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Chin B, Um J, Kim MK, Kim HS, Yim HS, Cho HJ, Lim SY, Kim Y, Jeon J, Park JS. Clinical presentation, viral shedding, and neutralizing antibody responses of mpox cases in South Korea: Single center experience. J Clin Virol 2024; 173:105692. [PMID: 38830304 DOI: 10.1016/j.jcv.2024.105692] [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: 01/24/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND A global mpox outbreak occurred in 2022, and a domestic outbreak started in South Korea in April 2023. This study aimed to evaluate the clinical characteristics, viral shedding, and immune response of mpox in South Korea. METHODS Patients hospitalized with mpox in the National Medical Center between September 2022 and June 2023 were included in this study. Oropharyngeal (OP), anogenital lesion (AL), and skin lesion (SL) swabs and blood samples were collected, and monkeypox virus (MPXV) DNA using real-time polymerase chain reaction (RT-PCR) and culture assays were performed. Neutralizing antibodies (NAbs) against MPXV A.2.1, B.1.1, and B.1.3 were detected using plaque reduction neutralization tests. RESULTS Eighteen patients were enrolled, of whom 17 (94.4 %) were male, with a median (IQR) age of 32.5 (24-51) years. While nine (50 %) were HIV-infected individuals, none of them revealed CD4+ counts less than 200 cells/μL. MPXV DNA was detected in 87.3 % and 82.7 % of patient's ALs and SLs, respectively, until 2 weeks after symptom onset. While MPXV was isolated for up to 15 days in all three sample types, the culture positivity decreased to 53.8 % and 42.9 % in ALs and SLs after 10 days, respectively, and 28.6 % and 22.2 %, respectively, after 2 weeks from symptom onset. The NAb titers against MPXV A.2.1 were significantly lower than those against B.1.1 and B.1.3. CONCLUSIONS Infectious MPXV was isolated from various anatomical sites up to 15 days after symptom onset. The MPXV NAb response was varied among different lineages, and this implies limited cross-lineage protection.
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Affiliation(s)
- BumSik Chin
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, South Korea
| | - Jihye Um
- Public Health Research Institute, National Medical Center, Seoul, South Korea; Department of Public Health, Korea University Graduate School, Seoul, South Korea
| | - Min-Kyung Kim
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, South Korea
| | - Hyang Su Kim
- Public Health Research Institute, National Medical Center, Seoul, South Korea
| | - Hong Soon Yim
- Public Health Research Institute, National Medical Center, Seoul, South Korea
| | - Hyee Jin Cho
- Department of Internal Medicine, National Medical Center, Seoul, South Korea
| | - So Yun Lim
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, South Korea
| | - Yeonjae Kim
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, South Korea
| | - Jaehyun Jeon
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, South Korea
| | - Jun-Sun Park
- Public Health Research Institute, National Medical Center, Seoul, South Korea.
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2
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Yang Y, Niu S, Shen C, Yang L, Song S, Peng Y, Xu Y, Guo L, Shen L, Liao Z, Liu J, Zhang S, Cui Y, Chen J, Chen S, Huang T, Wang F, Lu H, Liu Y. Longitudinal viral shedding and antibody response characteristics of men with acute infection of monkeypox virus: a prospective cohort study. Nat Commun 2024; 15:4488. [PMID: 38802350 PMCID: PMC11130326 DOI: 10.1038/s41467-024-48754-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024] Open
Abstract
Understanding of infection dynamics is important for public health measures against monkeypox virus (MPXV) infection. Herein, samples from multiple body sites and environmental fomites of 77 acute MPXV infections (HIV co-infection: N = 42) were collected every two to three days and used for detection of MPXV DNA, surface protein specific antibodies and neutralizing titers. Skin lesions show 100% positivity rate of MPXV DNA, followed by rectum (88.16%), saliva (83.78%) and oropharynx (78.95%). Positivity rate of oropharynx decreases rapidly after 7 days post symptom onset (d.p.o), while the rectum and saliva maintain a positivity rate similar to skin lesions. Viral dynamics are similar among skin lesions, saliva and oropharynx, with a peak at about 6 d.p.o. In contrast, viral levels in the rectum peak at the beginning of symptom onset and decrease rapidly thereafter. 52.66% of environmental fomite swabs are positive for MPXV DNA, with highest positivity rate (69.89%) from air-conditioning air outlets. High seropositivity against A29L (100%) and H3L (94.74%) are detected, while a correlation between IgG endpoint titers and neutralizing titers is only found for A29L. Most indexes are similar between HIV and Non-HIV participants, while HIV and rectitis are associated with higher viral loads in rectum.
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Affiliation(s)
- Yang Yang
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China.
- Guangdong Key Laboratory for Diagnosis and Treatment of Emerging Infectious diseases, Shenzhen, China.
- National Clinical Research Center for Infectious Disease, Shenzhen, China.
| | - Shiyu Niu
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
- Guangdong Key Laboratory for Diagnosis and Treatment of Emerging Infectious diseases, Shenzhen, China
- National Clinical Research Center for Infectious Disease, Shenzhen, China
| | - Chenguang Shen
- BSL-3 Laboratory (Guangdong), Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health; Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Liuqing Yang
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
- Guangdong Key Laboratory for Diagnosis and Treatment of Emerging Infectious diseases, Shenzhen, China
| | - Shuo Song
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
- Guangdong Key Laboratory for Diagnosis and Treatment of Emerging Infectious diseases, Shenzhen, China
| | - Yun Peng
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
- Guangdong Key Laboratory for Diagnosis and Treatment of Emerging Infectious diseases, Shenzhen, China
| | - Yifan Xu
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
- Guangdong Key Laboratory for Diagnosis and Treatment of Emerging Infectious diseases, Shenzhen, China
| | - Liping Guo
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
- Guangdong Key Laboratory for Diagnosis and Treatment of Emerging Infectious diseases, Shenzhen, China
| | - Liang Shen
- Department of Central Laboratory, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Zhonghui Liao
- School of Public Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Jiexiang Liu
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
- Guangdong Key Laboratory for Diagnosis and Treatment of Emerging Infectious diseases, Shenzhen, China
| | - Shengjie Zhang
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
- Guangdong Key Laboratory for Diagnosis and Treatment of Emerging Infectious diseases, Shenzhen, China
| | - Yanxin Cui
- School of Public Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Jiayin Chen
- National Clinical Research Center for Infectious Disease, Shenzhen, China
| | - Si Chen
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
- Guangdong Key Laboratory for Diagnosis and Treatment of Emerging Infectious diseases, Shenzhen, China
| | - Ting Huang
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
- Guangdong Key Laboratory for Diagnosis and Treatment of Emerging Infectious diseases, Shenzhen, China
| | - Fuxiang Wang
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China.
- Guangdong Key Laboratory for Diagnosis and Treatment of Emerging Infectious diseases, Shenzhen, China.
- National Clinical Research Center for Infectious Disease, Shenzhen, China.
| | - Hongzhou Lu
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China.
- Guangdong Key Laboratory for Diagnosis and Treatment of Emerging Infectious diseases, Shenzhen, China.
