Division of Medicine, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland, United States of America.
Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America.
PLoS Negl Trop Dis. 2023 Apr 20;17(4):e0010384. doi: 10.1371/journal.pntd.0010384. eCollection 2023 Apr.
We describe the results of a prospective observational study of the clinical natural history of human monkeypox (mpox) virus (MPXV) infections at the remote L'Hopital General de Reference de Kole (Kole hospital), the rainforest of the Congo River basin of the Democratic Republic of the Congo (DRC) from March 2007 until August 2011. The research was conducted jointly by the Institute National de Recherche Biomedical (INRB) and the US Army Medical Research Institute of Infectious Diseases (USAMRIID). The Kole hospital was one of the two previous WHO Mpox study sites (1981-1986). The hospital is staffed by a Spanish Order of Catholic Nuns from La Congregation Des Soeurs Missionnaires Du Christ Jesus including two Spanish physicians, who were members of the Order as well, were part of the WHO study on human mpox. Of 244 patients admitted with a clinical diagnosis of MPXV infection, 216 were positive in both the Pan-Orthopox and MPXV specific PCR. The cardinal observations of these 216 patients are summarized in this report. There were three deaths (3/216) among these hospitalized patients; fetal death occurred in 3 of 4 patients who were pregnant at admission, with the placenta of one fetus demonstrating prominent MPXV infection of the chorionic villi. The most common complaints were rash (96.8%), malaise (85.2%), sore throat (78.2%), and lymphadenopathy/adenopathy (57.4%). The most common physical exam findings were mpox rash (99.5%) and lymphadenopathy (98.6%). The single patient without the classic mpox rash had been previously vaccinated against smallpox. Age group of less than 5 years had the highest lesion count. Primary household cases tended to have higher lesion counts than secondary or later same household cases. Of the 216 patients, 200 were tested for IgM & IgG antibodies (Abs) to Orthopoxviruses. All 200 patients had anti-orthopoxvirus IgG Abs; whereas 189/200 were positive for IgM. Patients with hypoalbuminemia had a high risk of severe disease. Patients with fatal disease had higher maximum geometric mean values than survivors for the following variables, respectively: viral DNA in blood (DNAemia); maximum lesion count; day of admission mean AST and ALT.
我们描述了 2007 年 3 月至 2011 年 8 月期间在刚果民主共和国（刚果）刚果河流域热带雨林中的远程 Kole 总医院（Kole 医院）对人类猴痘（mpox）病毒（MPXV）感染的临床自然史进行的一项前瞻性观察研究结果。该研究由国家生物医学研究所（INRB）和美国陆军传染病医学研究所（USAMRIID）联合开展。Kole 医院是世界卫生组织（WHO）猴痘研究的两个前研究地点之一（1981-1986 年）。医院由来自拉孔贡西亚的天主教修女团的西班牙修女组成，其中包括两名西班牙医生，他们也是该命令的成员，也是世卫组织人类猴痘研究的一部分。在因临床诊断为 MPXV 感染而住院的 244 名患者中，216 名患者在 Pan-Orthopox 和 MPXV 特异性 PCR 中均为阳性。现将这些 216 名患者的主要观察结果总结如下。这些住院患者中有 3 人死亡（3/216）；3 名入院时已怀孕的患者中发生了胎儿死亡，其中 1 名胎儿的胎盘显示出明显的 MPXV 感染绒毛膜绒毛。最常见的抱怨是皮疹（96.8%）、不适（85.2%）、喉咙痛（78.2%）和淋巴结病/腺病（57.4%）。最常见的体格检查发现是猴痘皮疹（99.5%）和淋巴结病（98.6%）。唯一没有典型猴痘皮疹的患者曾接种过天花疫苗。年龄组小于 5 岁的患者病变计数最高。原发性家庭病例的病变计数高于继发性或以后的同一家庭病例。在 216 名患者中，200 名接受了针对正痘病毒的 IgM 和 IgG 抗体（Abs）检测。所有 200 名患者均具有抗正痘病毒 IgG Abs；而 189/200 名患者 IgM 阳性。低白蛋白血症患者患严重疾病的风险较高。死亡患者的以下变量的最大几何均数值均高于幸存者：血液中的病毒 DNA（DNAemia）；最大病变计数；入院日平均天冬氨酸转氨酶和丙氨酸转氨酶。
