Zentrum für Dermatopathologie Freiburg, Breisgau, Germany.
Private Dermatology Practice, Berlin, Germany.
J Cutan Pathol. 2023 Aug;50(8):706-710. doi: 10.1111/cup.14398. Epub 2023 Feb 7.
Human monkeypox is an emerging zoonosis with epidemic potential. Although it usually causes a mild disease, some patients are at risk for complications, including death. In face of the current outbreak of monkeypox in non-endemic areas, awareness is paramount to diagnose it timely, prompting an early break of the transmission chain. Histopathologic findings in vesiculopustular lesions of monkeypox are distinctive, consisting of ballooning and reticular degeneration of keratinocytes, necrosis, especially of the upper portions of the epithelium, multinucleation of keratinocytes, nuclear enlargement showing a "basophilic halo" around a "ground glass" eosinophilic center, the orthopoxvirus-specific cytoplasmic eosinophilic Guarnieri-type inclusions (in the pustular stage especially), and a dense mixed inflammatory cell infiltrate with prominent neutrophil exocytosis. The diagnosis of human monkeypox requires a high index of suspicion. In correlation with clinical information, histopathological findings allow for a presumptive diagnosis of monkeypox if polymerase chain reaction testing is not available. Both clinicians and pathologists can optimize diagnostic sensitivity, respectively, by considering the epidemiological context, sampling pustular lesions and providing data for clinicopathological correlation, and by intentionally searching the tell-tale eosinophilic inclusions in genital, anal and oral lesions with reticular and ballooning degenerescence.
人类猴痘是一种具有流行潜力的新兴人畜共患病。虽然它通常导致轻度疾病，但一些患者存在并发症风险，包括死亡。面对当前非流行地区的猴痘爆发，提高认识对于及时诊断至关重要，可以尽早打断传播链。猴痘水疱脓疱病变的组织病理学发现具有特征性，包括角质形成细胞的气球样和网状变性、坏死，特别是上皮的上部、角质形成细胞的多核、核增大，表现为“嗜碱性晕”围绕“磨砂玻璃”嗜酸性中心、正痘病毒特异性细胞质嗜酸性瓜尔内里型包涵体（特别是在脓疱期）以及密集的混合炎症细胞浸润，伴有明显的中性粒细胞外溢。人类猴痘的诊断需要高度怀疑。如果聚合酶链反应检测不可用，结合临床信息，组织病理学发现可提示猴痘的诊断。临床医生和病理医生分别可以通过考虑流行病学背景、采集脓疱性病变并提供临床病理相关性的数据以及有意在具有网状和气球样变性的生殖器、肛门和口腔病变中寻找明显的嗜酸性包涵体来优化诊断的敏感性。
