Cordeiro Rita, Pelerito Ana, de Carvalho Isabel Lopes, Lopo Sílvia, Neves Raquel, Rocha Raquel, Palminha Paula, Verdasca Nuno, Palhinhas Cláudia, Borrego Maria José, Manita Carla, Ferreira Idalina, Bettencourt Célia, Vieira Patrícia, Silva Sónia, Água-Doce Ivone, Roque Carla, Cordeiro Dora, Brondani Greice, Santos João Almeida, Martins Susana, Rodrigues Irene, Ribeiro Carlos, Núncio Maria Sofia, Gomes João Paulo, Batista Fernando da Conceição
Emergency Response and Biopreparedness Unit, Infectious Diseases Department, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal.
Institute of Environmental Health, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
J Med Virol. 2024 Dec;96(12):e70104. doi: 10.1002/jmv.70104.
Mpox is a zoonotic disease caused by the Monkeypox virus (MPXV), and since May 2022, tens of thousands of cases have been reported in non-endemic countries. We aimed to evaluate the suitability of different sample types for mpox diagnostic and assess the temporal dynamics of viral load. We evaluated 1914 samples from 953 laboratory-confirmed cases. The positivity rate was higher for lesion (91.3%) and rectal swabs (86.1%) when compared with oropharyngeal swabs (69.5%) and urines (41.2%), indicating higher viral loads for the former. Supporting this, lesion and rectal swabs showed lower median PCR C values (C = 23 and C = 24), compared to oropharyngeal swabs and urines (C = 31). Stable MPXV loads were observed in swabs from lesions up to 30 days after symptoms onset, contrasting with a considerable decrease in viral load in rectal and oropharyngeal swabs. Overall, these results point to lesion swabs as the most suitable samples for detecting MPXV in the 2022-2023 multicountry outbreak and show comparable accuracy to rectal swabs up to 8 days after symptoms onset. These findings, together with the observation that about 5% of patients were diagnosed through oropharyngeal swabs while having negative lesions, suggest that multisite testing should be performed to increase diagnostic sensitivity.
猴痘是一种由猴痘病毒（MPXV）引起的人畜共患病，自2022年5月以来，非流行国家已报告了数万例病例。我们旨在评估不同样本类型对猴痘诊断的适用性，并评估病毒载量的时间动态变化。我们对953例实验室确诊病例的1914份样本进行了评估。与口咽拭子（69.5%）和尿液（41.2%）相比，皮损拭子（91.3%）和直肠拭子（86.1%）的阳性率更高，这表明前者的病毒载量更高。支持这一点的是，与口咽拭子和尿液（C = 31）相比，皮损拭子和直肠拭子的PCR C值中位数更低（C = 23和C = 24）。在症状出现后长达30天的皮损拭子中观察到猴痘病毒载量稳定，这与直肠拭子和口咽拭子中病毒载量的显著下降形成对比。总体而言，这些结果表明皮损拭子是2022 - 2023年多国疫情中检测猴痘病毒最合适的样本，并且在症状出现后8天内与直肠拭子具有相当的准确性。这些发现，连同约5%的患者在皮损阴性时通过口咽拭子被诊断的观察结果，表明应进行多部位检测以提高诊断敏感性。
