nach oben

Current Dermatology Reports

Erschienen in:

12.12.2023 | REVIEW

Mpox: Diagnosis and Management for the Inpatient Dermatologist

verfasst von: Alexis G. Strahan, Sigrid Collier, John Trinidad, Joanna Harp, Esther E. Freeman

Erschienen in: Current Dermatology Reports | Ausgabe 4/2023

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Mpox, though largely a self-limited disease, may have severe manifestations requiring hospitalization, particularly in immunocompromised individuals. This review highlights the history and epidemiology, clinical course, diagnostic pearls, and management of mpox in the context of inpatient dermatology.

Recent Findings

The 2022 outbreak had unique features in comparison to previous outbreaks and endemic mpox, including a predominance of anogenital lesions and an atypical progression of lesion morphologies. The frequency of concurrent STIs is as high as 76%- necessitating co-testing for HIV and other STIs. Intradermal administration of the live, nonreplicating vaccine (Jynneos) requires 1/5^th of the standard dose, shows similar immunogenicity, and provides increased vaccination reach.

Summary

Mpox may require hospitalization in cases of severe disease, uncontrolled pain, or with other cutaneous complications. The inpatient dermatologist plays an important role diagnosis of mpox and should recognize the variability in morphologic presentation and need for STI and HIV co-testing.

World Health Organization. WHO Director-General’s statement at the press conference following IHR Emergency Committee regarding the multi-country outbreak of monkeypox - 23 July 2022. Report. Updated 23 July 2022. Accessed 3 May 2023.

CDC. 2022 Monkeypox Outbreak Global Map. Updated Nov 4 2022. Accessed 6 Nov 2022. https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html.

de Oliveira-Júnior JM, Tenório MDL, dos Santos Caduda S, Santana RRR, Martins-Filho PR. Reasons for hospitalization of patients with monkeypox: a quantitative evidence synthesis. Infection. 2022/10/18 2022. https://doi.org/10.1007/s15010-022-01937-1.

Fink DL, Callaby H, Luintel A, et al. Clinical features and management of individuals admitted to hospital with monkeypox and associated complications across the UK: a retrospective cohort study. Lancet Infect Dis. 2023;23(5):589–97. https://doi.org/10.1016/S1473-3099(22)00806-4.CrossRefPubMed

Huang YA, Howard-Jones AR, Durrani S, Wang Z, Williams PC. Monkeypox: a clinical update for paediatricians. J Paediatr Child Health. 2022;58(9):1532–8. https://doi.org/10.1111/jpc.16171.CrossRefPubMedPubMedCentral

Control CfD. Clinical considerations for mpox in children and adolescents. Accessed 1 May 2023. https://www.cdc.gov/poxvirus/mpox/clinicians/pediatric.html.

• Bunge EM, Hoet B, Chen L, et al. The changing epidemiology of human monkeypox-a potential threat? A systematic review. PLoS Negl Trop Dis. 2022;16(2):e0010141. https://doi.org/10.1371/journal.pntd.0010141. A systematic review of the evolution of epidemiology of mpox spanning from 1970 to present day- with an emphasis on case count, mortality, and geographic impact. This review highlights an increase in case count, particularly in central Africa, with a similarly rising median age- extending from early childhood to young adults.

von Magnus P AE, Petersen KB, Birch-Andersen A. A pox-like disease in cynomolgus monkeys. Acta Path Microbiol Scand. 1959;46(159).

Silva NIO, de Oliveira JS, Kroon EG, Trindade GS, Drumond BP. Here, there, and everywhere: the wide host range and geographic distribution of zoonotic orthopoxviruses. Viruses. 2020;13(1). https://doi.org/10.3390/v13010043.

10.

Breman JG, Kalisa R, Steniowski MV, Zanotto E, Gromyko AI, Arita I. Human monkeypox, 1970–79. Bull World Health Organ. 1980;58(2):165–82.PubMedPubMedCentral

11.

Beer EM, Rao VB. A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy. PLoS Negl Trop Dis.2019;13(10): e0007791. https://doi.org/10.1371/journal.pntd.0007791.CrossRefPubMedPubMedCentral

12.

