Characteristics of Human Mpox (Monkeypox) in 2022: A Systematic Review and Meta-Analysis

Association between Global Monkeypox Cases and Meteorological Factors

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