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Wu C, A R, Ye S, Ye F, Huo W, Lu R, Tang Y, Yang J, Meng X, Tang Y, Chen S, Zhao L, Huang B, Zhang Z, Chen Y, Li D, Wang W, Shan KJ, Lu J, Tan W. Rapid identification of full-length genome and tracing variations of monkeypox virus in clinical specimens based on mNGS and amplicon sequencing. Virol Sin 2024; 39:134-143. [PMID: 38070873 PMCID: PMC10877412 DOI: 10.1016/j.virs.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
The monkeypox virus (MPXV) has triggered a current outbreak globally. Genome sequencing of MPXV and rapid tracing of genetic variants will benefit disease diagnosis and control. It is a significant challenge but necessary to optimize the strategy and application of rapid full-length genome identification and to track variations of MPXV in clinical specimens with low viral loads, as it is one of the DNA viruses with the largest genome and the most AT-biased, and has a significant number of tandem repeats. Here we evaluated the performance of metagenomic and amplicon sequencing techniques, and three sequencing platforms in MPXV genome sequencing based on multiple clinical specimens of five mpox cases in Chinese mainland. We rapidly identified the full-length genome of MPXV with the assembly of accurate tandem repeats in multiple clinical specimens. Amplicon sequencing enables cost-effective and rapid sequencing of clinical specimens to obtain high-quality MPXV genomes. Third-generation sequencing facilitates the assembly of the terminal tandem repeat regions in the monkeypox virus genome and corrects a common misassembly in published sequences. Besides, several intra-host single nucleotide variations were identified in the first imported mpox case. This study offers an evaluation of various strategies aimed at identifying the complete genome of MPXV in clinical specimens. The findings of this study will significantly enhance the surveillance of MPXV.
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Affiliation(s)
- Changcheng Wu
- NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100052, China
| | - Ruhan A
- NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100052, China
| | - Sheng Ye
- Chongqing Municipal Key Laboratory for High Pathogenic Microbes, Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Fei Ye
- NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100052, China
| | - Weibang Huo
- NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100052, China
| | - Roujian Lu
- NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100052, China
| | - Yue Tang
- MGI, BGI-Shenzhen, Shenzhen, 518083, China; College of Life Sciences, University of Chinese Academy of Sciences, Beijing, 100049, China
| | | | - Xuehong Meng
- Thermo Fisher Scientific, Beijing, 100013, China
| | - Yun Tang
- Chongqing Municipal Key Laboratory for High Pathogenic Microbes, Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Shuang Chen
- Chongqing Municipal Key Laboratory for High Pathogenic Microbes, Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Li Zhao
- NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100052, China
| | - Baoying Huang
- NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100052, China
| | - Zhongxian Zhang
- NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100052, China; School of Public Health, Baotou Medical College, Baotou, 014030, China
| | - Yuda Chen
- NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100052, China; School of Public Health, Baotou Medical College, Baotou, 014030, China
| | - Dongfang Li
- BGI PathoGenesis Pharmaceutical Technology, Shenzhen, 518000, China
| | - Wenling Wang
- NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100052, China
| | - Ke-Jia Shan
- State Key Laboratory of Protein and Plant Gene Research, Center for Bioinformatics, School of Life Sciences, Peking University, Beijing, 100871, China
| | - Jian Lu
- State Key Laboratory of Protein and Plant Gene Research, Center for Bioinformatics, School of Life Sciences, Peking University, Beijing, 100871, China.
| | - Wenjie Tan
- NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100052, China; School of Public Health, Baotou Medical College, Baotou, 014030, China.
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Caldera JR, Gray HK, Garner OB, Yang S. FDA trial regulation of laboratory developed tests (LDTs): An academic medical center's experience with Mpox in-house testing. J Clin Virol 2023; 169:105611. [PMID: 37866092 DOI: 10.1016/j.jcv.2023.105611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 08/08/2023] [Accepted: 10/08/2023] [Indexed: 10/24/2023]
Abstract
The 2022 mpox outbreak presented a familiar challenge to clinical laboratories. Accordingly, our institution was able to swiftly implement in-house mpox testing to meet the imminent diagnostic needs of the public health emergency. While the FDA authorized laboratory-developed tests (LDTs) for lesion specimens, however, it restricted the testing of rectal swabs despite mounting evidence of its clinical utility. Notably, within the short timeframe when rectal testing was available, we identified a high-risk patient without apparent lesions who tested monkeypox-positive only by our in-house rectal swab assay. In order for our institution to continue testing non-lesion samples, The FDA required a separate Emergency Use Authorization (EUA) application that demanded additional resource-costly validation studies despite utilizing the same testing platform as lesion samples. Here, we provide a brief review of the history, current status, and legal scope surrounding LDT validations, with an in-depth comparison of the technical requirements by CLIA, CAP and the FDA. Importantly, we provide our experience with the mpox EUA submission process to serve as context for the challenges that may be imposed by the new FDA regulations. We hope that our experience will offer a valuable perspective that promotes constructive discourse towards addressing the imperative to offer high-quality laboratory diagnostics without compromising on the need of the medical laboratory community to provide effective patient care.