Update: multistate outbreak of monkeypox--Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003. MMWR Morb Mortal Wkly Rep. 2003;52(27):642–6.

13.

Reed KD, Melski JW, Graham MB, et al. The detection of monkeypox in humans in the Western Hemisphere. N Engl J Med. 2004;350(4):342–50. https://doi.org/10.1056/NEJMoa032299.CrossRefPubMed

14.

Organization WH. Monkeypox - Nigeria. Accessed 3 May 2023. https://www.who.int/emergencies/disease-outbreak-news/item/21-december-2017-monkeypox-nigeria-en.

15.

• Ogoina D, Iroezindu M, James HI, et al. Clinical course and outcome of human monkeypox in Nigeria. Clin Infect Dis. 2020;71(8):e210–4. https://doi.org/10.1093/cid/ciaa143. This retrospective review of 40 cases of mpox in Nigeria from 2017-2018 identified fever and vesiculopustular eruptions as the most common clinical signs, with much more severe and prolonged disease courses in individuals living with HIV-1.

16.

Yinka-Ogunleye ADM, Akinpelu A, et al. Monkeypox risk and mortality associated with HIV infection: a national case control study in Nigeria. SSRN. 2022. https://doi.org/10.2139/ssrn.4172063.CrossRef

17.

Yong SEF, Ng OT, Ho ZJM et al. Imported monkeypox, Singapore. Emerg Infect Dis. 2020;26(8):1826–30. https://doi.org/10.3201/eid2608.191387.

18.

Erez N, Achdout H, Milrot E, et al. Diagnosis of imported monkeypox, Israel, 2018. Emerg Infect Dis. 2019;25(5):980–3. https://doi.org/10.3201/eid2505.190076.CrossRefPubMedPubMedCentral

19.

Vaughan A, Aarons E, Astbury J et al. Two cases of monkeypox imported to the United Kingdom, September 2018. Euro Surveill. 2018;23(38). https://doi.org/10.2807/1560-7917.Es.2018.23.38.1800509.

20.

Agency UHS. Monkeypox cases confirmed in England – latest updates. 2022. 14 May 2022. https://www.gov.uk/government/news/monkeypox-cases-confirmed-in-england-latest-updates.

21.

Gigante CM, Korber B, Seabolt MH et al. Multiple lineages of monkeypox virus detected in the United States, 2021–2022. Science. 2022;378(6619):560–65. https://doi.org/10.1126/science.add4153.

22.

Isidro J, Borges V, Pinto M et al. Phylogenomic characterization and signs of microevolution in the 2022 multi-country outbreak of monkeypox virus. Nature Med. 2022;28(8):1569–1572. https://doi.org/10.1038/s41591-022-01907-y.

23.

Liu Q, Fu L, Wang B et al. Clinical characteristics of human mpox (monkeypox) in 2022: a systematic review and meta-analysis. Pathogens. 2023;12(1). https://doi.org/10.3390/pathogens12010146.

24.

Philpott D HC, Alroy KA et al. Epidemiologic and clinical characteristics of monkeypox cases — United States. MMWR Morb Mortal Wkly Rep. 2022;71: 1018–22.

25.

Mitjà O, Alemany A, Marks M, et al. Mpox in people with advanced HIV infection: a global case series. Lancet. 2023;401(10380):939–49. https://doi.org/10.1016/s0140-6736(23)00273-8.CrossRefPubMed

26.

Thornhill JP, Barkati S, Walmsley S, et al. Monkeypox virus infection in humans across 16 countries — April–June 2022. N Engl J Med. 2022;387(8):679–91. https://doi.org/10.1056/NEJMoa2207323.CrossRefPubMed

27.

• Benites-Zapata VA, Ulloque-Badaracco JR, Alarcon-Braga EA, et al. Clinical features, hospitalisation and deaths associated with monkeypox: a systematic review and meta-analysis. Ann Clin Microbiol Antimicrob. 2022;21(1):36. https://doi.org/10.1186/s12941-022-00527-1. In this systematic review and meta-analysis, clinical characteristics, hospitalizations and outcomes were summarized. Skin lesions in the genital area, lymphadenopathy, and pruritus were notable signs in the 2022 outbreak, differing from endemic mpox. One-third of all cases required hospitalization, yet only 4% reported fatal outcomes.