- National Clinical Research Center for Infectious Disease, Shenzhen, China.
| | - Yingxia Liu
- Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China.
- Guangdong Key Laboratory for Diagnosis and Treatment of Emerging Infectious diseases, Shenzhen, China.
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Malka MS, Parkinson M, Zucker J, McLean JR, Pereira MR, Yin MT, Gunaratne SH. A Prolonged Case of Severe Mpox as an Opportunistic Infection in Advanced AIDS. Cureus 2024; 16:e59947. [PMID: 38854169 PMCID: PMC11161852 DOI: 10.7759/cureus.59947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
The case report discusses a 29-year-old male with advanced HIV who experienced one of the longest, confirmed cases of monkeypox (mpox) infection. Despite treatment with antivirals and supportive care, including intravenous tecovirimat and vaccinia immune globulin, the patient's condition worsened over a six-and-a-half-month period. He suffered from widespread ulcerative, necrotic lesions and multiple complications, including acute kidney injury, multi-drug resistant bacterial infections, and respiratory failure. Despite repeated treatments, including brincidofovir, the patient remained PCR-positive for monkeypox virus (MPXV) with low cycle threshold (Ct) values, indicating active infection. The case underscores the severity of mpox in immunocompromised individuals, particularly those with advanced HIV, and highlights the challenges in managing such cases. The patient's persistently low CD4 count and unsuppressed HIV viral load likely contributed to the inability to clear the virus. The report emphasizes the need for further research to optimize treatment strategies for MPXV infection, especially in people living with HIV.
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Affiliation(s)
| | | | - Jason Zucker
- Infectious Disease, Columbia University, New York, USA
| | | | | | - Michael T Yin
- Infectious Disease, Columbia University Irving Medical Center, New York, USA
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Raccagni AR, Mancon A, Diotallevi S, Lolatto R, Bruzzesi E, Gismondo MR, Castagna A, Mileto D, Nozza S. Monkeypox Virus Neutralizing Antibodies at Six Months from Mpox Infection: Virologic Factors Associated with Poor Immunologic Response. Viruses 2024; 16:681. [PMID: 38793563 PMCID: PMC11125824 DOI: 10.3390/v16050681] [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: 03/27/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
A natural monkeypox virus infection may not induce sufficient neutralizing antibody responses in a subset of healthy individuals. The aim of this study was to evaluate monkeypox virus-neutralizing antibodies six months after infection and to assess the virological factors predictive of a poor immunological response. Antibodies were assessed using a plaque reduction neutralization test at six months from mpox infection; mpox cutaneous, oropharyngeal, and anal swabs, semen, and plasma samples were tested during infection. Overall, 95 people were included in the study; all developed detectable antibodies. People who were positive for the monkeypox virus for more days had higher levels of antibodies when considering all tested samples (p = 0.029) and all swabs (p = 0.005). Mpox cycle threshold values were not predictive of antibody titers. This study found that the overall days of monkeypox virus detection in the body, irrespective of the viral loads, were directly correlated with monkeypox virus neutralizing antibodies at six months after infection.
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Affiliation(s)
- Angelo Roberto Raccagni
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (E.B.); (A.C.); (S.N.)
| | - Alessandro Mancon
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, 20157 Milan, Italy; (A.M.); (M.R.G.); (D.M.)
| | - Sara Diotallevi
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (S.D.); (R.L.)
| | - Riccardo Lolatto
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (S.D.); (R.L.)
| | - Elena Bruzzesi
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (E.B.); (A.C.); (S.N.)
| | - Maria Rita Gismondo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, 20157 Milan, Italy; (A.M.); (M.R.G.); (D.M.)
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, University of Milan, 20157 Milan, Italy
| | - Antonella Castagna
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (E.B.); (A.C.); (S.N.)
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (S.D.); (R.L.)
| | - Davide Mileto
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, 20157 Milan, Italy; (A.M.); (M.R.G.); (D.M.)
| | - Silvia Nozza
- Infectious Diseases Unit, Vita-Salute San Raffaele University, 20132 Milan, Italy; (E.B.); (A.C.); (S.N.)
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (S.D.); (R.L.)
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Anderson M, Hodges A, Luk KC, Olivo A, Forberg K, Meyer TV, Strobel C, Kim M, Toolsie D, Moore NM, Goldstein Y, Rodgers M, Lucic D, Cloherty G. Development and Validation of Three Automated High-Throughput Molecular Tests to Detect Monkeypox Virus Infections. J Infect Dis 2024; 229:S137-S143. [PMID: 37739785 DOI: 10.1093/infdis/jiad406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/08/2023] [Accepted: 09/20/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND The 2022 outbreak of the clade IIb monkeypox virus and subsequent global spread lead to an urgent need for the development of high-throughput, sensitive, and reproducible diagnostic tests. METHODS We developed 3 assays to detect monkeypox virus, 2 (MPXV+ and MPXV) for m2000 RealTime and 1 (MPXV) for Alinity m platforms. Dual targets in E9L and B6R (MPXV+) and J2L and B7R (MPXV) increased mutation resistance. In silico prediction indicates MPXV+ cross-reactivity with orthopox viruses and specific monkeypox virus detection with MPXV. RESULTS m2000 RealTime MPXV+ and MPXV assay sensitivity was determined to be 3.2 plaque-forming units/mL using a reference virus culture diluted into universal transport medium (UTM). Alinity m MPXV lower limit of detection was 200 copies/mL using monkeypox virus plasmids in pooled UTM matrix. m2000 RealTime MPXV+ and MPXV assays were validated with lesion swabs in UTM and 1:1 saliva to UTM mixtures. Commercially available and remnant clinical lesion specimens in UTM were tested with RealTime MPXV+, RealTime MPXV and Alinity m MPXV assays and demonstrated high agreement to known mpox (MPX)-positive specimens. CONCLUSIONS RealTime MPXV+, RealTime MPXV, and Alinity MPXV are high throughput and sensitive assays used for the detection of monkeypox virus. These assays maybe useful during MPX outbreaks.
