Human monkeypox outbreak: Epidemiological data and therapeutic potential of topical cidofovir in a prospective cohort study

Sobral-Costas, Tristán Gabriel; Escudero-Tornero, Rafael; Servera-Negre, Guillermo; Bernardino, José I.; Arroyo, Almudena Gutiérrez; Díaz‐Menéndez, Marta; Busto-Leis, Jose Manuel; Álvarez, Patricia Roces; Pinto, Pedro Herranz; Cudós, Elena Sendagorta

doi:10.1016/j.jaad.2022.10.043

Cited by 21 publications

(14 citation statements)

References 18 publications

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“…In a recent study, 12 patients treated with topical cidofovir demonstrated faster resolution of Mpox lesions compared to those without cidofovir, suggesting possible use of topical cidofovir for the management of genital Mpox lesions. 17…”

Section: Discussionmentioning

confidence: 99%

“…The JYNNEOS vaccine has been approved for Mpox and is recommended for those at high risk for Mpox (recent exposure to Mpox, gay or bisexual men with multiple sexual partners). 16 Immunity is highest 2 weeks after the last dose. With respect to treatment with tecovirimat, referral to infectious disease specialists should be made to help determine qualification for treatment.…”

Section: Role Of Urologistsmentioning

confidence: 99%

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Mpox Genital Lesions: A Large Single-center Experience With Intermediate Follow-up

et al. 2023

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Purpose:Since the Mpox (formerly known as Monkeypox virus) global outbreak, there have been limited reports on the clinical course and management of genital lesions related to Mpox infections. Genital lesions have been reported to manifest in almost 50% of patients infected with Mpox. We set out to describe the clinical manifestations, management, and outcomes of a large cohort of subjects undergoing treatment with tecovirimat with intermediate follow-up.Materials and Methods:This was a retrospective case series of patients with genital Mpox lesions undergoing treatment with tecovirimat under the Centers for Disease Control and Prevention Emergency Authorization–Investigational protocol at a single, quaternary referral center. Fisher’s exact tests were used to assess the association between Mpox-related genital skin changes and selected categorical variables.Results:A total of 68 subjects were included. The mean age was 34.9 years, and all participants were assigned male sex at birth. The mean follow-up period was 20.3 days. Management consisted of supportive care, antibiotic treatment for bacterial superinfection, medical debridement with collagenase for severe lesions. Urological consultation was obtained in 5 (7.4%) cases. Sixteen (23.5%) patients had significant penile skin changes at final follow-up, which was significantly associated with lesion size (P = .001). No subjects in this cohort required surgical interventions.Conclusions:We report this large series of Mpox-related genital lesions in men undergoing treatment with tecovirimat. Urologists are not required for the routine diagnosis and treatment of these lesions, but are important in determining appropriate treatment for severe lesions.

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Section: Discussionmentioning

confidence: 99%

Section: Role Of Urologistsmentioning

confidence: 99%

Mpox Genital Lesions: A Large Single-center Experience With Intermediate Follow-up

et al. 2023

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“…The cidofovir 1% users got rid of the lesions within 12 days (median), while it took the other group 18 days (median). After 2 weeks, only 10% of patients who used topical cidofovir 1% had PCR-positive skin lesions, while 62.5% of patients who did not use cidofovir 1% had PCR-positive skin lesions [62].…”

Section: Topical Cidofovirmentioning

confidence: 96%

“…In a prospective study that included 24 mpox patients, half of the patients received only supportive care and the other half received supportive care plus topical cidofovir 1% cream [62]. The patients who used the cream healed faster than the patients who did not.…”

Section: Topical Cidofovirmentioning

confidence: 99%

Differential Diagnosis, Prevention, and Treatment of mpox (Monkeypox): A Review for Dermatologists

et al. 2023

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The current 2022 mpox (monkeypox) outbreak has been officially recognized as a public health emergency. The mpox clinical symptoms include high fever, fatigue, chills, headache, swollen lymph nodes, muscle aches, and a disseminated painful rash. However, recent cases of mpox have shown a shift in clinical symptoms, with anogenital skin lesions emerging as the predominant feature. Due to the predominant skin manifestations of mpox, dermatologists could be crucial in detecting new mpox cases and educating frontline healthcare professionals about mpox. The mpox virus is continuously evolving and has several variants. Genome sequencing has revealed that the Clade IIb variant is responsible for the 2022 mpox outbreak. Mpox spread may occur through animal-to-human and human-to-human transmission; however, unlike coronavirus disease 2019 (COVID-19), long-range airborne transmission has not been reported. Healthcare professionals are at higher risk of becoming infected since they are usually in close contact with both the patients and potentially contaminated fomites (e.g., examination table, gowns, gloves). Both public and healthcare professionals should take preventive and avoidance measures to limit the spread. Mpox is usually self-limiting and may require only symptomatic treatment; however, it may cause severe complications in special populations such as immunocompromised individuals. For severe infection, clinicians may consider antiviral drugs (off-label), tecovirimat and brincidofovir, originally approved for smallpox treatment. Two smallpox vaccines, ACAM2000 ® and JYNNEOS TM , can be used as pre-exposure prophylaxis against mpox. JYNNEOS TM , which carries approval for mpox use, has less adverse effect potential than ACAM2000 ® , and may also be used as post-exposure prophylaxis, preferably within 4 days of exposure. Key PointsGenital skin lesions are a dominant symptom in the recently reported mpox cases.Dermatologists and healthcare professionals should be more cautious and take certain preventive measures since they are usually in close contact with patients infected with the mpox virus.Clinicians usually recommend symptomatic treatment for mpox patients; however, tecovirimat and brincidofovir, two smallpox drugs, can be recommended off-label for severe mpox infections.

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“…However, this drug can cause damage to the kidneys after only one or two intravenous doses. Nevertheless, it was reported that topical administration of cidofovir could be an effective treatment for monkeypox skin lesions, avoiding adverse effects on the kidneys when the drug is administered intravenously (81) .…”

Section: Anti-viral Drugs Against Hpopxvsmentioning

confidence: 99%

Potential threat of human pathogenic orthopoxviruses to public health and control strategies

Zhang¹,

Zhou²,

Pei³

et al. 2023

Journal of Biosafety and Biosecurity

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Human monkeypox outbreak: Epidemiological data and therapeutic potential of topical cidofovir in a prospective cohort study

Cited by 21 publications

References 18 publications

Mpox Genital Lesions: A Large Single-center Experience With Intermediate Follow-up

Mpox Genital Lesions: A Large Single-center Experience With Intermediate Follow-up

Differential Diagnosis, Prevention, and Treatment of mpox (Monkeypox): A Review for Dermatologists

Potential threat of human pathogenic orthopoxviruses to public health and control strategies

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