Department of Dermatology, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany.
Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany.
Viruses. 2023 Aug 15;15(8):1748. doi: 10.3390/v15081748.
Monkeypox (mpox), a former rare viral zoonosis, has increasingly made it into the public eye since the major outbreak that started in May 2022. Mpox presents with skin lesions that change over time and go through different stages (macular, papular, pustular, and early and late ulceration). In this study, we evaluated skin biopsies of all stages. Therefore, five biopsies from four patients were analyzed histologically, immunohistochemically with anti- antibodies, and electron-microscopically. Notably, the early macular stage only showed subtle viropathic changes; it did not express of Orthopoxvirus proteins in immunohistochemistry and therefore can easily be missed histologically. In later stages, immunohistochemistry with anti- antibodies might be useful to distinguish mpox from differential diagnoses such as herpes virus infections. In the ulcerative stages, the identified occlusive vasculopathic changes could be an explanation for the severe pain of the lesions reported by some patients. Despite the small number of samples examined, our analysis suggests that the histological findings of mpox are highly dependent on the stage of the biopsied lesion. Therefore, knowledge of all different stages of histology is necessary to reliably diagnose mpox histologically, especially when molecular testing is not available.
猴痘（mpox），一种以前罕见的病毒性人畜共患病，自 2022 年 5 月开始的大规模爆发以来，越来越受到公众关注。mpox 的特征是皮肤损伤会随着时间的推移而变化，并经历不同的阶段（斑疹、丘疹、脓疱、早期和晚期溃疡）。在这项研究中，我们评估了所有阶段的皮肤活检。因此，对四名患者的五份活检进行了组织学、抗抗体免疫组织化学和电子显微镜分析。值得注意的是，早期斑疹阶段仅显示轻微的病毒病变；在免疫组织化学中不表达正痘病毒蛋白，因此很容易在组织学上被忽略。在后期，抗抗体的免疫组织化学可能有助于将 mpox 与疱疹病毒感染等鉴别诊断区分开来。在溃疡性阶段，所鉴定的闭塞性血管病变可能是一些患者报告的病变严重疼痛的原因。尽管检查的样本数量较少，但我们的分析表明，mpox 的组织学发现高度依赖于活检病变的阶段。因此，为了能够可靠地进行组织学诊断 mpox，特别是在没有分子检测的情况下，了解所有不同阶段的组织学知识是必要的。