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Affiliation(s)
- Mark Anderson
- Infectious Disease Research, Abbott Diagnostics Division, Abbott Park, Illinois, USA
- Abbott Pandemic Defense Coalition, Abbott Park, Illinois, USA
| | - Austin Hodges
- Infectious Disease Research, Abbott Diagnostics Division, Abbott Park, Illinois, USA
- Abbott Pandemic Defense Coalition, Abbott Park, Illinois, USA
| | - Ka-Cheung Luk
- Infectious Disease Research, Abbott Diagnostics Division, Abbott Park, Illinois, USA
- Abbott Pandemic Defense Coalition, Abbott Park, Illinois, USA
| | - Ana Olivo
- Infectious Disease Research, Abbott Diagnostics Division, Abbott Park, Illinois, USA
- Abbott Pandemic Defense Coalition, Abbott Park, Illinois, USA
| | - Kenn Forberg
- Infectious Disease Research, Abbott Diagnostics Division, Abbott Park, Illinois, USA
- Abbott Pandemic Defense Coalition, Abbott Park, Illinois, USA
| | - Todd V Meyer
- Infectious Disease Research, Abbott Diagnostics Division, Abbott Park, Illinois, USA
- Abbott Pandemic Defense Coalition, Abbott Park, Illinois, USA
| | - Carolyn Strobel
- Infectious Disease Research, Abbott Diagnostics Division, Abbott Park, Illinois, USA
- Abbott Pandemic Defense Coalition, Abbott Park, Illinois, USA
| | - Mark Kim
- Abbott Molecular Diagnostics, Des Plaines, Illinois, USA
| | - Dan Toolsie
- Abbott Molecular Diagnostics, Des Plaines, Illinois, USA
| | | | | | - Mary Rodgers
- Infectious Disease Research, Abbott Diagnostics Division, Abbott Park, Illinois, USA
- Abbott Pandemic Defense Coalition, Abbott Park, Illinois, USA
| | - Danijela Lucic
- Abbott Molecular Diagnostics, Des Plaines, Illinois, USA
| | - Gavin Cloherty
- Infectious Disease Research, Abbott Diagnostics Division, Abbott Park, Illinois, USA
- Abbott Pandemic Defense Coalition, Abbott Park, Illinois, USA
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Lucero-Obusan C, Oda G, Schirmer P, Edson C, Trevino C, Elbeik T, Holodniy M. Epidemiology of the 2022 Mpox Outbreak in the US Veterans Health Administration. J Infect Dis 2024; 229:S172-S180. [PMID: 38134309 DOI: 10.1093/infdis/jiad600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND In May 2022, mpox cases were reported in nonendemic countries, including the United States. We examined mpox infections in the Veterans Health Administration (VHA). METHODS Mpox diagnostic and whole genome sequencing (WGS) results, demographics, risk factors, hospitalizations, exposures, deaths, and pharmacy and immunization data were obtained from VHA data sources (23 May 2022-31 May 2023). RESULTS Of 1144 Veterans tested, 251 (21.9%) were presumptive positive for nonvariola orthopoxvirus (NVO) or confirmed positive for NVO and Monkeypox virus (MPXV). Incidence rate was 7.5 per 100 000 Veterans in care, with the highest rate observed in Veterans aged 25-34 years (13.83 cases per 100 000). Higher odds of NVO or NVO/MPXV positivity was associated with male sex; non-Hispanic Black race/ethnicity; syphilis or human immunodeficiency virus (HIV) positivity; or genital/rectal sample site, whereas older age and vaccination with JYNNEOS or vaccinia (smallpox) had lower odds. Among 209 with confirmatory testing, 90.4% reported intimate contact and/or an epidemiological link, 84.5% were men who have sex with men (MSM), 24.2% received tecovirimat, and 8.1% were hospitalized with 1 death. Eighty-six sequenced samples had evaluable WGS results. All were clade IIb, representing 10 different lineages from 20 states and the District of Columbia. CONCLUSIONS Mpox affected younger, MSM, non-Hispanic Black, and HIV/syphilis-positive men among US Veterans. Viral diversity was noted across geographic regions. At-risk Veterans would benefit from vaccination and risk reduction strategies for mpox and other sexually transmitted infections.
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Affiliation(s)
- Cynthia Lucero-Obusan
- Public Health National Program Office, US Department of Veterans Affairs, Washington, District of Columbia
- National Public Health Reference Laboratory, US Department of Veterans Affairs, Palo Alto, California
| | - Gina Oda
- Public Health National Program Office, US Department of Veterans Affairs, Washington, District of Columbia
- National Public Health Reference Laboratory, US Department of Veterans Affairs, Palo Alto, California
| | - Patricia Schirmer
- Public Health National Program Office, US Department of Veterans Affairs, Washington, District of Columbia
- National Public Health Reference Laboratory, US Department of Veterans Affairs, Palo Alto, California
| | - Connor Edson
- Public Health National Program Office, US Department of Veterans Affairs, Washington, District of Columbia
- National Public Health Reference Laboratory, US Department of Veterans Affairs, Palo Alto, California
| | - Christina Trevino
- Public Health National Program Office, US Department of Veterans Affairs, Washington, District of Columbia
- National Public Health Reference Laboratory, US Department of Veterans Affairs, Palo Alto, California
| | - Tarek Elbeik
- Public Health National Program Office, US Department of Veterans Affairs, Washington, District of Columbia
- National Public Health Reference Laboratory, US Department of Veterans Affairs, Palo Alto, California
| | - Mark Holodniy
- Public Health National Program Office, US Department of Veterans Affairs, Washington, District of Columbia
- National Public Health Reference Laboratory, US Department of Veterans Affairs, Palo Alto, California
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California
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Shin SU, Jung Y, Kim SE, Kim DM. Case report: atypical presentation of mpox with massive hematochezia and prolonged viral shedding despite tecovirimat treatment. BMC Infect Dis 2024; 24:183. [PMID: 38342913 PMCID: PMC10860225 DOI: 10.1186/s12879-024-09098-2] [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: 09/07/2023] [Accepted: 02/05/2024] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND The outbreak of mpox that occurred between 2022 and 2023 is primarily being transmitted through sexual contact. As of now, there is no consensus on the recommended duration of isolation to prevent sexual transmission of the virus. Moreover, this particular mpox outbreak has presented with distinct complications in comparison to previous occurrences. In this report, we present a case involving severe rectal bleeding from an ulcer in a mpox patient with a history of engaging in receptive sexual contact. CASE PRESENTATION A 30-year-old Korean man presented at the hospital with complaints of fever, multiple skin lesions, and anal pain. Monkeypox virus polymerase chain reaction (PCR) results were positive for skin lesions on the penis and wrist. The patient received a 12-day course of tecovirimat due to anal symptoms and perianal skin lesions. Following isolation for 12 days and after all skin scabs had naturally fallen off, with no new skin lesions emerging for a consecutive 48 hours-conforming to the criteria of the Korean Disease Control and Prevention Agency-the patient was discharged. However, 1 day after discharge, the patient returned to the hospital due to hematochezia. His hemoglobin level had significantly dropped from 14.0 g/dL to 8.2 g/dL. Sigmoidoscopy unveiled a sizable rectal ulceration with exposed blood vessels, prompting the application of hemostasis through metal clipping. Subsequent monkeypox virus real-time PCR conducted on rectal tissue and swabs yielded positive results (with cycle threshold values of 28.48 and 31.23, respectively). An abdominal CT scan exposed a perirectal abscess, for which ampicillin-sulbactam was administered. CONCLUSION This case underscores the importance of monitoring for bleeding complications and confirming the resolution of rectal lesions before discharging patients from isolation, particularly in cases where patients have a history of engaging in receptive sexual contact with men or are presenting with anal symptoms.