28.

DeWitt ME, Polk C, Williamson J, et al. Global monkeypox case hospitalisation rates: a rapid systematic review and meta-analysis. EClinicalMedicine. 2022;54: 101710. https://doi.org/10.1016/j.eclinm.2022.101710.CrossRefPubMedPubMedCentral

29.

Pourriyahi H, Aryanian Z, Afshar ZM, Goodarzi A. A systematic review and clinical atlas on mucocutaneous presentations of the current monkeypox outbreak: with a comprehensive approach to all dermatologic and nondermatologic aspects of the new and previous monkeypox outbreaks. J Med Virol. 2023;95(2): e28230. https://doi.org/10.1002/jmv.28230.CrossRefPubMed

30.

Control CfD. Mpox: Clinical Quick Reference. Accessed 3 May 2023. https://www.cdc.gov/poxvirus/mpox/clinicians/clinical-guidance-quick-reference.html.

31.

CDC. Science brief: detection and transmission of monkeypox virus. (DHCPP) DoH-CPaP; 2022. Oct 18, 2022. https://www.cdc.gov/poxvirus/monkeypox/about/science-behind-transmission.html.

32.

Ward T, Christie R, Paton RS, Cumming F, Overton CE. Transmission dynamics of monkeypox in the United Kingdom: contact tracing study. BMJ. 2022;379:e073153. https://doi.org/10.1136/bmj-2022-073153.CrossRefPubMedPubMedCentral

33.

Freeman EE, Abbott S, Kurpiel B, Okwor T. The dynamics of monkeypox transmission. BMJ. 2022;379: o2504. https://doi.org/10.1136/bmj.o2504.CrossRefPubMed

34.

Kipkorir V, Dhali A, Srichawla B, et al. The re-emerging monkeypox disease. Trop Med Int Health. 2022;27(11):961–9. https://doi.org/10.1111/tmi.13821.CrossRefPubMed

35.

CDC. Key characteristics for identifying monkeypox. Updated Aug 23 2022. Accessed 18 Nov 2022. https://www.cdc.gov/poxvirus/monkeypox/clinicians/clinical-recognition.html.

36.

Patel A, Bilinska J, Tam JCH, et al. Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series. BMJ. 2022;378:e072410. https://doi.org/10.1136/bmj-2022-072410.

37.

• Català A, Clavo-Escribano P, Riera-Monroig J et al. Monkeypox outbreak in Spain: clinical and epidemiological findings in a prospective cross-sectional study of 185 cases. British Jour Dermatol. https://doi.org/10.1111/bjd.21790. The prospective study highlights transmission of mpox in the 2022 outbreak via contact during sexual activity; and, additionally, authors characterize primary lesions as more homogenous in morphology in contrast to the generalized phase where lesions became heterogenous in type.

38.

• Prasad S, Casas CG, Strahan AG, et al. A dermatologic assessment of 101 mpox (monkeypox) cases from 13 countries during the outbreak: skin lesion morphology, clinical course, and scarring. J Am Acad Dermatol. 2022. https://doi.org/10.1016/j.jaad.2022.12.035. In this registry-based study, a review of 101 cases found that mpox skin lesions more often appeared prior to systemic symptoms, low lesion counts were present overall, and scarring is as a possible under-addressed sequala.

39.

Milano E, Belati A, De Santis L, et al. First case of paraphimosis as a severe complication of monkeypox. Vaccines (Basel). 2022;11(1). https://doi.org/10.3390/vaccines11010063.

40.

Huhn GD, Bauer AM, Yorita K, et al. Clinical characteristics of human monkeypox, and risk factors for severe disease. Clin Infect Dis. 2005;41(12):1742–51. https://doi.org/10.1086/498115.CrossRefPubMed

41.

Karmarkar E, Altwies EE, Desta R, et al. Report: a pox presenting without pox. Sex Transm Dis. 2022;49(12):855–7. https://doi.org/10.1097/olq.0000000000001700.CrossRefPubMedPubMedCentral

42.

