Treatment Failure in Patient with Severe Mpox and Untreated HIV, Maryland, USA

Филиппов, Е. В.; Duhan, Sanchit; Lehman, Laura; Keisham, Bijeta; Sethi, Vishal

doi:10.3201/eid2906.230059

Cited by 9 publications

(7 citation statements)

References 9 publications

(9 reference statements)

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“…Five studies stratified Mpox outcomes based on CD4 and or RNA viral load [ 15 , 23 , 25 , 26 , 40 ] (Table 2 ). Furthermore, 24 studies provided data on deaths among Mpox cases and included information on Immunosuppression source [ 11 – 19 , 25 , 31 – 43 , 45 ], as shown in Table 3 .…”

Section: Resultsmentioning

confidence: 99%

The impact of immunosuppression on the mortality and hospitalization of Monkeypox: a systematic review and meta-analysis of the 2022 outbreak

Azzam,

Khaled,

Salem

et al. 2024

Virol J

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Background Limited data is available regarding the severity and mortality of Mpox in individuals with immunocompromised conditions. Therefore, we performed this meta-analysis to understand the impact of HIV- or non-HIV-associated immunosuppression on the severity of Mpox requiring hospitalization and mortality. Methods A thorough literature search was performed from 2022 up to January 2024. The results were presented as odds ratios (ORs). We only included patients who required hospitalization for severity rather than isolation. Results A total of 34 studies were included in this analysis. Our analysis did not find a significant difference in the hospitalization risk between HIV-positive individuals and those who were HIV-negative (OR = 1.03; P = 0.85; 7 studies; CD4 count of fewer than 200 cells/µL was less than 0.5% across all studies). Patients with a CD4 count lower than 200 cells/µL or an unsuppressed RNA viral load (> 200 copies/ml) had a significantly higher hospitalization risk (OR = 5.3, P < 0.001) and (OR = 3, P < 0.001), respectively. Most of the reported deaths were reported in patients with HIV with CD4 counts below 200 cells/µL, with some fatal cases occurring in non-HIV immunosuppressed patients, particularly organ transplant recipients. Based on the autopsy findings, Mpox was confirmed in multiple organs, particularly the digestive tract, lung, and testes. Furthermore, some studies documented cases of death that were suspected to be related to hemophagocytic lymphohistiocytosis (HLH) and immune reconstitution inflammatory syndrome (IRIS). Most of the death reports showed concomitant non-Mpox infections at the time of hospitalization and death Conclusions Our finding shows that Mpox acts as an opportunistic pathogen in immunocompromised individuals. These individuals should be prioritized for early care and closely monitored for signs of deteriorating clinical conditions. Clinical manifestations and autopsy findings strongly suggest Mpox dissemination to multiple organs, particularly the digestive tract, and lungs. However, the presence of concomitant non-Mpox infections complicates the assessment of the attribution of Mpox to death. Caution should be exercised when interpreting data suggesting poorer outcomes in individuals with non-HIV immunosuppression, as current evidence is scarce and further research is needed.

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Section: Resultsmentioning

confidence: 99%

The impact of immunosuppression on the mortality and hospitalization of Monkeypox: a systematic review and meta-analysis of the 2022 outbreak

Azzam,

Khaled,

Salem

et al. 2024

Virol J

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“…En él, iniciaron el manejo con tecovirimat oral de 600 mg cada 12 horas, sin mejoría clínica, por lo que volvió a consultar. Inició antibioticoterapia con vancomicina y cefepima, en conjunto con tecovirimat y brincidofovir; sin embargo, el paciente desarrolló distrés respiratorio severo que resultó en un paro cardíaco (11).…”

Section: Tecovirimatunclassified

Espectro de manejo farmacológico de la infección por viruela del mono durante el brote de 2022

Coriat-Cruz,

Moreno-Gómez,

Cepeda-Londoño

2024

Univ. Med.

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Para esta revisión de la literatura, se describieron las propuestas planteadas para el manejo farmacológico de la infección por viruela del mono (Mpox) durante el brote de 2022. Con ese objetivo, se realizó una búsqueda sistematizada de la literatura utilizando las palabras claves: infections, monkeypox, therapeutics, treatment efficacy en Medline, a través de PubMed, donde se identificaron 54 artículos publicados desde 2001 a 2023, de los cuales se seleccionaron 26 para ser incluidos en los resultados. Se encontró que los tratamientos más documentados para tratar la infección por Mpox fueron el tecovirimat, seguido del cidofovir y del brincidofovir. El tecovirimat fue la opción terapéutica más segura y eficaz, con la capacidad en reducir la carga viral del Mpox con una tasa de supervivencia de al menos un 90 %. Sin embargo, ninguno de los tres medicamentos los ha aprobado la Administración de Alimentos y Medicamentos de los Estados Unidos para el tratamiento del Mpox, por lo que se reconoce la importancia de llevar a cabo estudios dirigidos para establecer esquemas de tratamiento mundial, considerando que el Mpox es una potencial arma biológica para todo el planeta.

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“…23,26 This growing body of data suggests PLWH with CD4+ T Cell counts less than 200 cells/mm 3 are at significantly increased risk for fatal outcome (Table 1). 5,7,23,[27][28][29][30][31][32][33][34][35][36][37] Of the most severe cases reported, patients often present with vast necrotizing skin lesions and to develop multiorgan involvement to include the pulmonary, gastrointestinal, musculoskeletal, and central nervous systems. 5,7,23,[27][28][29][30][31][32][33][34][35][36][37] Many develop bacterial superinfection, sepsis and acute respiratory distress syndrome (ARDS).…”

Section: Pathogenesis Of Mpoxmentioning

confidence: 99%

“…5,7,23,[27][28][29][30][31][32][33][34][35][36][37] Of the most severe cases reported, patients often present with vast necrotizing skin lesions and to develop multiorgan involvement to include the pulmonary, gastrointestinal, musculoskeletal, and central nervous systems. 5,7,23,[27][28][29][30][31][32][33][34][35][36][37] Many develop bacterial superinfection, sepsis and acute respiratory distress syndrome (ARDS). 5,7,29 Reports suggest that initiation of ART is often delayed for weeks after presentation.…”

Section: Pathogenesis Of Mpoxmentioning

confidence: 99%

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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Treatment Failure in Patient with Severe Mpox and Untreated HIV, Maryland, USA

Cited by 9 publications

References 9 publications

The impact of immunosuppression on the mortality and hospitalization of Monkeypox: a systematic review and meta-analysis of the 2022 outbreak

The impact of immunosuppression on the mortality and hospitalization of Monkeypox: a systematic review and meta-analysis of the 2022 outbreak

Espectro de manejo farmacológico de la infección por viruela del mono durante el brote de 2022

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

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