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Affiliation(s)
- Sung Un Shin
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Younggon Jung
- Department of Internal Medicine, St. Carollo Hospital, Suncheon, South Korea
| | - Seong Eun Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea.
| | - Dong Min Kim
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, South Korea
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8
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de Lima LF, Barbosa PP, Simeoni CL, de Paula RFDO, Proenca-Modena JL, de Araujo WR. Electrochemical Paper-Based Nanobiosensor for Rapid and Sensitive Detection of Monkeypox Virus. ACS APPLIED MATERIALS & INTERFACES 2023; 15:58079-58091. [PMID: 38063784 DOI: 10.1021/acsami.3c10730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Monkeypox virus (MPXV) infection was classified as a public health emergency of international concern by the World Health Organization (WHO) in 2022, being transmitted between humans by large respiratory droplets, in contact with skin lesions, fomites, and sexually. Currently, there are no available accessible and simple-to-use diagnostic tests that accurately detect MPXV antigens for decentralized and frequent testing. Here, we report an electrochemical biosensor to detect MPXV antigens in saliva and plasma samples within 15 min using accessible materials. The electrochemical system was manufactured onto a paper substrate engraved by a CO2 laser machine, modified with gold nanostructures (AuNS) and a monoclonal antibody, enabling sensitive detection of A29 viral protein. The diagnostic test is based on the use of electrochemical impedance spectroscopy (EIS) and can be run by a miniaturized potentiostat connected to a smartphone. The impedimetric biosensing method presented excellent analytical parameters, enabling the detection of A29 glycoprotein in the concentration ranging from 1 × 10-14 to 1 × 10-7 g mL-1, with a limit of detection (LOD) of 3.0 × 10-16 g mL-1. Furthermore, it enabled the detection of MPXV antigens in the concentration ranging from 1 × 10-1 to 1 × 104 PFU mL-1, with an LOD of 7.8 × 10-3 PFU mL-1. Importantly, no cross-reactivity was observed when our device was tested in the presence of other poxvirus and nonpoxvirus strains, indicating the adequate selectivity of our nanobiosensor for MPXV detection. Collectively, the nanobiosensor presents high greenness metrics associated with the use of a reproducible and large-scale fabrication method, an accessible and sustainable paper substrate, and a low volume of sample (2.5 μL), which could facilitate frequent testing of MPXV at point-of-care (POC).
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Affiliation(s)
- Lucas F de Lima
- Portable Chemical Sensors Lab, Department of Analytical Chemistry, Institute of Chemistry, State University of Campinas - UNICAMP, P.O. Box 6154, 13083-970 Campinas, SP, Brazil
| | - Priscilla P Barbosa
- Laboratory of Emerging Viruses, Department of Genetics, Evolution, Microbiology and Immunology, University of Campinas, Campinas, 13083-862 Campinas, SP, Brazil
- Experimental Medicine Research Cluster, State University of Campinas, Campinas, 13083-862 Campinas, SP, Brazil
| | - Camila L Simeoni
- Laboratory of Emerging Viruses, Department of Genetics, Evolution, Microbiology and Immunology, University of Campinas, Campinas, 13083-862 Campinas, SP, Brazil
- Experimental Medicine Research Cluster, State University of Campinas, Campinas, 13083-862 Campinas, SP, Brazil
| | - Rosemeire F de O de Paula
- Laboratory of Emerging Viruses, Department of Genetics, Evolution, Microbiology and Immunology, University of Campinas, Campinas, 13083-862 Campinas, SP, Brazil
| | - José Luiz Proenca-Modena
- Laboratory of Emerging Viruses, Department of Genetics, Evolution, Microbiology and Immunology, University of Campinas, Campinas, 13083-862 Campinas, SP, Brazil
- Experimental Medicine Research Cluster, State University of Campinas, Campinas, 13083-862 Campinas, SP, Brazil
| | - William R de Araujo
- Portable Chemical Sensors Lab, Department of Analytical Chemistry, Institute of Chemistry, State University of Campinas - UNICAMP, P.O. Box 6154, 13083-970 Campinas, SP, Brazil
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Low SJ, O'Neill MT, Kerry WJ, Krysiak M, Papadakis G, Whitehead LW, Savic I, Prestedge J, Williams L, Cooney JP, Tran T, Lim CK, Caly L, Towns JM, Bradshaw CS, Fairley C, Chow EPF, Chen MY, Pellegrini M, Pasricha S, Williamson DA. Rapid detection of monkeypox virus using a CRISPR-Cas12a mediated assay: a laboratory validation and evaluation study. THE LANCET. MICROBE 2023; 4:e800-e810. [PMID: 37722405 DOI: 10.1016/s2666-5247(23)00148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND The 2022 outbreak of mpox (formerly known as monkeypox) led to the spread of monkeypox virus (MPXV) in over 110 countries, demanding effective disease management and surveillance. As current diagnostics rely largely on centralised laboratory testing, our objective was to develop a simple rapid point-of-care assay to detect MPXV in clinical samples using isothermal amplification coupled with CRISPR and CRISPR-associated protein (Cas) technology. METHODS In this proof-of-concept study, we developed a portable isothermal amplification CRISPR-Cas12a-based assay for the detection of MPXV. We designed a panel of 22 primer-guide RNA sets using pangenome and gene-agnostic approaches, and subsequently shortlisted the three sets producing the strongest signals for evaluation of analytical sensitivity and specificity using a fluorescence-based readout. The set displaying 100% specificity and the lowest limit of detection (LOD) was selected for further assay validation using both a fluorescence-based and lateral-flow readout. Assay specificity was confirmed using a panel of viral and bacterial pathogens. Finally, we did a blind concordance study on genomic DNA extracted from 185 clinical samples, comparing assay results with a gold-standard quantitative PCR (qPCR) assay. We identified the optimal time to detection and analysed the performance of the assay relative to qPCR using receiver operating characteristic (ROC) curves. We also assessed the compatibility with lateral-flow strips, both visually and computationally, where strips were interpreted blinded to the fluorescence results on the basis of the presence or absence of test bands. FINDINGS With an optimal run duration of approximately 45 min from isothermal amplification to CRISPR-assay readout, the MPXV recombinase polymerase amplification CRISPR-Cas12a-based assay with the selected primer-guide set had an LOD of 1 copy per μL and 100% specificity against tested viral pathogens. Blinded concordance testing of 185 clinical samples resulted in 100% sensitivity (95% CI 89·3-100) and 99·3% specificity (95% CI 95·7-100) using the fluorescence readout. For optimal time to detection by fluorescence readout, we estimated the areas under the ROC curve to be 0·98 at 2 min and 0·99 at 4 min. Lateral-flow strips had 100% sensitivity (89·3-100) and 98·6% specificity (94·7-100) with both visual and computational assessment. Overall, lateral-flow results were highly concordant with fluorescence-based readouts (179 of 185 tests, 96·8% concordant), with discrepancies associated with low viral load samples. INTERPRETATION Our assay for the diagnosis of mpox displayed good performance characteristics compared with qPCR. Although optimisation of the assay will be required before deployment, its usability and versatility present a potential solution to MPXV detection in low-resource and remote settings, as well as a means of community-based, on-site testing. FUNDING Victorian Medical Research Accelerator Fund and the Australian Government Department of Health.