Bartholomew E, Kosche C, Leslie KS. Mpox infection presenting with morbilliform rash: a case series. JAAD Case Rep. 2023;35:98–102. https://doi.org/10.1016/j.jdcr.2023.03.001.CrossRefPubMedPubMedCentral

43.

Control CfD. Case definitions for use in the 2022 Mpox response. Accessed 3 May 2023. https://www.cdc.gov/poxvirus/mpox/clinicians/case-definition.html.

44.

Sharma R, Aashima, Nanda M, et al. Mapping cancer in Africa: a comprehensive and comparable characterization of 34 cancer types using estimates from GLOBOCAN 2020. Front Public Health. 2022;10:839835. https://doi.org/10.3389/fpubh.2022.839835.

45.

Curran KG, Eberly K, Russell OO, et al. HIV and sexually transmitted infections among persons with monkeypox - eight U.S. jurisdictions, May 17-July 22, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(36):1141–1147. https://doi.org/10.15585/mmwr.mm7136a1.

46.

Control CfD. Sexually transmitted infections treatment guidelines. Morb Mort Weekly Rep. 2021;70:2021.

47.

Control CfD. Guidelines for collecting and handling specimens for Mpox testing. Accessed 3 May 2023. https://www.cdc.gov/poxvirus/mpox/clinicians/prep-collection-specimens.html.

48.

Organization WH. Testing for mpox: individuals and communities. Accessed 14 Oct 2023. https://www.who.int/news-room/questions-and-answers/item/testing-for-mpox--individuals-and-communities#:~:text=Currently%2C%20mpox%20testing%20is%20done,recommended%20to%20test%20for%20mpox.

49.

Organization WH. Laboratory testing for the monkeypox virus: Interim Guidance. 2022;2022:23.

50.

Control CfD. Infection prevention and control of Mpox in healthcare settings. Accessed 3 May 2023. https://www.cdc.gov/poxvirus/mpox/clinicians/infection-control-healthcare.html.

51.

Lo Piccolo AJ, Wallach A, McPherson TD, et al. The role of a tertiary level safety net hospital in New York city’s 2022 Mpox outbreak. Health Secur Mar-Apr. 2023;21(2):146–55. https://doi.org/10.1089/hs.2022.0120.CrossRef

52.

Ahmed SK, El-Kader RGA, Lorenzo JM, et al. Hospital-based salient prevention and control measures to counteract the 2022 monkeypox outbreak. Health Sci Rep. 2023;6(1):e1057. https://doi.org/10.1002/hsr2.1057.

53.

Control CfD. Vaccination basics for healthcare professionals. Accessed 3 May 2023. https://www.cdc.gov/poxvirus/mpox/clinicians/vaccines/vaccine-basics-healthcare.html#vaccine-administration.

54.

Practice BB. Mpox (monkeypox). Accessed 3 May 2023. https://bestpractice.bmj.com/topics/en-us/1611/management-approach.

55.

Dermatology AAo. Monkeypox: caring for skin. Accessed 23 Oct 2022. https://www.aad.org/member/clinical-quality/clinical-care/monkeypox/treatment.

56.

Hunt SC, Azad S. ABCDEFGHI systematic approach to wound assessment and management. Adv Skin Wound Care. 2022;35(7):366–74. https://doi.org/10.1097/01.Asw.0000831064.06943.86.CrossRefPubMed

57.

Childs DR, Murthy AS. Overview of wound healing and management. Surg Clin North Am. 2017;97(1):189–7. https://doi.org/10.1016/j.suc.2016.08.013.CrossRefPubMed

58.

• Català A, Riera J, Fuertes I. Mpox - formerly monkey pox - in dermatology: a review of epidemiologic features, clinical presentation, diagnosis, and treatment. Actas Dermosifiliogr. 2023;114(4):318–326. MPOX (antes viruela del mono): revisión de los aspectos clínicos, epidemiológicos, diagnósticos y terapéuticos más relevantes para el dermatólogo. https://doi.org/10.1016/j.ad.2023.01.002. In this review, authors summarize the findings during the 2022 outbreak, highlighting contact during sexual activity as the primary mode of transmission, the self-limiting nature of most courses, and polymerase chain reaction analysis as the test of choice for diagnosis of mpox.

