临床特征和猴痘的长期预后：从急性感染到 6 个月随访的队列研究。
Clinical spectrum and long-term outcomes of mpox: a cohort study spanning from acute infection to six-month follow-up.
机构信息
Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
出版信息
BMC Infect Dis. 2024 Mar 15;24(1):317. doi: 10.1186/s12879-024-09191-6.
BACKGROUND
Cases of mpox have been reported worldwide since May 2022. Limited knowledge exists regarding the long-term course of this disease. To assess sequelae in terms of scarring and quality of life (QoL) in mpox patients 4-6 months after initial infection.
METHODS
Prospective observational study on clinical characteristics and symptoms of patients with polymerase chain reaction (PCR)-confirmed mpox, including both outpatients and inpatients. Follow-up visits were conducted at 4-6 months, assessing the Patient and Observer Scar Assessment Scale (POSAS), the Dermatology Life Quality Index (DLQI) and sexual impairment, using a numeric rating scale (NRS) from 0 to 10.
RESULTS
Forty-three patients, age range 19-64 years, 41 men (all identifying as MSM) and 2 women, were included. Upon diagnosis, skin or mucosal lesions were present in 93.0% of cases, with 73.3% reporting pain (median intensity: 8, Q1-Q3: 6-10). Anal involvement resulted in a significantly higher frequency of pain than genital lesions (RR: 3.60, 95%-CI: 1.48-8.74). Inpatient treatment due to pain, superinfection, abscess or other indications was required in 20 patients (46.5%). After 4-6 months, most patients did not have significant limitations, scars or pain. However, compared to patients without such complications, patients with superinfection or abscess during the acute phase had significantly more extensive scar formation (median PSAS: 24.0 vs. 11.0, p = 0.039) and experienced a significantly greater impairment of their QoL (median DLQI: 2.0 vs. 0.0, p = 0.036) and sexuality (median NRS: 5.0 vs. 0.0, p = 0.017).
CONCLUSION
We observed a wide range of clinical mpox manifestations, with some patients experiencing significant pain and requiring hospitalization. After 4-6 months, most patients recovered without significant sequelae, but those with abscesses or superinfections during the initial infection experienced a significant reduction in QoL and sexuality. Adequate treatment, including antiseptic and antibiotic therapy during the acute phase, may help prevent such complications, and hence, improve long-term outcomes.
背景
自 2022 年 5 月以来，全球已报告了猴痘病例。关于这种疾病的长期病程，人们的了解有限。为了评估感染后 4-6 个月时猴痘患者的疤痕和生活质量 (QoL) 后遗症。
方法
对聚合酶链反应 (PCR) 确诊的猴痘患者的临床特征和症状进行前瞻性观察研究，包括门诊和住院患者。在 4-6 个月时进行随访，评估患者和观察者疤痕评估量表 (POSAS)、皮肤病生活质量指数 (DLQI) 和性障碍，使用数字评分量表 (NRS) 从 0 到 10 进行评分。
结果
43 名年龄在 19-64 岁之间的患者，其中 41 名男性(均为男男性接触者)和 2 名女性，包括在内。诊断时，93.0%的病例存在皮肤或粘膜损伤，73.3%的患者报告疼痛(中位数强度：8，Q1-Q3：6-10)。肛门受累引起的疼痛频率明显高于生殖器病变(相对风险：3.60，95%-CI：1.48-8.74)。由于疼痛、继发感染、脓肿或其他原因，20 名患者(46.5%)需要住院治疗。4-6 个月后，大多数患者没有明显的限制、疤痕或疼痛。然而，与没有这些并发症的患者相比，急性期继发感染或脓肿的患者疤痕形成明显更广泛(中位数 POSAS：24.0 与 11.0，p=0.039)，生活质量(QoL)和性健康显著受损(中位数 DLQI：2.0 与 0.0，p=0.036)和性健康(中位数 NRS：5.0 与 0.0，p=0.017)。
结论
我们观察到猴痘的临床表现范围广泛，一些患者经历了严重的疼痛，需要住院治疗。4-6 个月后，大多数患者康复，没有明显的后遗症，但在初始感染期间出现脓肿或继发感染的患者，生活质量和性健康显著下降。在急性期进行适当的治疗，包括使用防腐剂和抗生素治疗，可能有助于预防这些并发症，从而改善长期结局。
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