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Affiliation(s)
- Soo Jen Low
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Matthew T O'Neill
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - William J Kerry
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Marcelina Krysiak
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Georgina Papadakis
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Lachlan W Whitehead
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Ivana Savic
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Jacqueline Prestedge
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Lewis Williams
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - James P Cooney
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Thomas Tran
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Chuan K Lim
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Leon Caly
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Janet M Towns
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Christopher Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Marc Pellegrini
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Shivani Pasricha
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Deborah A Williamson
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia; Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
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Correia C, Alpalhão M, de Sousa D, Vieitez-Frade J, Pelerito A, Cordeiro R, Lopes de Carvalho I, Núncio MS, Ferreira J, Filipe P. Detection of mpox using polymerase chain reaction from the skin and oropharynx over the course of infection: A prospective study. J Am Acad Dermatol 2023; 89:822-823. [PMID: 37295504 DOI: 10.1016/j.jaad.2023.05.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/04/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Catarina Correia
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal; Dermatology University Clinic, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
| | - Miguel Alpalhão
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal; Dermatology University Clinic, Faculty of Medicine, University of Lisbon, Lisbon, Portugal; Dermatology Research Unit (PFilipe Lab), Instituto de Medicina Molecular Joao Lobo Antunes, University of Lisbon, Lisbon, Portugal
| | - Diogo de Sousa
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal; Dermatology University Clinic, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Joana Vieitez-Frade
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal; Dermatology University Clinic, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Ana Pelerito
- Department of Infectious Diseases, Emergency Response and Biopreparedness Unit, National Institute of Health, Lisbon, Portugal
| | - Rita Cordeiro
- Department of Infectious Diseases, Emergency Response and Biopreparedness Unit, National Institute of Health, Lisbon, Portugal
| | - Isabel Lopes de Carvalho
- Department of Infectious Diseases, Emergency Response and Biopreparedness Unit, National Institute of Health, Lisbon, Portugal
| | - Maria Sofia Núncio
- Department of Infectious Diseases, Emergency Response and Biopreparedness Unit, National Institute of Health, Lisbon, Portugal
| | - João Ferreira
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal; Dermatology Research Unit (PFilipe Lab), Instituto de Medicina Molecular Joao Lobo Antunes, University of Lisbon, Lisbon, Portugal
| | - Paulo Filipe
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal; Dermatology University Clinic, Faculty of Medicine, University of Lisbon, Lisbon, Portugal; Dermatology Research Unit (PFilipe Lab), Instituto de Medicina Molecular Joao Lobo Antunes, University of Lisbon, Lisbon, Portugal
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11
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Decousser JW, Romano-Bertrand S, Aho Glele LS, Baron R, Carre Y, Cassier P, Dananche C, Depaix-Champagnac F, Fournier S, Racaud J, Rogues AM, Tamames C, Keita-Perse O, Parneix P, Lavigne T. Healthcare worker protection against mpox contamination: position paper of the French Society for Hospital Hygiene. J Hosp Infect 2023; 140:156-164. [PMID: 37562588 DOI: 10.1016/j.jhin.2023.08.004] [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: 06/25/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
In the context of the recent re-emergence of mpox worldwide, the French Society for Hospital Hygiene (SF2H) performed a literature review of the transmission paths and proposed specific recommendations for healthcare workers (HCWs) caring for patients with suspected or confirmed MPXV. In developed countries, the risk of contamination among HCWs in healthcare facilities seemed to be very low, limited to contamination through needle stick injuries. Two additional contamination cases were reported and not fully explained. Beyond healthcare settings, the analysis of the literature highlighted (i) a main contamination route during sexual intercourse, mainly among men who have sex with men, and (ii) a very low secondary attack rate in other contexts, such as schools or jails. Numerous studies have reported molecular or virus identification on surfaces or in the air surrounding patients, without any association with the low secondary case incidence; moreover, the minimum infectious dose through air or mucosal exposure is still unknown. Owing to the lack of evidence of MPXV respiratory transmission in the healthcare setting, the SF2H recommends the implementation of standard and contact precautions combined with medical/surgical mask use. Owing to the lack of evidence of transcutaneous contamination, the SF2H recommends the use of gloves only if contact with cutaneous lesions or mucous membranes occurs. Regarding the risk of contamination from the environment in healthcare facilities, additional studies must be conducted to investigate this.
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Affiliation(s)
- J-W Decousser
- Equipe Opérationnelle d'Hygiène, Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris, UR DYNAMYC 7380, Faculté de Santé, Univ Paris-Est Créteil (UPEC), Enva, USC ANSES, Créteil, France.
| | - S Romano-Bertrand
- HydroSciences Montpellier, IRD, CNRS, Montpellier University, Hospital Hygiene and Infection Control Department, University Hospital of Montpellier, Montpellier, France
| | - L S Aho Glele
- Epidémiologie et hygiène hospitalière, Centre Hospitalo-Universitaire de Dijon, hôpital d'enfants, Dijon, France
| | - R Baron
- Service Hygiène Hospitalière, Pôle Recherche et Santè Publique, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Y Carre
- CHU de Bordeaux, Pôle de Santé Publique, Infection Control Unit, Bordeaux, France
| | - P Cassier
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, Institut des Agents Infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - C Dananche
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, Service Hygiène, épidémiologie, infectiovigilance et prévention Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| | | | - S Fournier
- Service Prévention du risque infectieux, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - J Racaud
- Service de lutte des infections nosocomiales, Centre Hospitalier Alpes-Leman, Contamine-sur-Arve, France
| | - A-M Rogues
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, CHU Bordeaux, Hygiene Hospitalière, Bordeaux, France
| | - C Tamames
- Service de Prévention et contrôle de l'infection, site Pitié Salpêtrière, Paris, France
| | - O Keita-Perse
- Service d'Epidémiologie et d'Hygiène Hospitalière, Centre Hospitalier Princesse Grace, Monaco
| | - P Parneix
- Nouvelle Aquitaine Healthcare-Associated Infection Control Centre, Bordeaux University Hospital, Bordeaux, France
| | - T Lavigne
- Service d'Hygiène Hospitalière, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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12
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Noy-Porat T, Tamir H, Alcalay R, Rosenfeld R, Epstein E, Cherry L, Achdout H, Erez N, Politi B, Yahalom-Ronen Y, Weiss S, Melamed S, Israely T, Mazor O, Paran N, Makdasi E. Generation of recombinant mAbs to vaccinia virus displaying high affinity and potent neutralization. Microbiol Spectr 2023; 11:e0159823. [PMID: 37737634 PMCID: PMC10581037 DOI: 10.1128/spectrum.01598-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/23/2023] [Indexed: 09/23/2023] Open
Abstract
Members of the Orthopoxvirus genus can cause severe infections in humans. Global vaccination against smallpox, caused by the variola virus, resulted in the eradication of the disease in 1980. Shortly thereafter, vaccination was discontinued, and as a result, a large proportion of the current population is not protected against orthopoxviruses. The concerns that the variola virus or other engineered forms of poxviruses may re-emerge as bioweapons and the sporadic outbreaks of zoonotic members of the family, such as Mpox, which are becoming more frequent and prevalent, also emphasize the need for an effective treatment against orthopoxviruses. To date, the most effective way to prevent or control an orthopoxvirus outbreak is through vaccination. However, the traditional vaccinia-based vaccine may cause severe side effects. Vaccinia immune globulin was approved by the U.S. Food and Drug Administration (FDA) for the treatment of vaccine adverse reactions and was also used occasionally for the treatment of severe orthopoxvirus infections. However, this treatment carries many disadvantages and is also in short supply. Thus, a recombinant alternative is highly needed. In this study, two non-human primates were immunized with live vaccinia virus, producing a robust and diverse antibody response. A phage-display library was constructed based on the animal's lymphatic organs, and a panel of neutralizing monoclonal antibodies (mAbs), recognizing diverse proteins of the vaccinia virus, was selected and characterized. These antibodies recognized both mature virion and enveloped virion forms of the virus and exhibited high affinity and potent in vitro neutralization capabilities. Furthermore, these monoclonal antibodies were able to neutralize Mpox 2018 and 2022 strains, suggesting a potential for cross-species protection. We suggest that a combination of these mAbs has the potential to serve as recombinant therapy both for vaccinia vaccine adverse reactions and for orthopoxvirus infections. IMPORTANCE In this manuscript, we report the isolation and characterization of several recombinant neutralizing monoclonal antibodies (mAbs) identified by screening a phage-display library constructed from lymphatic cells collected from immunized non-human primates. The antibodies target several different antigens of the vaccinia virus, covering both mature virion and extracellular enveloped virion forms of the virus. We document strong evidence indicating that they exhibit excellent affinity to their respective antigens and, most importantly, optimal in vitro neutralization of the virus, which exceeded that of vaccinia immune globulin. Furthermore, we present the ability of these novel isolated mAbs (as well as the sera collected from vaccinia-immunized animals) to neutralize two Mpox strains from the 2018 to 2022 outbreaks. We believe that these antibodies have the potential to be used for the treatment of vaccinia vaccine adverse reactions, for other orthopoxvirus infections, and in cases of unexpected bioterror scenarios.