59.

Roett MA, Mayor MT, Uduhiri KA. Diagnosis and management of genital ulcers. Am Fam Physician. 2012;85(3):254–62.PubMed

60.

Control CfD. Clinical considerations for pain management of Mpox. Accessed 3 May 2023. https://www.cdc.gov/poxvirus/mpox/clinicians/pain-management.html.

61.

World Health Organization. Clinical management and infection prevention and control for monkeypox: Interim rapid response guidance, 10 June 2022. 2022. 10 June 2022. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1.

62.

Hennessee I, Shelus V, McArdle CE, et al. Epidemiologic and clinical features of children and adolescents aged <18 years with monkeypox - United States, May 17-September 24, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(44):1407–11. https://doi.org/10.15585/mmwr.mm7144a4.CrossRefPubMedPubMedCentral

63.

Mbala PK, Huggins JW, Riu-Rovira T, et al. Maternal and fetal outcomes among pregnant women with human monkeypox infection in the democratic republic of congo. J Infect Dis. 2017;216(7):824–8. https://doi.org/10.1093/infdis/jix260.CrossRefPubMed

64.

JJ M-T. Clinical aspects of monkeypox in DRC. Monkeypox epidemiology, surveillance, and laboratory capacity in DRC. Accessed 14 Oct 2023. https://cdn.who.int/media/docs/default-source/blue-print/day-1_jean-jacques-muyembe_drc_monkeypox-meeting_02june2022.pdf?sfvrsn=d133676a_3.

65.

Control CfD. Guidance for tecovirimat use. cdc.gov. Accessed 3 May 2023. https://www.cdc.gov/poxvirus/mpox/clinicians/Tecovirimat.html.

66.

Administration FD. FDA approves the first drug with an indication for treatment of smallpox. 2018. 13 July 2018. https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-indication-treatment-smallpox.

67.

Russo AT, Grosenbach DW, Brasel TL, et al. Effects of treatment delay on efficacy of tecovirimat following lethal aerosol monkeypox virus challenge in cynomolgus macaques. J Infect Dis. 2018;218(9):1490–9. https://doi.org/10.1093/infdis/jiy326.CrossRefPubMedPubMedCentral

68.

• Rao AK, Schrodt CA, Minhaj FS, et al. Interim clinical treatment considerations for severe manifestations of Mpox - United States, February 2023. MMWR Morb Mortal Wkly Rep. 2023;72(9):232–43. https://doi.org/10.15585/mmwr.mm7209a4. In this Morbidity and Mortality Weekly Report by the Centers for Disease Control and Prevention, a consensus is provided on the management of more severe clinical cases of mpox, notably the use of medical countermeasures such as tecovirimat and prioritization of optimizing immune status for those with known immunosuppressive states.

69.

Shamim MA, Padhi BK, Satapathy P, et al. The use of antivirals in the treatment of human monkeypox outbreaks: a systematic review. Int J Infect Dis. 2023;127:150–61. https://doi.org/10.1016/j.ijid.2022.11.040.CrossRefPubMed

70.

Andrei G, Snoeck R. Cidofovir activity against poxvirus infections. Viruses. 2010;2(12):2803–30. https://doi.org/10.3390/v2122803.CrossRefPubMedPubMedCentral

71.

Rizk JG, Lippi G, Henry BM, Forthal DN, Rizk Y. Prevention and treatment of monkeypox. Drugs. 2022;82(9):957–63. https://doi.org/10.1007/s40265-022-01742-y.CrossRefPubMedPubMedCentral

72.

Control CfD. Treatment Information for Healthcare Professionals. Accessed 3 May 2023. https://www.cdc.gov/poxvirus/mpox/clinicians/treatment.html#anchor_1655488284069.

73.

