Mimics of Monkeypox: Considerations for the emergency medicine clinician

Long, Brit; Liang, Stephen Y.; Carius, Brandon M; Chavez, Summer; Gottlieb, Michael; Koyfman, Alex; Brady, William J.

doi:10.1016/j.ajem.2023.01.007

Cited by 8 publications

(15 citation statements)

References 61 publications

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“…In Africa, there is a significant number of reported cases of coinfection with mpox and VZV, with the hypothesis suggesting that the varicella skin vesicle may serve as an entry point for mpox that resides on a fomite within a child's environment 11 . It is worth noting that mpox often presents symptoms similar to those of VZV 41 . In our coinfected patient, we observed high‐grade fever, headache, and lesions/rashes throughout the entire body.…”

Section: Discussionmentioning

confidence: 62%

“…11 It is worth noting that mpox often presents symptoms similar to those of VZV. 41 In our coinfected patient, we observed high-grade fever, headache, and lesions/rashes throughout the entire body. Typically, mpox patients experience a febrile prodrome with a high fever before the appearance of the rash, while VZV is characterized by a low-grade fever during rash onset.…”

Section: Discussionmentioning

confidence: 67%

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Genomic characterization of the first mpox and varicella‐zoster co‐infection in Pakistan (2023) through next‐generation sequencing

Umair,

Jamal,

Haider

et al. 2023

Journal of Medical Virology

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The global mpox outbreak spanning 2022–2023 has affected numerous countries worldwide. In this study, we present the first report on the detection, whole‐genome sequence, and coinfection of the mpox virus and varicella zoster virus (VZV) from Pakistan. During April–May 2023, samples from 20 suspected cases of mpox were tested at the National Institutes of Health, Islamabad among which 4 tested positive. All four cases had a travel history of Saudi Arabia. All the suspected samples were processed by using a Zymo research kit for DNA extraction, followed by qRT‐PCR amplification by using a DaAn Gene detection kit for the mpox virus. Further, two of the positive samples with a low Ct value (<20) were subjected to whole‐genome sequencing using a metagenomic approach on the iSeq (Illumina) platform. The sequencing results revealed Clade IIb and genotype A.2.1 of MPXV, which clustered with viruses from Slovenia and the UK in July and June 2022, respectively. Our analysis identified two novel nonsynonymous substitutions in mpox virus, namely V98I in OPG046 and P600S in OPG109. Furthermore, we successfully retrieved the complete genome of VZV from the same sample, belonging to Clade 5. This study represents the first positive case of MPXV in Pakistan and the coinfection of mpox and VZV by using a metagenome approach providing insights into their complete genomes. Our results highlight the importance of surveillance at the point of entries, strengthening lab capacities including next‐generation sequencing, and using differential diagnosis for timely and accurate detection of mpox cases.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 67%

Genomic characterization of the first mpox and varicella‐zoster co‐infection in Pakistan (2023) through next‐generation sequencing

Umair,

Jamal,

Haider

et al. 2023

Journal of Medical Virology

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“…The clinical features of mpox, chickenpox, and smallpox are relatively similar [12]. Table 1 compares mpox, smallpox and chickenpox, and presents their differential diagnosis [12][13][14][15]. The common symptoms of mpox include high fever, chills, headache, swollen lymph nodes, muscle aches, and a painful cutaneous eruption that usually appears as raised bumps on the skin and tends to distribute on the face, genitals, and extremities (Fig.…”

Section: Clinical Symptoms and Differential Diagnosismentioning

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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“…The pustular stage of the rash typically lasts for 5 days, after which the pustules become crusted, and then drop off approximately 2 to 3 weeks on recovery from the illness. [12][13][14][15][17][18][19][20][21] The lesions may be in the same phase of development or be present in various stages of development, similar to the rash of chickenpox. In the 2022 outbreak among pediatric patients, the mpox rash occurred most often on the trunk, and only a minority of children had a diffuse rash.…”

Section: Clinical Signs and Symptomsmentioning

confidence: 99%

“…[8][9][10][11][12][13][14][15][16][17][18][19][20] For those with anogenital involvement, rectal pain was a common complaint. 14,16,[19][20][21] Complications of mpox include bacterial infections, pneumonitis, keratitis, sepsis, encephalitis, and in rare cases, fulminant hepatosplenic infiltration. [10][11][12][13][14]17 Previous research has suggested children younger than 8 years, children with eczema and other skin conditions, and those with immunocompromising conditions (HIV, malignancy, diabetes, and those with history of chronic steroid or other immunosuppressive therapy) are at higher risk of severe disease.…”

Section: Clinical Signs and Symptomsmentioning

confidence: 99%

Mpox

Jafari,

Woodward

2023

Pediatr Emer Care

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Human mpox (formerly known as monkeypox) is a zoonotic disease that causes a smallpox-like infection in humans. The mpox virus, the causative agent of mpox, was first reported to cause human disease in a 9-month-old infant in the Democratic Republic of the Congo in 1970. Since that time, periodic outbreaks in primarily endemic regions have occurred, typically secondary to transmission from wildlife reservoirs. However, in May 2022, after a rapid rise in worldwide cases in largely nonendemic countries, the World Health Organization declared mpox a Public Health Emergency of International Concern. As of January 2022, more than 80,000 cases of mpox in nonendemic countries have occurred, and more than 25,000 cases in the United States alone. Most of these cases occurred in adults, with the highest frequency among men who had sex with men. Children and adolescents represented only 0.3% of US cases as of September 2022, with most infections in young children the result of direct contact with an infected household member. Although infection remains uncommon in US children and teens, pediatric emergency and urgent care providers should be aware of the clinical features, treatment, and prophylaxis of this important emerging infectious disease.

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Mimics of Monkeypox: Considerations for the emergency medicine clinician

Cited by 8 publications

References 61 publications

Genomic characterization of the first mpox and varicella‐zoster co‐infection in Pakistan (2023) through next‐generation sequencing

Genomic characterization of the first mpox and varicella‐zoster co‐infection in Pakistan (2023) through next‐generation sequencing

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

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