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Akiyama Y, Morioka S, Tsuzuki S, Yoshikawa T, Yamato M, Nakamura H, Shimojima M, Takakusaki M, Saito S, Takahashi K, Sanada M, Komatsubara M, Takebuchi K, Yamaguchi E, Suzuki T, Shimokawa K, Kurosu T, Kawahara M, Oishi K, Ebihara H, Ohmagari N. Efficacy and viral dynamics of tecovirimat in patients with MPOX: A multicenter open-label, double-arm trial in Japan. J Infect Chemother 2024; 30:488-493. [PMID: 38042298 DOI: 10.1016/j.jiac.2023.11.025] [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: 09/01/2023] [Revised: 11/13/2023] [Accepted: 11/26/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION Tecovirimat's application in treating mpox remains under-researched, leaving gaps in clinical and virological understanding. METHODS The Tecopox study in Japan evaluated the efficacy and safety of tecovirimat in patients with smallpox or mpox, who were divided into oral tecovirimat and control groups. Patients with mpox enrolled between June 28, 2022, and April 30, 2023, were included. Demographic and clinical details along with blood, urine, pharyngeal swab, and skin lesion samples were gathered for viral analysis. A multivariable Tobit regression model was employed to identify factors influencing prolonged viral detection. RESULTS Nineteen patients were allocated to the tecovirimat group, and no patients were allocated to the control group. The median age was 38.5 years, and all patients were males. Ten patients (52.6%) were infected with human immunodeficiency virus (HIV). Sixteen patients (84.2%) had severe disease. Nine of the 15 patients (60.0%) (four patients withdrew before day 14) had negative PCR results for skin lesion specimens 14 days after inclusion. The mortality rates were 0% on days 14 and 30. No severe adverse events were reported. HIV status and the number of days from symptom onset to tecovirimat administration were associated with lower Ct values (p = 0.027 and p < 0.001, respectively). The median number of days when PCR testing did not detect the mpox virus in each patient was 19.5 days. CONCLUSION Early tecovirimat administration might reduce viral shedding duration, thereby mitigating infection spread. Moreover, patients infected with HIV showed prolonged viral shedding, increasing the transmission risk compared to those without HIV.
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Affiliation(s)
- Yutaro Akiyama
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Shinichiro Morioka
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan; AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan; Emerging and Reemerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Sendai, Japan.
| | - Shinya Tsuzuki
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan; AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Tomoki Yoshikawa
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Masaya Yamato
- Division of General Internal Medicine and Infectious Diseases, Rinku General Medical Center, Izumisano, Japan
| | - Hideta Nakamura
- Division of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus Graduate School of Medicine, Japan
| | - Masayuki Shimojima
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Mizue Takakusaki
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Sho Saito
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Kozue Takahashi
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Mio Sanada
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Mika Komatsubara
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Kaoru Takebuchi
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Etsuko Yamaguchi
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Tetsuya Suzuki
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan; Emerging and Reemerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Sendai, Japan; Department of Infectious Diseases, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Komei Shimokawa
- Division of Pharmacy, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Takeshi Kurosu
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Madoka Kawahara
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kohei Oishi
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hideki Ebihara
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan; AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
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Olivencia GR, García MV, Arribas MV, Casabona J, Martínez M, De Novales FM. Hospitalization determinants in patients with Mpox disease: The CEME-22 Project. Heliyon 2024; 10:e30564. [PMID: 38756609 PMCID: PMC11096956 DOI: 10.1016/j.heliyon.2024.e30564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024] Open
Abstract
Objectives This sub-analysis seeks to delineate and characterize factors influencing hospitalization in individuals diagnosed with Mpox disease amidst the initial outbreak in Spain in the onset of 2022. Methods Employing a non-probabilistic convenience sampling approach, a retrospective multicenter investigation was carried out to examine Monkeypox virus infection within Spanish healthcare facilities. Results The median duration of the disease was 16 days, with 4.2 % of cases resulting in hospitalization. There was a single ICU admission leading to fatality. Sequelae were observed in 2.3 % of cases. Multivariate analysis revealed that hospitalization decisions were influenced by immunosuppression and severe symptoms, including gastrointestinal, neurological, ear-nose-throat, and respiratory manifestations. Significant analytical parameter differences were restricted to hemoglobin levels at diagnosis. Conclusions This study elucidates factors influencing hospitalization decisions for Monkeypox patients in Spain, emphasizing the importance of immunosuppression and extracutaneous symptoms involving the gastrointestinal, ear-nose-throat, and respiratory pathways. In summary, hospitalization determinations arise from the interplay of these crucial dimensions.