Tippin TK, Morrison ME, Brundage TM, Momméja-Marin H. Brincidofovir is not a substrate for the human organic anion transporter 1: a mechanistic explanation for the lack of nephrotoxicity observed in clinical studies. Ther Drug Monit. 2016;38(6):777–86. https://doi.org/10.1097/ftd.0000000000000353.CrossRefPubMedPubMedCentral

74.

Fox T, Gould S, Princy N, Rowland T, Lutje V, Kuehn R. Therapeutics for treating mpox in humans. Cochrane Database Syst Rev. 2023;3(3):Cd015769. https://doi.org/10.1002/14651858.Cd015769.

75.

Owens LE, Currie DW, Kramarow EA, et al. JYNNEOS vaccination coverage among persons at risk for Mpox - United States, May 22, 2022-January 31, 2023. MMWR Morb Mortal Wkly Rep. 2023;72(13):342–7. https://doi.org/10.15585/mmwr.mm7213a4.CrossRefPubMedPubMedCentral

76.

Control CfD. Interim clinical considerations for use of JYNNEOS and ACAM2000 vaccines during the 2022 U.S. Mpox outbreak. Accessed 3 May 2023. https://www.cdc.gov/poxvirus/mpox/clinicians/vaccines/vaccine-considerations.html.

77.

Brooks JT, Marks P, Goldstein RH, Walensky RP. Intradermal vaccination for monkeypox — benefits for individual and public health. N Engl J Med. 2022;387(13):1151–3. https://doi.org/10.1056/NEJMp2211311.CrossRefPubMed

78.

Frey SE, Wald A, Edupuganti S, et al. Comparison of lyophilized versus liquid modified vaccinia Ankara (MVA) formulations and subcutaneous versus intradermal routes of administration in healthy vaccinia-naïve subjects. Vaccine. 2015;33(39):5225–34. https://doi.org/10.1016/j.vaccine.2015.06.075.

79.

Adminstration FD. Fact sheet for healthcare providers administering vaccine: emergency use authorization of jynneos (smallpox and monkeypox vaccine, live, non-replicating) for prevention of monkeypox disease in individuals determined to be at high risk for monkeypox infection. 2022. 16 Aug 2022.

80.

Administration FD. ACAM2000, (Smallpox (Vaccinia) vaccine, live) product insert. 2007.

81.

Control CfD. ACAM 2000 Vaccine. cdc.gov. Accessed 3 May 2023. https://www.cdc.gov/poxvirus/mpox/interim-considerations/acam2000-vaccine.html.

82.

Brown K, Leggat PA. Human monkeypox: current state of knowledge and implications for the future. Trop Med Infect Dis. Dec 20 2016;1(1). https://doi.org/10.3390/tropicalmed1010008.

83.

Meaume S, Le Pillouer-Prost A, Richert B, Roseeuw D, Vadoud J. Management of scars: updated practical guidelines and use of silicones. Eur J Dermatol. 2014;24(4):435–43. https://doi.org/10.1684/ejd.2014.2356.CrossRef

84.

Ortiz-Martínez Y, Rodríguez-Morales AJ, Franco-Paredes C, et al. Monkeypox - a description of the clinical progression of skin lesions: a case report from Colorado, USA. Ther Adv Infect Dis. 2022;9:20499361221117730. https://doi.org/10.1177/20499361221117726.CrossRef

85.

de Sousa D, Frade J, Patrocínio J, Borges-Costa J, Filipe P. Monkeypox infection and bacterial cellulitis: a complication to look for. Int J Infect Dis. 2022;123:180–2. https://doi.org/10.1016/j.ijid.2022.08.024.CrossRefPubMedPubMedCentral

86.

Mailhe M, Beaumont AL, Thy M, et al. Clinical characteristics of ambulatory and hospitalized patients with monkeypox virus infection: an observational cohort study. Clin Microbiol Infect. 2023;29(2):233–9. https://doi.org/10.1016/j.cmi.2022.08.012.CrossRefPubMed

87.

Ki V, Rotstein C. Bacterial skin and soft tissue infections in adults: a review of their epidemiology, pathogenesis, diagnosis, treatment and site of care. Can J Infect Dis Med Microbiol. 2008;19(2):173–84. https://doi.org/10.1155/2008/846453.CrossRefPubMedPubMedCentral

88.

