Research

14 pages, 1335 KiB

Open AccessArticle

Clinical Predictors of Monkeypox Diagnosis: A Case-Control Study in a Nonendemic Region during the 2022 Outbreak

by Alberto Kousuke De la Herrán-Arita, Cuitláhuac González-Galindo, Gerardo Kenny Inzunza-Leyva, Marco Antonio Valdez-Flores, Claudia Desiree Norzagaray-Valenzuela, Alejandro Camacho-Zamora, José Candelario Batiz-Beltrán, Francisco Javier Urrea-Ramírez, Alejandra Romero-Utrilla, Carla Angulo-Rojo, Alma Marlene Guadrón-Llanos, Verónica Judith Picos-Cárdenas, Josué Camberos-Barraza, Ángel Radamés Rábago-Monzón and Juan Fidel Osuna-Ramos

Microorganisms 2023, 11(9), 2287; https://doi.org/10.3390/microorganisms11092287 - 11 Sep 2023

Viewed by 2286

Abstract

Monkeypox (Mpox) is an emerging zoonotic disease with the potential for severe complications. Early identification and diagnosis are essential to prompt treatment, control its spread, and reduce the risk of human-to-human transmission. This study aimed to develop a clinical diagnostic tool and describe [...] Read more.

Monkeypox (Mpox) is an emerging zoonotic disease with the potential for severe complications. Early identification and diagnosis are essential to prompt treatment, control its spread, and reduce the risk of human-to-human transmission. This study aimed to develop a clinical diagnostic tool and describe the clinical and sociodemographic features of 19 PCR-confirmed Mpox cases during an outbreak in a nonendemic region of northwestern Mexico. The median age of patients was 35 years, and most were male. Mpox-positive patients commonly reported symptoms such as fever, lumbago, and asthenia, in addition to experiencing painful ulcers and a high frequency of HIV infection among people living with HIV (PLWH). Two diagnostic models using logistic regression were devised, with the best model exhibiting a prediction accuracy of 0.92 (95% CI: 0.8–1), a sensitivity of 0.86, and a specificity of 0.93. The high predictive values and accuracy of the top-performing model highlight its potential to significantly improve early Mpox diagnosis and treatment in clinical settings, aiding in the control of future outbreaks. Full article

(This article belongs to the Special Issue Monkeypox—Current Knowledge and Future Perspectives)

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13 pages, 4062 KiB

Open AccessCommunication

Monkeypox: A Histopathological and Transmission Electron Microscopy Study

by Chiara Moltrasio, Francesca Laura Boggio, Maurizio Romagnuolo, Rachele Cagliani, Manuela Sironi, Alessandra Di Benedetto, Angelo Valerio Marzano, Biagio Eugenio Leone and Barbara Vergani

Microorganisms 2023, 11(7), 1781; https://doi.org/10.3390/microorganisms11071781 - 09 Jul 2023

Cited by 4 | Viewed by 1974

Abstract

The global outbreak of human monkeypox virus (hMPXV1) in 2022 highlighted the usefulness of dermatological manifestations for its diagnosis. Infection by the human monkeypox virus thus necessitated inclusion in the diagnostic repertoire of dermatopathology. To assess the histopathological and microscopical findings of cutaneous [...] Read more.

The global outbreak of human monkeypox virus (hMPXV1) in 2022 highlighted the usefulness of dermatological manifestations for its diagnosis. Infection by the human monkeypox virus thus necessitated inclusion in the diagnostic repertoire of dermatopathology. To assess the histopathological and microscopical findings of cutaneous lesions related to hMPXV infection, we analyzed skin biopsies from patients with positive MPXV DNA polymerase chain reaction presenting with a typical course of hMPXV1 infection. The most prominent histopathological findings were ascribable to a pustular stage in which epidermal necrosis with areas of non-viable keratinocytes and a “shadow cell” appearance were evident; in some cases, the deep portion of the hair follicle and the acrosyringial epithelium were affected. The main cytopathic modifications included ballooning keratinocytes, followed by Guarnieri bodies and a ground glass appearance of the keratinocytes’ nuclei, together with a dense mixed inflammatory cell infiltrate with prominent neutrophil exocytosis. Transmission electron microscopy analysis demonstrated viral particle aggregates in the cytoplasm of keratinocytes, without any involvement of the nucleus. Interestingly, we also found the presence of viral particles in infected mesenchymal cells, although to a lesser extent than in epithelial cells. Through this study, we contributed to expanding the histological and microscopic knowledge of the human mpox virus, a key step to understanding current and potential future trends of the disease, as well as of other Orthopoxvirus infections. Full article

