Department of Internal Medicine, Infectious Diseases Unit, Niger Delta University/Niger Delta University Teaching Hospital, Bayelsa, Nigeria.
Department of Medicine, Emory University, Atlanta, GA, USA.
Clin Microbiol Infect. 2023 Dec;29(12):1493-1501. doi: 10.1016/j.cmi.2023.09.004. Epub 2023 Sep 12.
Historically, human mpox was predominantly a zoonotic disease occurring more frequently in rural children in Africa and characterized by a largely self-limiting febrile centrifugal monomorphic rash illness. However, the 2022 mpox global outbreak has shown that the disease is changing in many ways, including sustained human-to-human transmission via sexual contact, novel clinical presentations, and adverse associations between mpox and advanced HIV.
The aim of this paper is to review the traditional and emerging clinical aspects of human mpox and provide updated information on the clinical course and outcome of the disease.
We searched electronic databases including PubMed and Google Scholar and identified relevant published literature on mpox.
The clinical presentation of human mpox is influenced by the route of infectious exposure, the strain and dose of the infecting virus, and the host immune system. Exposure to the virus can result in sub-clinical or clinical diseases of variable severity. Infections caused by clade I viral strains are more severe than class IIa and IIb strains, which are associated with a milder febrile rash illness, and with anogenital skin lesions in clade IIb infections. Most cases of mpox recover entirely within 2-4 weeks after onset of illness and a few develop skin-related sequelae. Overall, people with advanced HIV infection, children <5 years of age, and pregnant women may present with more severe disease and higher case fatalities.
The continued endemicity of the classical mpox in Africa, the emergence of a new clinical form of the disease during the 2022 global outbreak, and the adverse associations between advanced HIV and mpox have implications for the surveillance, clinical diagnosis, and management of human mpox.
历史上，人类猴痘主要是一种在非洲农村儿童中更为常见的人畜共患病，其特征是一种主要为自限性发热离心性单形皮疹疾病。然而，2022 年猴痘全球暴发表明，该疾病在许多方面正在发生变化，包括通过性接触持续的人与人之间传播、新的临床表现以及猴痘与晚期 HIV 之间的不良关联。
本文旨在综述人类猴痘的传统和新兴临床方面，并提供有关该疾病临床过程和结局的最新信息。
我们搜索了包括 PubMed 和 Google Scholar 在内的电子数据库，并确定了有关猴痘的相关已发表文献。
人类猴痘的临床表现受感染暴露途径、感染病毒的株系和剂量以及宿主免疫系统的影响。暴露于病毒可导致严重程度不同的亚临床或临床疾病。I 类病毒株引起的感染比 IIa 和 IIb 类株引起的感染更为严重，后者与较轻的发热皮疹疾病以及 IIb 类感染的生殖器皮肤病变有关。大多数猴痘病例在发病后 2-4 周内完全康复，少数会出现皮肤相关后遗症。总体而言，晚期 HIV 感染、<5 岁儿童和孕妇可能会出现更严重的疾病和更高的病死率。
非洲经典猴痘的持续流行、2022 年全球暴发期间出现的新的疾病临床形式以及晚期 HIV 与猴痘之间的不良关联，对人类猴痘的监测、临床诊断和管理具有重要意义。