Moody S, Lamb T, Jackson E, et al. Assessment and management of secondary bacterial infections complicating Mpox (Monkeypox) using a telemedicine service. A prospective cohort study. Int J STD AIDS. 2023:9564624231162760. https://doi.org/10.1177/09564624231162760.

89.

• Miller MJ, Cash-Goldwasser S, Marx GE, et al. Severe monkeypox in hospitalized patients - United States, August 10-October 10, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(44):1412–7. https://doi.org/10.15585/mmwr.mm7144e1. In this Morbidity and Mortality Weekly Report by the Centers for Disease Control and Prevention, authors summarize 57 cases of individuals hospitalized for severe manifestations of mpox- 82% of whom were living with HIV. 1/3rd required ICU admission and 21% died. Of those cases examined, the majority were severely immunosuppressed (CD4+ counts <50, undergoing chemotherapy, solid organ transplant recipients, or pregnant).

90.

Prevention CfDCa. Clinical considerations for treatment and prophylaxis of mpox infection in people who are immunocompromised. Accessed 4 Feb 2023. https://www.cdc.gov/poxvirus/monkeypox/clinicians/people-with-HIV.html.

91.

Govind A, Lazarte SM, Kitchell E, et al. Severe Mpox infections in people with uncontrolled human immunodeficiency virus (HIV). Clin Infect Dis. 2023. https://doi.org/10.1093/cid/ciad052.

92.

D’Antonio F, Pagani G, Buca D, Khalil A. Monkeypox infection in pregnancy: a systematic review and metaanalysis. Am J Obstet Gynecol MFM. 2023;5(1):100747. https://doi.org/10.1016/j.ajogmf.2022.100747.CrossRefPubMed

93.

Prevention CfDCa. Clinical considerations for Mpox in people who are pregnant or breastfeeding. Accessed 23 Apr 2023. https://www.cdc.gov/poxvirus/mpox/clinicians/pregnancy.html.

94.

Dashraath P, Nielsen-Saines K, Mattar C, Musso D, Tambyah P, Baud D. Guidelines for pregnant individuals with monkeypox virus exposure. Lancet. 2022;400(10345):21–2. https://doi.org/10.1016/s0140-6736(22)01063-7.CrossRefPubMedPubMedCentral

95.

Aguilera-Alonso D, Alonso-Cadenas JA, Roguera-Sopena M, Lorusso N, Miguel LGS, Calvo C. Monkeypox virus infections in children in Spain during the first months of the 2022 outbreak. Lancet Child Adolesc Health. 2022;6(11):e22–3. https://doi.org/10.1016/s2352-4642(22)00250-4.CrossRefPubMedPubMedCentral

96.

Eni-Olotu AO. Ensuring equitable access in lessons learnt from mpox. Bmj. 2023;380:547. https://doi.org/10.1136/bmj.p547.

97.

Kozlov M. WHO may soon end mpox emergency - but outbreaks rage in Africa. Nature. 2023;614(7949):600–1. https://doi.org/10.1038/d41586-023-00391-9.CrossRefPubMed

98.

• Ogoina D. A brief history of monkeypox in Nigeria. IDSA. 2023. https://www.idsociety.org/science-speaks-blog/2022/a-brief-history-of-monkeypox-in-nigeria/#/+/0/publishedDate_na_dt/desc/. In this feature for the Infectious Disease Society of America, Dr. Dimie Ogoina provides a unique view of mpox through the lens of his work as an infectious disease physician at Niger Delta University Teaching Hospital. He highlights the paucity of resources, notably vaccine access, and attention given to research on the continent of Africa- an area where mpox has both higher case fatality and has remained endemic for the last 50 years.

99.

Breman JG, Henderson DA. Diagnosis and management of smallpox. N Engl J Med. 2002;346(17):1300–8. https://doi.org/10.1056/NEJMra020025.CrossRefPubMed

100.