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Affiliation(s)
- J R Caldera
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Hannah K Gray
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Omai B Garner
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Shangxin Yang
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
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Ordoñez-González I, López-Zamora B, Medina G, Reyes-Navarro GV, Navarro AO, Cruz-Domínguez MP, Vera-Lastra O, Saavedra MÁ. Human monkeypox coinfection with syphilis in an immunocompromised patient. Dermatol Reports 2023; 15:9591. [PMID: 37397408 PMCID: PMC10312107 DOI: 10.4081/dr.2022.9591] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 07/04/2023] Open
Abstract
Monkeypox is a viral zoonosis from the Poxviridae family that spreads at an unprecedented rate. It is transmitted through contact with skin lesions, respiratory droplets, body fluids, and sexual contact. The diverse presentation of the disease leads to misdiagnosis. Thus, clinicians should have a high index of suspicion, mainly with diseases with skin lesions. The most vulnerable group to developing this disease are individuals with risky sexual relationships, sexually transmitted infections, or human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). To date, only one case of coinfection with the monkeypox virus, syphilis, and HIV has been reported; however, no cases have been revealed in the Mexican territory. Herein we describe an unusual case of syphilis-monkeypox coinfection in an immunocompromised patient; despite his coinfection, he had a favorable prognosis. Furthermore, we attach allusive pictures of the natural evolution of dermatological lesions.
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Affiliation(s)
| | | | - Gabriela Medina
- Unidad de Investigación de Medicina Translacional, Hospital de Especialidades Centro Médico Nacional La Raza, IMSS, Mexico City
- Universidad Nacional Autónoma de México, Mexico City
| | | | - Alberto Ordinola Navarro
- Universidad Nacional Autónoma de México, Mexico City
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - María Pilar Cruz-Domínguez
- Universidad Nacional Autónoma de México, Mexico City
- Dirección de Educación e Investigación, Hospital de Especialidades Centro Médico Nacional La Raza, IMSS, Mexico City
| | - Olga Vera-Lastra
- Universidad Nacional Autónoma de México, Mexico City
- Departamento de Medicina Interna, Hospital de Especialidades Centro Médico Nacional La Raza, IMSS, Mexico City
| | - Miguel Ángel Saavedra
- Universidad Nacional Autónoma de México, Mexico City
- División de Investigación, Hospital de Especialidades Centro Médico Nacional La Raza, IMSS, Mexico City, Mexico
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Perzia B, Theotoka D, Li K, Moss E, Matesva M, Gill M, Kibe M, Chow J, Green S. Treatment of ocular-involving monkeypox virus with topical trifluridine and oral tecovirimat in the 2022 monkeypox virus outbreak. Am J Ophthalmol Case Rep 2023; 29:101779. [PMID: 36573234 PMCID: PMC9744718 DOI: 10.1016/j.ajoc.2022.101779] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose To report a case of ocular involving monkeypox infection in the United States during the 2022 outbreak, and to review the literature regarding its clinical manifestations and management known to date. Observations A 36-year-old man with well controlled HIV presented to the emergency department with anal pain, diffuse rash, right eye pain, and right eye redness after he tested positive for monkeypox one week prior. Ocular examination showed bilateral periorbital vesicular lesions, right eye conjunctival injection, and a single white plaque on his right medial bulbar conjunctiva. Macular, vesicular, and pustular lesions were noted throughout his body, including the genital and perianal region. His ocular and systemic symptoms completely resolved after treatment with a ten-day course of 1% trifluridine and moxifloxacin drops in both eyes, as well as two weeks of oral tecovirimat. Conclusion and Importance In July of 2022, monkeypox virus was declared a global health emergency by the World Health Organization; however, there are no standard guidelines for monkeypox treatment. Data on its clinical presentation and course, especially pertaining to ocular manifestations, is limited. We highlight the importance of recognizing ophthalmic manifestations of monkeypox virus and a possible therapeutic approach to help guide the management of these patients.
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Key Words
- ART, Antiretroviral therapy
- CDC, Centers for Disease Control and Prevention
- Conjunctival lesion
- Conjunctivitis
- MPV, Monkeypox virus
- Monkeypox virus
- OCT, Optical coherence tomography
- OD, right eye
- OS, left eye
- OSSN, Ocular surface squamous neoplasia
- OU, both eyes
- Ocular manifestations
- PCP, Primary care physician
- STI, Sexually transmitted infection
- VIG, Vaccinia immune globulin
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Affiliation(s)
- Brittany Perzia
- Department of Ophthalmology and Visual Science, Yale School of Medicine, 40 Temple Street, New Haven, CT, 06510, USA
| | - Despoina Theotoka
- Department of Ophthalmology and Visual Science, Yale School of Medicine, 40 Temple Street, New Haven, CT, 06510, USA
| | - Katie Li
- Department of Ophthalmology and Visual Science, Yale School of Medicine, 40 Temple Street, New Haven, CT, 06510, USA,Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Emily Moss
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Mitchelle Matesva
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Mohsain Gill
- Department of Ophthalmology and Visual Science, Yale School of Medicine, 40 Temple Street, New Haven, CT, 06510, USA
| | - Mercy Kibe
- Department of Ophthalmology and Visual Science, Yale School of Medicine, 40 Temple Street, New Haven, CT, 06510, USA
| | - Jessica Chow
- Department of Ophthalmology and Visual Science, Yale School of Medicine, 40 Temple Street, New Haven, CT, 06510, USA
| | - Stephanie Green
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA,Corresponding author
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Clinical Manifestation, Transmission, Pathogenesis, and Diagnosis of Monkeypox Virus: A Comprehensive Review. Life (Basel) 2023; 13:life13020522. [PMID: 36836879 PMCID: PMC9962527 DOI: 10.3390/life13020522] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
Monkeypox virus is a double-stranded DNA virus species that causes disease in humans and mammals. It is a zoonotic virus belongs the genus Orthopoxviral, the family of Poxviridae, associated with the smallpox virus in many aspects. The first human case of monkeypox was reported throughout the Democratic Republic of Congo in 1970. In April 2022, several cases were recorded in widespread regions of Africa, the Northern and western hemispheres. The current review spotlights taxonomic classification, clinical presentations during infection, and the pathogenicity of the monkeypox virus in humans. Furthermore, the current review also highlights different diagnostics used for virus detection.
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