(This article belongs to the Special Issue Monkeypox—Current Knowledge and Future Perspectives)

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14 pages, 2300 KiB

Open AccessArticle

Mpox Patient Journey in Israel

by Tal Patalon, Galit Perez, Yaki Saciuk, Ziva Refaeli and Sivan Gazit

Microorganisms 2023, 11(4), 1042; https://doi.org/10.3390/microorganisms11041042 - 16 Apr 2023

Viewed by 1360

Abstract

Reports on Mpox have, thus far, characterized the disease, but mostly through a single timepoint view. The aim of this study was to characterize Mpox in the Israeli setting, in general, alongside compiling a detailed patient journey from multiple in-depth interviews with infected [...] Read more.

Reports on Mpox have, thus far, characterized the disease, but mostly through a single timepoint view. The aim of this study was to characterize Mpox in the Israeli setting, in general, alongside compiling a detailed patient journey from multiple in-depth interviews with infected individuals. This descriptive study followed two complimentary paths: retrospective and prospective. The first consisted of interviews with Mpox patients, while the retrospective part included the retrieval of anonymized electronic medical records of patients diagnosed with Mpox between May and November 2022. Patient characteristics in Israel were, overall, comparable to global reports. We found that the median time from symptoms to first suspicion of Mpox was 3.5 days, while the median time from the first symptom to a confirmatory test was 6.5 days, which could explain the surge in Israel. The duration of lesions did not alter in terms of their anatomical location, while lower Ct values correlated both with a longer symptom duration and more symptoms. Most patients reported anxiety to a high degree. Clinical trials that consist of a long-term relationship with the medical researchers contribute greatly to a deeper understanding of the patient journey, especially for unfamiliar or stigmatized diseases. Emerging infections, such as Mpox, should be further investigated to assess asymptomatic carriers, especially when rapidly spreading. Full article

(This article belongs to the Special Issue Monkeypox—Current Knowledge and Future Perspectives)

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Review

Jump to: Research, Other

19 pages, 860 KiB

Open AccessReview

A Review of the Past, Present, and Future of the Monkeypox Virus: Challenges, Opportunities, and Lessons from COVID-19 for Global Health Security

by Rahim Hirani, Kaleb Noruzi, Aroubah Iqbal, Anum S. Hussaini, Rafay A. Khan, Aleksandr Harutyunyan, Mill Etienne and Raj K. Tiwari

Microorganisms 2023, 11(11), 2713; https://doi.org/10.3390/microorganisms11112713 - 06 Nov 2023

Cited by 1 | Viewed by 1359

Abstract

Monkeypox, a rare but significant zoonotic and orthopoxviral disease, has garnered increasing attention due to its potential for human-to-human transmission and its recent resurgence in multiple countries throughout Europe, North America, and Oceania. The disease has emerged as a novel threat to the [...] Read more.

Monkeypox, a rare but significant zoonotic and orthopoxviral disease, has garnered increasing attention due to its potential for human-to-human transmission and its recent resurgence in multiple countries throughout Europe, North America, and Oceania. The disease has emerged as a novel threat to the global health systems that are still striving to recover from the major shocks of the COVID-19 pandemic. The unusual manifestation of the illness highlights a substantial knowledge deficit and necessitates the immediate development of a public health action strategy, considering the epidemiological differences observed in the ongoing outbreak and the appearance of cases in non-endemic nations. This literature review aims to synthesize existing knowledge on monkeypox, encompassing its historical context, etiology, epidemiology, surveillance, prevention, transmission, clinical presentation, diagnosis, treatments, and recent outbreak. Particular attention is given to both advances and gaps in our understanding of monkeypox, and we point toward future directions for research and intervention efforts as pertains to vaccine development and distribution. Lastly, we will also review the recent outbreak through a sociopolitical lens as relates to decision-making strategies, especially given the lessons learned from COVID-19. Full article