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Affiliation(s)
| | | | | | - J. Casabona
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Spain
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Taha AM, Elrosasy A, Mahmoud AM, Saed SAA, Moawad WAET, Hamouda E, Nguyen D, Tran VP, Pham HT, Sah S, Barboza JJ, Sah R. The effect of HIV and mpox co-infection on clinical outcomes: Systematic review and meta-analysis. HIV Med 2024. [PMID: 38443319 DOI: 10.1111/hiv.13622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/05/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Co-infection with HIV and mpox is a significant issue for public health because of the potential combined impact on clinical outcomes. However, the existing literature lacks a comprehensive synthesis of the available evidence. The purpose of this meta-analysis is to provide insight into the impact of HIV and mpox co-infection on clinical outcomes. METHODS We systematically searched major electronic databases (PubMed, Embase, Cochrane Central, and Web of Science) for pertinent studies published up to June 2023. Included were studies that described the clinical outcomes of people who had both mpox and HIV. We performed the analysis using OpenMeta and STATA 17 software. RESULTS With an overall number of participants of 35 207, 21 studies that met the inclusion criteria were considered. The greatest number of the studies (n = 10) were cohort designs, with three being cross-sectional and eight being case series studies. The meta-analysis found that people who had both HIV and mpox had a higher hospitalization rate than those who only had mpox (odds ratio [OR] 1.848; 95% confidence interval [CI] 0.918-3.719, p = 0.085, I2 = 60.19%, p = 0.020). Furthermore, co-infected patients had higher mortality rates than those who did not have HIV co-infection (OR 3.887; 95% CI 2.272-6.650, p < 0.001). Meta-regression analysis showed that CD4 levels can significantly predict the risk of hospitalization (p = 0.016) and death (p = 0.031). DISCUSSION HIV causes immunosuppression, making it difficult for the body to mount an effective immune response against pathogens such as mpox. Individuals who are co-infected are at a higher risk of severe disease and death, according to our findings. Although hospitalization rates did not differ significantly between the two groups, it is critical to prioritize interventions and improve management strategies tailored specifically for people living with HIV. CONCLUSION This meta-analysis provides substantial evidence that HIV and mpox co-infection has a negative impact on clinical outcomes. Co-infected individuals had higher hospitalization and significantly higher mortality rates. These findings highlight the significance of early diagnosis, prompt treatment initiation, and effective management strategies for people living with HIV and mpox.
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Affiliation(s)
| | - Amr Elrosasy
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | | | - Esraa Hamouda
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
- Department of Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Dang Nguyen
- Massachusetts General Hospital, Corrigan Minehan Heart Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Hoang Tran Pham
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Sanjit Sah
- Research Scientist, Global Consortium for Public Health and Research, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, India
- SR Sanjeevani Hospital, Siraha, Nepal
| | | | - Ranjit Sah
- Department of Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, India
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de Sousa D, Volovetska Y, Nunes D, Lemos C, Borges-Costa J, Filipe P. Clinical and Epidemiological Characteristics of Mpox in HIV-Infected and Uninfected Men Who Have Sex with Men: A Retrospective Study in Lisbon. Viruses 2024; 16:225. [PMID: 38400001 PMCID: PMC10892182 DOI: 10.3390/v16020225] [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: 01/07/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
The resurgence of Mpox, predominantly among men who have sex with men (MSM), has prompted an analysis of its clinical manifestations and epidemiological patterns, particularly in individuals living with human immunodeficiency virus (HIV). This retrospective study aims to delineate and compare the clinical presentations and epidemiological characteristics of Mpox among HIV-positive and HIV-negative individuals. A total of 58 confirmed Mpox cases from a dermatology department in Lisbon were analyzed, focusing on mucocutaneous manifestations, systemic symptoms, and laboratory parameters. Our findings indicate no significant difference in disease severity and presentation between HIV-positive and HIV-negative groups, suggesting that HIV status may not be a determinant of Mpox severity, but rather an indicator of increased sexual risk behaviors, a recognized risk factor for Mpox transmission.
