Manchester University NHS Foundation Trust, North Manchester General Hospital, Manchester, UK.
Centre of Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford Oxford, UK.
Int J STD AIDS. 2023 Jun;34(7):434-438. doi: 10.1177/09564624231162760. Epub 2023 Mar 15.
During spring 2022, an outbreak of Monkeypox (mpox) emerged as an infection of concern in Europe. Due to the overlapping clinical features of mpox and bacterial infections, diagnosis of concomitant bacterial infection is challenging. In this prospective cohort study, we report the incidence, severity, and progression of patients with secondary bacterial infection complicating mpox infection.
Data were collected via a bespoke mpox telemedicine service provided by Infection services at North Manchester General Hospital, UK. A diagnosis of secondary bacterial infection was based on the history (balanitis, surrounding erythema, purulent discharge and nasal ulceration) and review of patient-collected medical photography. Patient were reviewed face-to-face where necessary.
Secondary bacterial infection was diagnosed in 15 of 129 (11.6%) patients with mpox. Three patients with secondary bacterial infection (3/129, 2.3%) required admission to hospital and one patient underwent surgical debridement. Median healing (thus, isolation) times were longer in those with bacterial infection.
In this prospective cohort study of patients with mpox, secondary bacterial infection was infrequent and predominantly mild. The virtual ward and telemedicine follow up allowed for the prompt recognition of secondary bacterial infections and timely antibiotic administration. Due to concerns regarding nosocomial transmission, mild clinical course and limited inpatient bed capacity, we believe this model of outpatient management for mpox (Clade II B.1 lineage) could be replicated in other low risk populations where suitable home isolation facilities exist.
2022 年春季，猴痘（mpox）在欧洲爆发，成为一种令人关注的感染。由于 mpox 和细菌感染的临床特征重叠，因此诊断合并细菌感染具有挑战性。在这项前瞻性队列研究中，我们报告了继发细菌感染合并 mpox 感染患者的发病率、严重程度和进展情况。
通过英国北曼彻斯特综合医院传染病科提供的专门 mpox 远程医疗服务收集数据。继发细菌感染的诊断基于病史（龟头炎、周围红斑、脓性分泌物和鼻溃疡）和患者收集的医学摄影回顾。必要时进行面对面复查。
在 129 例 mpox 患者中，有 15 例（11.6%）诊断为继发细菌感染。3 例继发细菌感染患者（3/129，2.3%）需要住院治疗，1 例患者接受了手术清创。有细菌感染的患者的中位愈合（即隔离）时间更长。
在这项 mpox 患者的前瞻性队列研究中，继发细菌感染并不常见，且主要为轻度。虚拟病房和远程医疗随访能够及时发现继发细菌感染并及时给予抗生素治疗。由于担心医院内传播、轻度临床病程和有限的住院床位容量，我们认为这种针对 Clade II B.1 谱系的 mpox 门诊管理模式可以在其他存在适当家庭隔离设施的低风险人群中复制。
