Dermatology and Venereology Unit, Department of Internal Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria.
Pan-African Network For Rapid Research, Response, Relief and Preparedness for Infectious Disease Epidemics (PANDORA-ID-NET), Institute of Viral Hemorrhagic Fevers and Emerging Pathogens (Formerly Institute of Lassa Fever Research and Control), Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria.
J Med Case Rep. 2023 Nov 26;17(1):492. doi: 10.1186/s13256-023-04225-0.
Mpox, previously known as monkeypox, -is an orthopoxvirus infection of the skin and previously a public health emergency of international concern. It reemerged in Nigeria over 5 years ago and has since spread to other parts of the world. This is a case report of a confirmed patient who was managed at Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria before the global surge. This report shows peculiar differences from previous patients managed at the same center in terms of the relatively prolonged eruptive phase, possible seasonal occurrence of mpox in the community, and some traditional care for mpox and skin rashes. It also corroborates previous reports of possible sexual transmission of mpox in Nigeria before the report from the global outbreak.
The patient is a 30-year-old Nigerian male artisan with a 2-month history of raised rashes on the body that started on the genitals then involved other parts of the body. There was history of sore throat and unprotected sex with a female partner with similar rash whose other sexual history could not be ascertained. There was also history of "seasonal" rash in his village for about 7 years prior to his symptoms. Examination showed multiple vesicles and some nodules (ulcerating, healing, and healed) on the face, trunk, limbs, gluteal region, scrotum, palms, and sole, an almost circumferential penile ulcer, and lymphadenopathy. Polymerase chain reaction skin samples sent for mpox returned positive, while retroviral and coronavirus disease 2019 screenings were negative. He was managed in isolation while contact tracing in the affected community was initiated.
Atypical presentations of mpox, as managed in Irrua before the global surge, emphasize the varied spectrum of presentations (typical and atypical) in Nigeria. Therefore, there is a need for a higher index of suspicion for the uncommon presentations which will strengthen case recognition, case management, and community-based interventions as well as surveillance in the prevention and control of mpox in Irrua, its environs, Nigeria, and the world.
猴痘，以前称为猴痘，是一种皮肤正痘病毒感染，以前是国际关注的突发公共卫生事件。它在 5 年前在尼日利亚再次出现，此后已传播到世界其他地区。这是一例在全球疫情爆发前在尼日利亚 Irrua Specialist 教学医院接受治疗的确诊患者的病例报告。与以前在同一中心管理的患者相比，该报告显示出一些特殊的差异，包括爆发期相对延长、社区中可能出现季节性猴痘以及一些用于治疗猴痘和皮疹的传统方法。它还证实了在全球疫情爆发前尼日利亚报告的猴痘可能通过性传播的先前报告。
患者是一名 30 岁的尼日利亚男性工匠，有 2 个月的身体皮疹史，皮疹首先出现在生殖器上，然后累及身体其他部位。他有咽痛和与有类似皮疹的女性伴侣发生无保护性行为的病史，无法确定其其他性行为史。在出现症状前 7 年，他的村庄也有“季节性”皮疹史。检查显示面部、躯干、四肢、臀部、阴囊、手掌和脚底有多个水疱和一些结节（溃疡、愈合和愈合），阴茎几乎呈环状溃疡，以及淋巴结病。送去进行猴痘聚合酶链反应皮肤样本检测呈阳性，而逆转录病毒和冠状病毒病 2019 检测均为阴性。他在隔离的情况下接受了治疗，同时在受影响的社区中启动了接触者追踪。
在全球疫情爆发前在 Irrua 管理的猴痘不典型表现强调了尼日利亚猴痘表现（典型和非典型）的多样性。因此，需要对不常见的表现提高警惕，这将加强病例识别、病例管理以及社区为基础的干预措施，以及在预防和控制尼日利亚 Irrua 及其周边地区、尼日利亚和世界的猴痘方面进行监测。