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Affiliation(s)
- Tal Noy-Porat
- Israel Institute for Biological Research, Ness Ziona, Israel
| | - Hadas Tamir
- Israel Institute for Biological Research, Ness Ziona, Israel
| | - Ron Alcalay
- Israel Institute for Biological Research, Ness Ziona, Israel
| | - Ronit Rosenfeld
- Israel Institute for Biological Research, Ness Ziona, Israel
| | - Eyal Epstein
- Israel Institute for Biological Research, Ness Ziona, Israel
| | - Lilach Cherry
- Israel Institute for Biological Research, Ness Ziona, Israel
| | - Hagit Achdout
- Israel Institute for Biological Research, Ness Ziona, Israel
| | - Noam Erez
- Israel Institute for Biological Research, Ness Ziona, Israel
| | - Boaz Politi
- Israel Institute for Biological Research, Ness Ziona, Israel
| | | | - Shay Weiss
- Israel Institute for Biological Research, Ness Ziona, Israel
| | - Sharon Melamed
- Israel Institute for Biological Research, Ness Ziona, Israel
| | - Tomer Israely
- Israel Institute for Biological Research, Ness Ziona, Israel
| | - Ohad Mazor
- Israel Institute for Biological Research, Ness Ziona, Israel
| | - Nir Paran
- Israel Institute for Biological Research, Ness Ziona, Israel
| | - Efi Makdasi
- Israel Institute for Biological Research, Ness Ziona, Israel
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13
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Kim H, Kwon R, Lee H, Lee SW, Rahmati M, Koyanagi A, Smith L, Kim MS, López Sánchez GF, Elena D, Yeo SG, Shin JI, Cho W, Yon DK. Viral load dynamics and shedding kinetics of mpox infection: a systematic review and meta-analysis. J Travel Med 2023; 30:taad111. [PMID: 37581603 DOI: 10.1093/jtm/taad111] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Viral load dynamics and shedding kinetics are critical factors for studying infectious diseases. However, evidence on the viral dynamics of mpox remains limited and inconclusive. Thus, we aimed to provide a comprehensive understanding of the viral load and viability of the re-emerged mpox virus since 2022. METHODS For this systematic review and meta-analysis, we searched PubMed/MEDLINE, Embase and Google Scholar for published articles that are related to mpox viral dynamics up to April 2023. RESULTS From 19 studies, 880 samples and 1477 specimens were collected. The pooled median Ct values appeared in the following order: skin lesion [Ct value 21.7 (IQR 17.8-25.5)], anorectal [22.3 (16.9-27.6)], saliva [25.9 (22.5-31.1)], oral [29.0 (24.5-32.8)], semen [29.6 (25.9-33.4)], urine [30.5 (24.6-36.4)], pharyngeal [31.9 (26.5-37.3)], urethra [33.0 (28.0-35.0)] and blood [33.2 (30.4-36.1)]. People living with human immunodeficiency virus (HIV) have a lower Ct value in the skin [skin HIV+, 19.2 (18.3-20.0) vs skin HIV-, 25.4 (21.2-29.0)]. From the Ct values and test day since symptom onset, we identified temporal trends of viral load for each specimen type. Changes in the trend were observed at 4 days in saliva, 5 days in blood, 6 days in skin, 7 days in anorectal, urine, semen and pharyngeal and 8 days in the urethra. We determined optimal Ct cutoff values for anorectal (34.0), saliva (27.7) and urethra (33.0) specimens, where a Ct value above each cutoff suggests minimal viral viability. Using these cutoff values, we derived the duration of viable viral isolation in each specific specimen type (anorectal 19 days, saliva 14 days and urethra 14 days). CONCLUSION Skin lesion, anorectal and saliva samples contained the highest viral load. The peak viral load manifests within 4-8 days after symptom onset, and viable virus detection was presumed to cease within 14-19 days from symptom onset in anorectal, saliva and urethral samples.
