Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA.
Am J Transplant. 2023 Dec;23(12):1972-1979. doi: 10.1016/j.ajt.2023.07.016. Epub 2023 Jul 27.
In 2022, the largest global outbreak of mpox to date emerged. In the immunocompetent host, mpox generally presents as a self-limiting illness. However, immunosuppression, such as that seen with advanced HIV, has been associated with significant morbidity and mortality related to mpox infection. To evaluate the impact of immunosuppression related to solid organ transplantation on clinical features and outcomes of mpox we established a multicenter case registry. Eleven cases from 7 participating centers in the USA were submitted. All cases occurred in males. The majority were kidney transplant recipients (91%, n = 10). Median duration of symptoms at presentation was 6 days (range, 3-14 days). Rates of hospitalization were high (73%, n = 8) with a median length of stay of 4.5 days (range, 1-10 days). Mpox in solid organ transplant recipients was associated with a high burden of skin lesions and systemic symptoms. Fever, fatigue, pharyngitis, and proctitis were commonly reported. Other clinical features included headache, myalgia, epididymo-orchitis, urinary retention, hematemesis, pneumonitis, and circulatory shock. All patients received treatment with tecovirimat. There was 1 mpox-related death in the cohort. Infection was reported to have resolved at 30-day follow-up in all other cases.
2022 年，出现了迄今为止最大的猴痘全球疫情。在免疫功能正常的宿主中，猴痘通常表现为自限性疾病。然而，免疫抑制，如晚期 HIV 所导致的免疫抑制，与猴痘感染相关的发病率和死亡率显著增加有关。为了评估与实体器官移植相关的免疫抑制对猴痘临床特征和结局的影响，我们建立了一个多中心病例登记处。来自美国 7 个参与中心的 11 例病例被提交。所有病例均发生于男性。大多数为肾移植受者（91%，n=10）。发病时症状的中位持续时间为 6 天（范围，3-14 天）。住院率很高（73%，n=8），中位住院时间为 4.5 天（范围，1-10 天）。实体器官移植受者中的猴痘与皮肤损伤和全身症状负担高有关。发热、疲劳、咽炎和直肠炎是常见的报告症状。其他临床特征包括头痛、肌痛、附睾炎或睾丸炎、尿潴留、呕血、肺炎和循环性休克。所有患者均接受特考韦瑞治疗。该队列中有 1 例猴痘相关死亡。在所有其他病例中，报告在 30 天随访时感染已得到解决。