(This article belongs to the Special Issue Monkeypox—Current Knowledge and Future Perspectives)

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31 pages, 3661 KiB

Open AccessReview

Overview of Diagnostic Methods, Disease Prevalence and Transmission of Mpox (Formerly Monkeypox) in Humans and Animal Reservoirs

by Ravendra P. Chauhan, Ronen Fogel and Janice Limson

Microorganisms 2023, 11(5), 1186; https://doi.org/10.3390/microorganisms11051186 - 30 Apr 2023

Cited by 8 | Viewed by 2974

Abstract

Mpox—formerly monkeypox—is a re-emerging zoonotic virus disease, with large numbers of human cases reported during multi-country outbreaks in 2022. The close similarities in clinical symptoms that Mpox shares with many orthopoxvirus (OPXV) diseases make its diagnosis challenging, requiring laboratory testing for confirmation. This [...] Read more.

Mpox—formerly monkeypox—is a re-emerging zoonotic virus disease, with large numbers of human cases reported during multi-country outbreaks in 2022. The close similarities in clinical symptoms that Mpox shares with many orthopoxvirus (OPXV) diseases make its diagnosis challenging, requiring laboratory testing for confirmation. This review focuses on the diagnostic methods used for Mpox detection in naturally infected humans and animal reservoirs, disease prevalence and transmission, clinical symptoms and signs, and currently known host ranges. Using specific search terms, up to 2 September 2022, we identified 104 relevant original research articles and case reports from NCBI-PubMed and Google Scholar databases for inclusion in the study. Our analyses observed that molecular identification techniques are overwhelmingly being used in current diagnoses, especially real-time PCR (3982/7059 cases; n = 41 studies) and conventional PCR (430/1830 cases; n = 30 studies) approaches being most-frequently-used to diagnose Mpox cases in humans. Additionally, detection of Mpox genomes, using qPCR and/or conventional PCR coupled to genome sequencing methods, offered both reliable detection and epidemiological analyses of evolving Mpox strains; identified the emergence and transmission of a novel clade ‘hMPXV-1A’ lineage B.1 during 2022 outbreaks globally. While a few current serologic assays, such as ELISA, reported on the detection of OPXV- and Mpox-specific IgG (891/2801 cases; n = 17 studies) and IgM antibodies (241/2688 cases; n = 11 studies), hemagglutination inhibition (HI) detected Mpox antibodies in human samples (88/430 cases; n = 6 studies), most other serologic and immunographic assays used were OPXV-specific. Interestingly, virus isolation (228/1259 cases; n = 24 studies), electron microscopy (216/1226 cases; n = 18 studies), and immunohistochemistry (28/40; n = 7 studies) remain useful methods of Mpox detection in humans in select instances using clinical and tissue samples. In animals, OPXV- and Mpox-DNA and antibodies were detected in various species of nonhuman primates, rodents, shrews, opossums, a dog, and a pig. With evolving transmission dynamics of Mpox, information on reliable and rapid detection methods and clinical symptoms of disease is critical for disease management. Full article

(This article belongs to the Special Issue Monkeypox—Current Knowledge and Future Perspectives)

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18 pages, 2340 KiB

Open AccessReview

Animal Models Used in Monkeypox Research

by Marianna Domán, Enikő Fehér, Renáta Varga-Kugler, Ferenc Jakab and Krisztián Bányai

Microorganisms 2022, 10(11), 2192; https://doi.org/10.3390/microorganisms10112192 - 04 Nov 2022

Cited by 8 | Viewed by 2309

Abstract

Monkeypox is an emerging zoonotic disease with a growing prevalence outside of its endemic area, posing a significant threat to public health. Despite the epidemiological and field investigations of monkeypox, little is known about its maintenance in natural reservoirs, biological implications or disease [...] Read more.