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Affiliation(s)
- Hakyoung Kim
- Department of Medicine, Kyung Hee University College of Medicine, Seoul 02447, South Korea
| | - Rosie Kwon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul 02447, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul 02447, South Korea
| | - Hojae Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul 02447, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul 02447, South Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon 16419, South Korea
| | - Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad 6815144316, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan 7718897111, Iran
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona 08830, Spain
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | - Min Seo Kim
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Guillermo F López Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia 30120, Spain
| | - Dragioti Elena
- Department of Medical and Health Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping 581 83, Sweden
- Research Laboratory Psychology of Patients, Families, and Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina 45221, Greece
| | - Seung Geun Yeo
- Department of Otolaryngology - Head & Neck Surgery, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul 02447, South Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, South Korea
- Severance Underwood Meta-research Center, Institute of Convergence Science, Yonsei University, Seoul 03722, South Korea
| | - Wonyoung Cho
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul 02447, South Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul 02447, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul 02447, South Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul 02447, South Korea
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Di Bari S, Mondi A, Pinnetti C, Mazzotta V, Carletti F, Matusali G, Vincenti D, Gagliardini R, Santoro R, Fontana C, Maggi F, Girardi E, Vaia F, Antinori A. A Case of Severe Mpox Complicated with Streptococcus pyogenes Sepsis in a Patient with HIV Infection. Pathogens 2023; 12:1073. [PMID: 37764881 PMCID: PMC10534985 DOI: 10.3390/pathogens12091073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Since May 2022, a global outbreak of human Mpox has rapidly spread in non-endemic countries. We report a case of a 34-year-old man admitted to hospital for a six-day history of fever associated with vesiculo-pustular rash involving the face, limbs, trunk and perianal region, lymphadenopathy and severe proctitis and pharyngitis. He was HIV-positive and virologically suppressed by stable antiretroviral therapy. On admission, Mpox virus-specific RT-PCR was positive from multiple samples. Additionally, blood cultures yielded Streptococcus pyogenes, prompting a 14-day-course of penicillin G and clindamycin. Due to the worsening of proctitis along with right ocular mucosa involvement, tecovirimat treatment was started with a rapid improvement in both skin and mucosal involvement. The patient was discharged after 21 days of hospitalization and the complete clinical resolution occurred 38 days after symptom onset. This is a case of Mpox with extensive multi-mucosal (ocular, pharyngeal and rectal) and cutaneous extension and S. pyogenes bacteraemia probably related to bacterial translocation from the skin or oral cavity that was eased by Mpox lesions/inflammation. The HIVinfection, although well controlled by antiretroviral therapy, could have played a role in the severe course of Mpox, suggesting the importance of a prompt antiviral treatment in HIV-positive patients.
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15
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Raccagni AR, Mileto D, Rizzo A, Gismondo MR, Castagna A, Nozza S. Late positivization of oropharyngeal, plasma, anal, semen, and urine specimens which tested negative at the time of mpox diagnosis. Clin Microbiol Infect 2023; 29:1096-1097. [PMID: 37182641 DOI: 10.1016/j.cmi.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/20/2023] [Accepted: 05/06/2023] [Indexed: 05/16/2023]
Affiliation(s)
| | - Davide Mileto
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Luigi Sacco Hospital, Milan, Italy
| | - Alberto Rizzo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Luigi Sacco Hospital, Milan, Italy
| | - Maria Rita Gismondo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Luigi Sacco Hospital, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University, Milan, Italy; Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Nozza
- Vita-Salute San Raffaele University, Milan, Italy; Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
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16
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Cardoso M, Ragan I, Hartson L, Goodrich RP. Emerging Pathogen Threats in Transfusion Medicine: Improving Safety and Confidence with Pathogen Reduction Technologies. Pathogens 2023; 12:911. [PMID: 37513758 PMCID: PMC10383627 DOI: 10.3390/pathogens12070911] [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: 05/24/2023] [Revised: 06/30/2023] [Accepted: 07/02/2023] [Indexed: 07/30/2023] Open
Abstract
Emerging infectious disease threats are becoming more frequent due to various social, political, and geographical pressures, including increased human-animal contact, global trade, transportation, and changing climate conditions. Since blood products for transfusion are derived from donated blood from the general population, emerging agents spread by blood contact or the transfusion of blood products are also a potential risk. Blood transfusions are essential in treating patients with anemia, blood loss, and other medical conditions. However, these lifesaving procedures can contribute to infectious disease transmission, particularly to vulnerable populations. New methods have been implemented on a global basis for the prevention of transfusion transmissions via plasma, platelets, and whole blood products. Implementing proactive pathogen reduction methods may reduce the likelihood of disease transmission via blood transfusions, even for newly emerging agents whose transmissibility and susceptibility are still being evaluated as they emerge. In this review, we consider the Mirasol PRT system for blood safety, which is based on a photochemical method involving riboflavin and UV light. We provide examples of how emerging threats, such as Ebola, SARS-CoV-2, hepatitis E, mpox and other agents, have been evaluated in real time regarding effectiveness of this method in reducing the likelihood of disease transmission via transfusions.
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Affiliation(s)
- Marcia Cardoso
- Terumo BCT, Inc., TERUMO Böood and Cell Technologies, Zaventem, 41 1930 Brussels, Belgium
| | - Izabela Ragan
- Infectious Disease Research Center, Department of Biomedical Science, Colorado State University, Fort Collins, CO 80521, USA
| | - Lindsay Hartson
- Infectious Disease Research Center, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80521, USA
| | - Raymond P Goodrich
- Infectious Disease Research Center, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80521, USA
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17
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Rani I, Satapathy P, Goyal A, Shamim MA, Pal A, Squitti R, Goswami K, Pradhan KB, Rustagi S, Hermis AH, Barboza JJ, Rodriguez-Morales AJ, Sah R, Padhi BK. Viral Loads in Skin Samples of Patients with Monkeypox Virus Infection: A Systematic Review and Meta-Analysis. Viruses 2023; 15:1386. [PMID: 37376686 DOI: 10.3390/v15061386] [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: 04/14/2023] [Revised: 05/11/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
Despite monkeypox (mpox) being a public health emergency, there is limited knowledge about the risk of infectivity from skin viral loads during mpox infection. Thus, the aim of this study was to estimate cutaneous viral loads among mpox patients globally. Several databases, including Cochrane, EBSCOHost, EMBASE, ProQuest, PubMed, Scopus, and Web of Science, and preprint servers were searched concerning skin mpox viral loads in confirmed mpox subjects. In this systematic review and meta-analysis, a total of 331 articles were initially screened after the removal of duplicate entries. A total of nine articles were included in the systematic review and meta-analysis for the overall estimation of viral loads (Ct) using a random-effect model. The pooled cutaneous mpox viral load (lower Ct) was 21.71 (95% CI: 20.68-22.75) with a majority of positivity rates being 100%, highlighting a higher infectivity risk from skin lesions. The current results strongly support that skin mpox viral loads may be a dominant source of rapid transmission during current multi-national outbreaks. This important finding can help in constructing useful measures in relevant health policy.
