Mpox: Special Considerations in the Immunocompromised Host

Barnes, Ashley H.; Smith, Christopher; Dash, A. P.; Shishido, Akira

doi:10.1007/s40506-022-00260-5

Cited by 3 publications

(6 citation statements)

References 49 publications

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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%

“…1) [12,15,16]. The eruption typically progresses rapidly from macules to papules, papules to vesicles, vesicles to pustules, pustules to umbilicated pustules, and finally to a crusted residual [13,17]. Mpox patients may not have all types of lesions during an eruption, and not all of their lesions may not be in the same stage [13].…”

Section: Clinical Symptoms and Differential Diagnosismentioning

confidence: 99%

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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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Section: Clinical Symptoms and Differential Diagnosismentioning

confidence: 99%

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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“…49 Like the other countermeasures, its effectiveness against poxviruses is limited to case reports. 48 F I G U R E 2 Depiction of the progression of severe mpox in uncontrolled human immunodeficiency virus (HIV) patients and proposed management strategy. Clinical events are represented over time.…”

Section: Countermeasuresmentioning

confidence: 99%

“…It is currently only available through an FDA‐authorized emergency use‐IND 47 . The clinical effectiveness data for these drugs against human MPXV infection is limited to case reports and cohort studies 48 . Importantly, usage of these drugs may be limited by their toxicities: cidofovir is a known potent nephrotoxin and brincidofovir has been associated with significant hepatotoxicity 46…”

Section: Countermeasuresmentioning

confidence: 99%

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Optimal management of severe mpox in patients with uncontrolled human immunodeficiency virus

Shishido,

Street

2023

Journal of Medical Virology

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In May 2022, a cluster of nontravel‐related cases of human mpox were reported in the United Kingdom. The outbreak has since spread worldwide infecting over 85 000 patients and causing over 100 deaths. Recent data clearly suggest that patients infected with human immunodeficiency virus (HIV) with CD4 counts less than 200 cells per mm3 suffer significantly worse outcomes than immunocompetent patients. The available countermeasures lack robust clinical data and are deployed based on in vitro and animal studies as well as extrapolations from use against other poxviruses. In many cases, despite administration of these available treatments, initiation of antiretroviral therapy (ART), and management of suspected immune reconstitution inflammatory syndrome after initiating ART, patients die. This review summarizes available data, identifies knowledge gaps and proposes recommendations on the management of severe mpox in people living with HIV.

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Potential use of cidofovir, brincidofovir, and tecovirimat drugs in fighting monkeypox infection: recent trends and advancements

Rani,

Joshi,

Sharma

et al. 2023

Naunyn-Schmiedeberg's Arch Pharmacol

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Mpox: Special Considerations in the Immunocompromised Host

Cited by 3 publications

References 49 publications

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

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

Optimal management of severe mpox in patients with uncontrolled human immunodeficiency virus

Potential use of cidofovir, brincidofovir, and tecovirimat drugs in fighting monkeypox infection: recent trends and advancements

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