Corey L, Adams HG, Brown ZA, Holmes KK. Genital herpes simplex virus infections: clinical manifestations, course, and complications. Annals Intern Med. 1983;98(6):958–972. https://doi.org/10.7326/0003-4819-98-6-958.

101.

Straus SE, Ostrove JM, Inchauspé G, et al. NIH conference. Varicella-zoster virus infections. Biology, natural history, treatment, and prevention. Ann Intern Med. 1988;108(2):221–37. https://doi.org/10.7326/0003-4819-108-2-221.

102.

van der Wouden JC, van der Sande R, Kruithof EJ, Sollie A, van Suijlekom-Smit LW, Koning S. Interventions for cutaneous molluscum contagiosum. Cochrane Database Syst Rev. 2017;5(5):Cd004767. https://doi.org/10.1002/14651858.CD004767.pub4.

103.

Sherrard J, Barlow D. Gonorrhoea in men: clinical and diagnostic aspects. Genitourin Med. 1996;72(6):422–6. https://doi.org/10.1136/sti.72.6.422.CrossRefPubMedPubMedCentral

104.

French P. Syphilis Bmj. 2007;334(7585):143–7. https://doi.org/10.1136/bmj.39085.518148.BE.CrossRefPubMed

105.

Mabey D, Peeling RW. Lymphogranuloma venereum. Sex Transm Infect. 2002;78(2):90–2. https://doi.org/10.1136/sti.78.2.90.CrossRefPubMedPubMedCentral

106.

Lewis DA. Epidemiology, clinical features, diagnosis and treatment of Haemophilus ducreyi - a disappearing pathogen? Expert Rev Anti Infect Ther. 2014;12(6):687–96. https://doi.org/10.1586/14787210.2014.892414.CrossRefPubMed

Titel: Mpox: Diagnosis and Management for the Inpatient Dermatologist
verfasst von: Alexis G. Strahan
Sigrid Collier
John Trinidad
Joanna Harp
Esther E. Freeman
Publikationsdatum: 12.12.2023
Verlag: Springer US
Erschienen in: Current Dermatology Reports / Ausgabe 4/2023
Elektronische ISSN: 2162-4933
DOI: https://doi.org/10.1007/s13671-023-00411-x

Leitlinien kompakt für die Dermatologie

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Dermatologie

Riesenzellarteriitis: 15% der Patienten sind von okkulter Form betroffen

16.05.2024 Riesenzellarteriitis Nachrichten

In einer retrospektiven Untersuchung haben Forschende aus Belgien und den Niederlanden die okkulte Form der Riesenzellarteriitis genauer unter die Lupe genommen. In puncto Therapie und Rezidivraten stellten sie keinen sehr großen Unterschied zu Erkrankten mit kranialen Symptomen fest.

Betalaktam-Allergie: praxisnahes Vorgehen beim Delabeling

16.05.2024 Pädiatrische Allergologie Nachrichten

Die große Mehrheit der vermeintlichen Penicillinallergien sind keine. Da das „Etikett“ Betalaktam-Allergie oft schon in der Kindheit erworben wird, kann ein frühzeitiges Delabeling lebenslange Vorteile bringen. Ein Team von Pädiaterinnen und Pädiatern aus Kanada stellt vor, wie sie dabei vorgehen.

Isotretinoin: Risiko für schwere Laboranomalien „marginal erhöht“

08.05.2024 Akne Nachrichten

Die Aknetherapie mit Isotretinoin kann einen Anstieg von Leberenzymen und Blutfetten verursachen. Das Risiko für schwere Störungen ist laut einer Forschungsgruppe der Universität Lübeck aber nur marginal erhöht und auf einen engen Zeitraum konzentriert.

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Update Dermatologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2023

Incidence and Characteristics of Melanoma in Multiple Sclerosis Patients Treated With Fingolimod: A Systematic Review

The Future of Patch Testing: Reimbursement Models, Workforce Shortages, and Negotiating in the House of Medicine

Patch Testing in Atopic Children: Is There a Difference?

Update on Cutaneous Small Vessel Vasculitis: Terminology, Morphology, Diagnostic Evaluation, and Management

Inpatient Evaluation and Management of Generalized Pustular Dermatoses