Monkeypox is an emerging zoonotic disease with a growing prevalence outside of its endemic area, posing a significant threat to public health. Despite the epidemiological and field investigations of monkeypox, little is known about its maintenance in natural reservoirs, biological implications or disease management. African rodents are considered possible reservoirs, although many mammalian species have been naturally infected with the monkeypox virus (MPXV). The involvement of domestic livestock and pets in spillover events cannot be ruled out, which may facilitate secondary virus transmission to humans. Investigation of MPXV infection in putative reservoir species and non-human primates experimentally uncovered novel findings relevant to the course of pathogenesis, virulence factors and transmission of MPXV that provided valuable information for designing appropriate prevention measures and effective vaccines. Full article

(This article belongs to the Special Issue Monkeypox—Current Knowledge and Future Perspectives)

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10 pages, 262 KiB

Open AccessReview

Human Monkeypox: A Comprehensive Narrative Review and Analysis of the Public Health Implications

by Francesco Di Gennaro, Nicola Veronese, Claudia Marotta, Jae Il Shin, Ai Koyanagi, Andrea Silenzi, Mario Antunes, Annalisa Saracino, Davide Fiore Bavaro, Pinar Soysal, Francesco Vladimiro Segala, Laurie Butler, Eugenio Milano, Mario Barbagallo, Yvonne Barnett, Christopher Parris, Emanuele Nicastri, Damiano Pizzol and Lee Smith

Microorganisms 2022, 10(8), 1633; https://doi.org/10.3390/microorganisms10081633 - 12 Aug 2022

Cited by 43 | Viewed by 5427

Abstract

Recently, numerous cases of monkeypox were reported from several non-endemic countries in Europe, North America, and Oceania, suggesting an unusual and alarming public health issue, particularly considering that the disease is not directly related to human or animal travels. Attention is currently being [...] Read more.

Recently, numerous cases of monkeypox were reported from several non-endemic countries in Europe, North America, and Oceania, suggesting an unusual and alarming public health issue, particularly considering that the disease is not directly related to human or animal travels. Attention is currently being drawn to this phenomenon since more than 70% of the global population is no longer vaccinated against smallpox. Indeed, the smallpox vaccination also confers some indirect degree of protection against other poxviruses, including monkeypox. We performed a narrative review to describe the existing literature with regard to monkeypox using the MEDLINE, EMBASE, and Scopus databases. This review aims to provide updated evidence of findings on the epidemiology, clinical features, diagnosis, management, and prevention of monkeypox, also considering the concurrent zoonotic pandemic caused by the COVID-19 coronavirus, SARS-CoV-2. Full article

(This article belongs to the Special Issue Monkeypox—Current Knowledge and Future Perspectives)

Other

Jump to: Research, Review

11 pages, 599 KiB

Open AccessPerspective

Can Acanthamoeba Harbor Monkeypox Virus?

by Ruqaiyyah Siddiqui, Jibran Sualeh Muhammad, Ahmad M. Alharbi, Hasan Alfahemi and Naveed Ahmed Khan

Microorganisms 2023, 11(4), 855; https://doi.org/10.3390/microorganisms11040855 - 27 Mar 2023

Viewed by 1752

Abstract

Acanthamoeba is well known to host a variety of microorganisms such as viruses, bacteria, protozoa, and yeast. Given the recent number of cases of monkeypox infection, we speculate that amoebae may be aiding viral transmission to the susceptible hosts. Although there is no [...] Read more.

Acanthamoeba is well known to host a variety of microorganisms such as viruses, bacteria, protozoa, and yeast. Given the recent number of cases of monkeypox infection, we speculate that amoebae may be aiding viral transmission to the susceptible hosts. Although there is no confirmatory evidence to suggest that Acanthamoeba is a host to monkeypox (a double-stranded DNA virus), the recent discovery of mimivirus (another double-stranded DNA virus) from Acanthamoeba, suggests that amoebae may shelter monkeypox virus. Furthermore, given the possible spread of monkeypox virus from animals to humans during an earlier outbreak, which came about after patients came in contact with prairie dogs, it is likely that animals may also act as mixing vessel between ubiquitously distributed Acanthamoeba and monkeypox virus, in addition to the environmental habitat that acts as an interface in complex interactions between diverse microorganisms and the host. Full article

(This article belongs to the Special Issue Monkeypox—Current Knowledge and Future Perspectives)

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