Monkeypox (mpox) in immunosuppressed patients

Abstract

The World Health Organization (WHO) proclaimed a public health emergency in July 2022 due to the emergence of Mpox (formerly monkeypox) while the globe was still dealing with the COVID-19 epidemic. The characteristics of mpox in immunocompetent individuals are well-characterized, despite difficulties in diagnostics, immunization, and access to treatment that persist in low-income countries. Patients with weakened immune systems are more likely to spread an illness and die from it than healthy people because they cannot mount a protective immune response against it, such as a neutralizing IgG and poxvirus-specific Th1 response. A health warning on severe mpox in people who are immunocompromised due to Human Immunodeficiency virus (HIV) and other illnesses was released by the U.S. Centers for Disease Control and Prevention (CDC) on September 29, 2022. The advice does not specifically include primary immunodeficiency, but it does define other immunocompromising disorders as “having autoimmune disease with immunodeficiency as a clinical component”. Both those with healthy immune systems and those with weakened immune systems, such as those who are immunosuppressed, older people, children, etc., have encountered serious health issues, but the latter group is more likely to do so. According to the advisory, “of the people with severe mpox manifestations for whom CDC has been consulted, the majority have had HIV with CD4 counts 200 cells/ml, indicating substantial immunosuppression”. However, new cases are still expected to be discovered, especially in low-income countries with limited access to diagnosis, treatment, and prevention, and where a large percentage of the mpox-infected population also has advanced HIV infection. Thus, further research is always needed to determine the best way to treat mpox in immunocompromised people. In this context, we discussed /reviewed the mpox clinical presentation, available treatment options and current preventive guidelines in immunocompromised patients.

Challenges and Counteracting Strategies Including Optimum Health Service Practices for Frontline Nurses During the Mpox Outbreak and Futuristic Vision

“…The mpox virus can be spread to humans from infected animals, usually rodents. Human-to-human transmission occurs through direct contact with an infected person's skin lesions, scabs, bed linen, needle-stick injury, and clothing ( Ahmed, Dabou, Abdelsamad, Mohamed, Chandran, Chakraborty, et al, 2023 ; Ahmed, El-Kader, Lorenzo, Chakraborty, Dhama, Mohammed, et al, 2023 ; Ahmed, Mohamed, Dabou, Abuijlan, Chandran, El-Shall, et al, 2023 ; Ahmed, Rashad, et al, 2022 ; Altindis et al, 2022 ; Harapan et al, 2022 ; Migaud et al, 2023 ; Mitjà et al, 2023 ). Respiratory excretions can also result in the spread of the disease from one person to another, where mpox virus particles can remain infectious in aerosols for 18–90 hours ( Verreault et al, 2013 ), and mpox disease usually lasts 2–4 weeks ( Ophinni et al, 2022 ).…”

“…Better clinical management of mpox is needed to reduce symptoms, prevent complications, and shorten the duration of any lasting effects ( Ahmed, Mohamed, Dabou, Abuijlan, Chandran, El-Shall, et al, 2023 ; Kipps, 2022 ). The best way to stop the spread of mpox is to make people aware of the risks they face and the steps they may take to limit their exposure to the virus ( Kumar et al, 2022 ).…”

Human Monkeypox: A Comprehensive Overview of Epidemiology, Pathogenesis, Diagnosis, Treatment, and Prevention Strategies

“…The state of dysfunction of the immune response that could be temporary or permanent is defined as immunosuppression, which could be due to disease conditions such as HIV/AIDS, hematologic malignancies, autoimmune illness, innate immunodeficiencies and solid-organ transplantation or induced by medication such corticosteroids [ 65 ].…”

Epidemiological and Clinical Characteristics of Mpox in Cisgender and Transgender Women and Non-Binary Individuals Assigned to the Female Sex at Birth: A Comprehensive, Critical Global Perspective

“…Since then, Mpox has been reported in humans in several other central and western African countries [ 3 , 4 ]. Characterized by flu-like symptoms, such as a fever, fatigue, lymphadenopathy, and a rash, it generally spans 2–4 weeks, often resolving itself, though severe cases can occur in immunocompromised individuals [ 5 ]. A distinctive feature of Mpox is the rash that develops, often beginning on the face and then spreading to other parts of the body, including the palms of the hands and the soles of the feet.…”