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Affiliation(s)
- Diogo de Sousa
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte, 1349-008 Lisbon, Portugal
| | - Yuliya Volovetska
- Clinical Pathology Department, Centro Hospitalar Universitário Lisboa Norte, 1349-008 Lisbon, Portugal
| | - Daniel Nunes
- Clinical Pathology Department, Centro Hospitalar Universitário Lisboa Norte, 1349-008 Lisbon, Portugal
| | - Carlos Lemos
- Clinical Pathology Department, Centro Hospitalar Universitário Lisboa Norte, 1349-008 Lisbon, Portugal
| | - João Borges-Costa
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte, 1349-008 Lisbon, Portugal
- Dermatology University Clinic, Faculty of Medicine, University of Lisbon, 1169-050 Lisbon, Portugal
- Instituto de Higiene e Medicina Tropical, Nova University of Lisbon, 1349-008 Lisbon, Portugal
| | - Paulo Filipe
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte, 1349-008 Lisbon, Portugal
- Instituto de Higiene e Medicina Tropical, Nova University of Lisbon, 1349-008 Lisbon, Portugal
- Dermatology Research Unit, Instituto de Medicina Molecular, University of Lisbon, 1169-050 Lisbon, Portugal
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Grossegesse M, Stern D, Hofmann N, Surtees R, Kohl C, Michel J, Nitsche A. Serological methods for the detection of antibodies against monkeypox virus applicable for laboratories with different biosafety levels. J Med Virol 2023; 95:e29261. [PMID: 38054557 DOI: 10.1002/jmv.29261] [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: 06/19/2023] [Revised: 10/27/2023] [Accepted: 11/11/2023] [Indexed: 12/07/2023]
Abstract
The monkeypox virus (MPXV) outbreak in 2022 has renewed interest in the detection of antibodies against orthopox viruses (OPXV) and MPXV, as serological methods can aid diagnostics and are key to epidemiological studies. Here three complementary serological methods are described with different strengths to aid the development and evaluation of in-house assays: An immunofluorescence assay (IFA) for specific detection of IgG and IgM, an enzyme-linked immunosorbent assay for higher sample throughput to aid epidemiological studies and a neutralization test to detect virus neutralizing antibodies. As implementation of MPXV-specific diagnostics is often hampered by the requirement for a dedicated biosafety level 3 laboratory (BSL-3), the focus of this study is on biosafety aspects to facilitate safe testing also under BSL-2 conditions. To this aim, it was analyzed whether OPXV, which can be handled under BSL-2 conditions, could be used as less virulent alternatives to MPXV. Furthermore, an inactivation method was established to remove up to five log-steps of infectious virus particles from viraemic sera without compromising antibody detection. The results show that immunological cross-reactivity between OPXV provides an opportunity for the interchangeable usage of different OPXV species in serological assays, enabling MPXV serology outside of BSL-3 facilities.
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Affiliation(s)
- Marica Grossegesse
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens: Highly Pathogenic Viruses (ZBS 1), Berlin, Germany
| | - Daniel Stern
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens: Biological Toxins (ZBS 3), Berlin, Germany
| | - Natalie Hofmann
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens: Highly Pathogenic Viruses (ZBS 1), Berlin, Germany
| | - Rebecca Surtees
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens: Highly Pathogenic Viruses (ZBS 1), Berlin, Germany
| | - Claudia Kohl
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens: Highly Pathogenic Viruses (ZBS 1), Berlin, Germany
| | - Janine Michel
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens: Highly Pathogenic Viruses (ZBS 1), Berlin, Germany
| | - Andreas Nitsche
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens: Highly Pathogenic Viruses (ZBS 1), Berlin, Germany
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