2022 年 5 月至 10 月期间，意大利米兰一家三级医院的人类猴痘病例：流行病学特征和临床特征。
Human Monkeypox Experience in a Tertiary Level Hospital in Milan, Italy, between May and October 2022: Epidemiological Features and Clinical Characteristics.
机构信息
Infectious and Tropical Diseases Department, Vita-Salute San Raffaele University, 20127 Milan, Italy.
Laboratory of Clinical Microbiology, Virology and Bioemergencies, Sacco Hospital, 20900 Milan, Italy.
出版信息
Viruses. 2023 Mar 2;15(3):667. doi: 10.3390/v15030667.
BACKGROUND
(mpxv) started to spread to Europe and North America at the beginning of the current outbreak in May 2022, and the World Health Organization (WHO) declared Human Monkeypox (mpox) as a public health emergency of international concern (PHEIC) in July 2022. The aim of this observational analysis is to describe demographical data, symptoms presentation and clinical course till outcome of individuals diagnosed with mpox, between May and October 2022, at our open-access Sexual Health Clinic in IRCCS San Raffaele Hospital in Milan, Italy.
METHODS
Among people who accessed our Sexual Health Clinic, we considered, as suspected diagnosis of mpox, individuals with consistent symptoms and epidemiological criteria. Following the physical examination, oropharyngeal, anal, genital and cutaneous swabs, plus plasma, urine and seminal fluid were collected as biological materials to detect mpxv DNA. We also performed a screening for sexually transmitted infections (STIs).
RESULTS
Overall, 140 individuals with mpox were included in this study. Median age was 37 (interquartile, IQR 33, 43) years old. Males were 137 (98%) and men who have sex with men (MSM) were 134 (96%). As risk factors, we detected travels abroad in 35 (25%) individuals and close contact with mpox cases in 49 (35%). There were 66 (47%) people living with HIV (PLWH). Most frequent symptoms were fever (59%), lymphadenopathy (57%), cutaneous (77%), genital (42%), anal (34%) and oral (26%) lesions, proctitis (39%), sore throat (22%) and generalized rash (5%). At mpox diagnosis, we also observed in 18 (13%) cases, syphilis in 14 (10%) and in 12 (9%). Two (1%) people received a concomitant diagnosis of HIV infection. We attended to 21 (15%) complications, with nine (6%) cases of hospitalization including six (IQR 3,7) median hospital days. Forty-five (32%) patients were treated with non-steroidal anti-inflammatory drugs (NSAIDs), 37 (26%) with antibiotics and eight (6%) with antiviral drugs.
CONCLUSIONS
Similarly to other international cohorts, sexual transmission was most frequently present, and concomitant STIs were common. Symptoms were heterogenous, self-resolving and responsive to therapy. Hospitalization was necessary in few patients. There is uncertainty about the future development of mpox and further studies (e.g., potential disease reservoirs, other possible means of transmission, predictors of severe disease) are still needed.
背景
（mpxv）于 2022 年 5 月当前疫情开始时开始传播到欧洲和北美，世界卫生组织（WHO）于 2022 年 7 月宣布人类猴痘（mpox）为国际关注的突发公共卫生事件（PHEIC）。本观察性分析的目的是描述 2022 年 5 月至 10 月期间在意大利米兰 IRCCS 圣拉斐尔医院的开放获取性健康诊所就诊的，诊断为猴痘的个体的人口统计学数据、症状表现和临床病程直至结局。
方法
在来我们性健康诊所就诊的人群中，我们将有一致症状和流行病学标准的个体视为猴痘疑似病例。体格检查后，采集口咽、肛门、生殖器和皮肤拭子，以及血浆、尿液和精液作为生物材料，以检测 mpxv DNA。我们还对性传播感染（STIs）进行了筛查。
结果
本研究共纳入 140 例猴痘患者。中位年龄为 37 岁（四分位距，IQR 33，43）。男性 137 例（98%），男男性接触者（MSM）134 例（96%）。作为危险因素，我们在 35 例（25%）个体中检测到出国旅行，在 49 例（35%）个体中检测到与猴痘病例的密切接触。有 66 例（47%）人携带艾滋病毒（PLWH）。最常见的症状是发热（59%）、淋巴结病（57%）、皮肤（77%）、生殖器（42%）、肛门（34%）和口腔（26%）病变、直肠炎（39%）、咽痛（22%）和全身皮疹（5%）。在猴痘诊断时，我们还观察到 18 例（13%）梅毒，14 例（10%）和 12 例（9%）。有 2 例（1%）人同时诊断为 HIV 感染。我们共处理了 21 例（15%）并发症，其中 9 例（6%）需要住院治疗，中位数住院天数为 6 天（IQR 3,7）。45 例（32%）患者接受非甾体抗炎药（NSAIDs）治疗，37 例（26%）接受抗生素治疗，8 例（6%）接受抗病毒药物治疗。
结论
与其他国际队列一样，性传播最为常见，同时存在性传播感染也很常见。症状表现多样，具有自限性，对治疗有反应。少数患者需要住院治疗。猴痘的未来发展仍存在不确定性，需要进一步研究（例如，潜在的疾病储库、其他可能的传播途径、严重疾病的预测因素）。
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