Viral bloodstream detection in mpox patients: An observational multicentric study

Rizzo, Alberto; Moschese, Davide; Trentacapilli, Benedetta; Cossu, Maria Vittoria; Giacomelli, Andrea; Salari, Federica; Bianchi, Micol; Raccagni, Angelo Roberto; Micheli, Valeria; Gori, Andrea; Messina, Emanuela; Antinori, Spinello; Gismondo, Maria Rita; Castagna, Antonella; Mileto, Davide; Rizzardini, Giuliano; Lombardi, Alessandra; Nozza, Silvia

doi:10.1016/j.jinf.2023.04.001

Cited by 2 publications

(5 citation statements)

References 6 publications

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“…However, MPXV cases have exponentially increased worldwide since May 2022, and the diseases may result in higher severity and morbidity in recipients of blood components and organ transplants 31 , 34 , 35 . As for other studies 13 , 15 , 18 , 36 , we detected MPXV DNA at low levels in plasma specimens, with the median Ct value > 30 during week 1 dropping to Ct = 36 during week 2 and > 40 during week 3. These data, together with the lack of isolation of viable viruses in any of the bloodstream samples tested, support the low probability that this sample may be a potential source of infection transmission.…”

Section: Discussionsupporting

confidence: 84%

“…The MPXV DNA frequency of detection in bloodstream samples varied among the different studies carried out during the 2022 outbreak 13 , 15 , ranging from 7 to 88% frequency at diagnosis. Rizzo et al 36 showed that 65% of MPXV patients were viremic at diagnosis, having more frequently disseminated skin lesions and a higher percentage of systemic symptoms as compared to non-viremic patients, suggesting that bloodstream dissemination might represent a fundamental step in the disease pathogenesis. In our cohort of MPXV patients, we found that 70% of plasma samples resulted in positive MPXV DNA during weeks 1 and 2, decreasing to 27.3% during week 3; despite the limited number in this last time range, no positive samples collected during week 4 were found to be positive in this study cohort including all MPXV patients with no immunosuppression or AIDS.…”

Section: Discussionmentioning

confidence: 99%

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MPXV DNA kinetics in bloodstream and other body fluids samples

Meschi,

Colavita,

Carletti

et al. 2024

Sci Rep

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Since spring 2022, the global epidemiology of the monkeypox virus (MPXV) has changed. The unprecedented increase of human clade II MPXV cases worldwide heightened concerns about this emerging zoonotic disease. We analysed the positivity rates, viral loads, infectiousness, and persistence of MPXV DNA for up to 4 months in several biological samples from 89 MPXV-confirmed cases. Our data showed that viral loads and positivity rates were higher during the first two weeks of symptoms for all sample types. Amongst no-skin-samples, respiratory specimens showed higher MPXV DNA levels and median time until viral clearance, suggesting their usefulness in supporting MPXV diagnosis, investigating asymptomatic patients, and monitoring viral shedding. Infectious virus was cultured from respiratory samples, semen, and stools, with high viral loads and collected within the first 10 days. Notably, only one saliva and one semen were found positive for viral DNA after 71 and 31 days from symptoms, respectively. The focus on bloodstream samples showed the best testing sensitivity in plasma, reporting the overall highest MPXV DNA detection rate and viral loads during the 3-week follow-up as compared to serum and whole-blood. The data here presented can be useful for MPXV diagnostics and a better understanding of the potential alternative routes of its onward transmission.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

MPXV DNA kinetics in bloodstream and other body fluids samples

Meschi,

Colavita,

Carletti

et al. 2024

Sci Rep

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“…To counterbalance the risk of failing to diagnose mpox, clinicians have been increasingly encouraged to collect more than one sample [13][14][15][16], possibly consisting of the triad of lesion, oropharyngeal swab, and blood samples. With the aim to elucidate the diagnostic role of multisite sampling, Rizzo et al [15] analyzed 966 samples (including 252 lesion samples and 278 oropharyngeal swabs among others) from 625 patients with clinical evidence of mpox.…”

Section: Discussionmentioning

confidence: 99%

“…Not surprisingly, plasma samples (whole blood samples in our study) showed the highest Ct values (median (IQR), 34 [(31-35) in the Batty et al's study [11] and mean value (SD), 35.5 ± 2.7 in our study). Although the clinical significance of viremia is unclear [6], blood samples may hold value in the early days of clinical presentation [16] or for viral load monitoring [13]. Unlike previous studies [10,11], we included whole blood (not plasma) as a non-swab biological matrix for the QIAstat-Dx assay.…”

Section: Discussionmentioning

confidence: 99%

“…In one of these studies [11], human samples other than skin lesion material, which remains the preferred clinical sample based on the WHO's mpox laboratory testing guidelines [12], were used. Accordingly, testing multiple samples, including those from the oropharyngeal tract (which the WHO recommends as an additional diagnostic sample [12]) or blood (which the WHO considers as an investigational sample [12]), may be helpful for mpox diagnosis [13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Performance of a Novel Real-Time PCR-Based Assay for Rapid Monkeypox Virus Detection in Human Samples

Liotti,

Marchetti,

Falletta

et al. 2023

Microorganisms

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The ongoing epidemic of mpox, namely human monkeypox virus (MPXV) infection, requires rapid and reliable laboratory diagnosis. We report on the QIAstat-Dx viral vesicular panel PCR assay that allows the detection of (within 75 min) six vesicular disease-causing viruses, including MPXV. We analyzed 168 clinical samples, known to be positive (51 samples) or negative (117 samples) for MPXV clade II, obtained from patients at their mpox diagnosis or follow-up. QIAstat assay results were compared to those of a MPXV-specific reference PCR assay. The QIAstat assay detected MPXV (clade II) in 51 (100%) of 51 samples and did not detect MPXV in 117 (100%) of 117 samples, resulting in a positive or negative agreement of 100% (95% CI, 93.0–100) and 100% (95% CI, 96.8–100), respectively. Of the 20 patients diagnosed with mpox, 18 (90.0%) had at least a vesicular swab and 1 (5.0%) had only an oropharyngeal swab positive for MPXV. At mpox follow-ups, 2 (10.0%) of 20 patients had first-time positive whole blood samples. Thirteen MPXV-negative samples were positive for mpox-mimicking viruses. Our findings show the excellent performance of the QIAstat-Dx assay for MPXV detection in clinical samples. Further studies are needed before considering a large-scale application of the QIAstat-Dx assay.

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Viral bloodstream detection in mpox patients: An observational multicentric study

Cited by 2 publications

References 6 publications

MPXV DNA kinetics in bloodstream and other body fluids samples

MPXV DNA kinetics in bloodstream and other body fluids samples

Performance of a Novel Real-Time PCR-Based Assay for Rapid Monkeypox Virus Detection in Human Samples

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