Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Institute of Virology, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Clin Microbiol Infect. 2023 Jan;29(1):112.e5-112.e9. doi: 10.1016/j.cmi.2022.09.012. Epub 2022 Sep 23.
Since April 2022, increasing numbers of monkeypox (MPX) cases have been reported outside endemic areas as part of an international outbreak. Our study shows aspects of clinical manifestations as well as epidemiological and virological features impacting transmission, for which only scarce data are available so far.
We present a descriptive study consisting of epidemiological, clinical and virological data of four patients with confirmed MPX diagnosis. Follow-up examinations included in-depth virological investigations, including MPX virus-specific quantitative PCR and virus isolation.
Between 22 May 2022, and 21 June 2022, four patients with MPX were evaluated. The number of lesions ranged between one and more than 30, with asynchronous eruptions. The periorificial distribution of initial lesions together with the case histories strongly suggest human-to-human transmission during intimate contacts in sexual activities. None of the patients reported about memorable lesions on the skin of potential risk contacts. Virological sampling showed positive MPX virus-specific quantitative PCR results from swabs of the primary lesions (until day 22 after symptom onset), pharyngeal and anal mucosa, urine, seminal fluid, blood and samples of non-affected skin. Virus isolation was positive in 6/14 samples (lesional skin, anal and pharyngeal mucosa). One patient required inpatient treatment for bacterial superinfection; in another patient, three sexually transmitted co-infections were present.
Our report demonstrates asynchronous multiple-site lesions of MPX with prolonged PCR positivity in mucosal swabs, swabs of non-affected skin, urine and seminal fluid. In addition, infectious virus was confirmed on lesional skin and mucosal swabs. The observed virological kinetics together with the suspected pre-symptomatic transmission may lead to effective and sustained human-to-human transmission, particularly in sexual networks. Preventive measures such as vaccination and post-exposure prophylaxis may become important for MPX control in vulnerable groups.
自 2022 年 4 月以来，猴痘（MPX）病例在非流行地区的报告数量不断增加，这是国际暴发的一部分。我们的研究显示了影响传播的临床表现以及流行病学和病毒学特征的各个方面，迄今为止，这些方面的数据还很稀缺。
我们进行了一项描述性研究，包括四例确诊猴痘患者的流行病学、临床和病毒学数据。随访检查包括深入的病毒学调查，包括猴痘病毒特异性定量 PCR 和病毒分离。
在 2022 年 5 月 22 日至 6 月 21 日期间，评估了四例猴痘患者。病变数量在 1 个至 30 多个之间，存在不同步的爆发。初始病变的口周分布以及病史强烈提示在性活动中密切接触时发生了人际传播。没有患者报告潜在接触者皮肤上有记忆性病变。病毒学采样显示，从原发性病变（症状出现后第 22 天）、咽和肛门黏膜、尿液、精液、血液和未受影响的皮肤样本中，猴痘病毒特异性定量 PCR 结果均为阳性。在 14 个样本中的 6 个（病变皮肤、肛门和咽黏膜）中分离出病毒。一名患者因细菌合并感染需要住院治疗；另一名患者存在三种性传播合并感染。
我们的报告表明，猴痘具有异步多部位病变，黏膜拭子、未受影响的皮肤拭子、尿液和精液中的 PCR 阳性持续时间较长。此外，在病变皮肤和黏膜拭子上也确认了传染性病毒。观察到的病毒动力学以及疑似的症状前传播可能导致人与人之间的有效和持续传播，特别是在性网络中。对于易感染人群，预防措施如疫苗接种和暴露后预防可能成为猴痘控制的重要手段。