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Affiliation(s)
- Isha Rani
- Department of Biochemistry, Maharishi Markandeshwar College of Medical Sciences and Research (MMCMSR), Sadopur Ambala 134007, India
- Global Center for Evidence Synthesis, Chandigarh 160036, India
| | | | - Anmol Goyal
- Global Center for Evidence Synthesis, Chandigarh 160036, India
- Department of Community Medicine, Maharishi Markandeshwar College of Medical Sciences and Research (MMCMSR), SadopurAmbala 134007, India
| | - Muhammad Aaqib Shamim
- Global Center for Evidence Synthesis, Chandigarh 160036, India
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Jodhpur 342001, India
| | - Amit Pal
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Kalyani 741250, India
| | - Rosanna Squitti
- Department of Laboratory Science, Research and Development Division, Fatebenefratelli Isola Tiberina, Gemelli Isola, 00186 Rome, Italy
| | - Kalyan Goswami
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Kalyani 741250, India
| | - Keerti Bhusan Pradhan
- Department of Healthcare Management, Chitkara School of Health Sciences, Chitkara University Punjab, Patiala 140401, India
| | | | - Alaa Hamza Hermis
- Nursing Department, Al-Mustaqbal University College, Hillah 51001, Iraq
| | - Joshuan J Barboza
- Escuela de Medicina, Universidad César Vallejo, Trujillo 13007, Peru
| | - Alfonso J Rodriguez-Morales
- Clinical Epidemiology and Biostatistics, School of Medicine, Universidad Científica del Sur, Lima 4861, Peru
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut P.O. Box 36, Lebanon
| | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Kathmandu 44600, Nepal
- Department of Clinical Microbiology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune 411000, India
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune 411018, India
| | - Bijaya K Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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18
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Peris MP, Clusa L, Alonso H, Escolar C, Fortuño B, Rezusta A, Milagro A. Clinical Performance Evaluation of a Rapid Real-Time PCR Assay for Monkeypox Diagnosis: a Retrospective and Comparative Study. Microbiol Spectr 2023; 11:e0051023. [PMID: 37191553 PMCID: PMC10269760 DOI: 10.1128/spectrum.00510-23] [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: 02/03/2023] [Accepted: 04/24/2023] [Indexed: 05/17/2023] Open
Abstract
In an increasingly globalized and interconnected world, the outbreak of an infectious disease in one country can become a worrying health emergency for the whole world. A current example is the 2022 monkeypox virus (mpox) outbreak affecting multiple areas across the world. In this context, strategies to interrupt transmission as soon as possible by identifying cases, clusters, and sources of infection should be developed around the world to prevent these crises. The aim of this retrospective and collaborative study was to perform external clinical validation of the VIASURE monkeypox virus real-time PCR detection kit (CerTest Biotec, Spain) with ready-to-use reagents designed for the rapid detection of mpox. A total of 165 samples with suspected infection were used for this analysis. The standard procedures of the clinical microbiology laboratory of the Miguel Servet University Hospital, using the RealStar Orthopoxvirus PCR kit v1.0 (Altona Diagnostics) and bidirectional Sanger sequencing (STAB VIDA, Caparica, Portugal), were considered reference techniques. Furthermore, a subset of 67 mpox-negative samples and 13 mpox-positive samples were routinely tested for clinical diagnosis of other rash/ulcerative pathologies. Accuracy testing resulted in appropriate clinical validation values, as follows: sensitivity, 1 (95% confidence interval [CI], 0.97 to 1); specificity, 1 (95% CI, 0.98 to 1); positive predictive value, 1 (95% CI, 0.93 to 1); negative predictive value, 1 (95% CI, 0.95 to 1). The strength of agreement between assays was almost perfect. The added value is the useful support for the specific diagnosis of mpox infections due to the diagnostic specificity data obtained. IMPORTANCE Given that a large number of mpox outbreaks have been reported worldwide since 2022 in countries in which the disease is not endemic, the main concern for clinicians and global health systems should be to develop effective, available, and easy-to-implement diagnostic strategies to interrupt mpox transmission as soon as possible. This retrospective study demonstrates the satisfactory clinical parameters of a commercially available molecular diagnostic kit for routine testing for mpox in clinical diagnostic laboratories.
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Affiliation(s)
- María Paz Peris
- Institute for Health Research Aragón, Zaragoza, Spain
- Department of Animal Pathology, Faculty of Veterinary Sciences, University of Zaragoza, Zaragoza, Spain
| | - Laura Clusa
- Institute for Health Research Aragón, Zaragoza, Spain
| | - Henar Alonso
- Department of Microbiology, Pediatrics, Radiology, and Public Health, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Cristina Escolar
- Department of Animal Production and Food Science, Faculty of Veterinary Sciences, University of Zaragoza, Zaragoza, Spain
| | - Blanca Fortuño
- Institute for Health Research Aragón, Zaragoza, Spain
- Miguel Servet University Hospital, Microbiology, Zaragoza, Spain
| | - Antonio Rezusta
- Institute for Health Research Aragón, Zaragoza, Spain
- Miguel Servet University Hospital, Microbiology, Zaragoza, Spain
| | - Ana Milagro
- Institute for Health Research Aragón, Zaragoza, Spain
- Miguel Servet University Hospital, Microbiology, Zaragoza, Spain
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19
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Chauhan RP, Fogel R, Limson J. Overview of Diagnostic Methods, Disease Prevalence and Transmission of Mpox (Formerly Monkeypox) in Humans and Animal Reservoirs. Microorganisms 2023; 11:1186. [PMID: 37317160 DOI: 10.3390/microorganisms11051186] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 06/16/2023] Open
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 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.
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Affiliation(s)
- Ravendra P Chauhan
- Biotechnology Innovation Centre, Rhodes University, Makhanda 6139, Eastern Cape, South Africa
| | - Ronen Fogel
- Biotechnology Innovation Centre, Rhodes University, Makhanda 6139, Eastern Cape, South Africa
| | - Janice Limson
- Biotechnology Innovation Centre, Rhodes University, Makhanda 6139, Eastern Cape, South Africa
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20
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Raccagni AR, Canetti D, Mileto D, Tamburini AM, Candela C, Albarello L, Bracchitta F, Mancon A, Micheli V, Gismondo MR, Castagna A, Nozza S. Two individuals with potential monkeypox virus reinfection. THE LANCET. INFECTIOUS DISEASES 2023; 23:522-524. [PMID: 37031694 PMCID: PMC10079276 DOI: 10.1016/s1473-3099(23)00185-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 04/11/2023]
Affiliation(s)
| | - Diana Canetti
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Davide Mileto
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy
| | - Andrea Marco Tamburini
- Gastrointestinal Surgery Unit, Vita Salute San Raffaele University, Milan, Italy; Gastrointestinal Surgery Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Candela
- Infectious Diseases Unit, Vita Salute San Raffaele University, Milan, Italy
| | - Luca Albarello
- Department of Pathology, Vita Salute San Raffaele University, Milan, Italy; Department of Pathology, San Raffaele Scientific Institute, Milan, Italy
| | - Fiorenza Bracchitta
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy
| | - Alessandro Mancon
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy
| | - Valeria Micheli
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy
| | - Maria Rita Gismondo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy; Department of Biomedical and Clinical Sciences Luigi Sacco University Hospital, University of Milan, Italy
| | - Antonella Castagna
- Infectious Diseases Unit, Vita Salute San Raffaele University, Milan, Italy; Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Nozza
- Infectious Diseases Unit, Vita Salute San Raffaele University, Milan, Italy; Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
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21
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Beeson A, Styczynski A, Hutson CL, Whitehill F, Angelo KM, Minhaj FS, Morgan C, Ciampaglio K, Reynolds MG, McCollum AM, Guagliardo SAJ. Mpox respiratory transmission: the state of the evidence. THE LANCET. MICROBE 2023; 4:e277-e283. [PMID: 36898398 PMCID: PMC9991082 DOI: 10.1016/s2666-5247(23)00034-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/09/2023]
Abstract
The relative contribution of the respiratory route to transmission of mpox (formerly known as monkeypox) is unclear. We review the evidence for respiratory transmission of monkeypox virus (MPXV), examining key works from animal models, human outbreaks and case reports, and environmental studies. Laboratory experiments have initiated MPXV infection in animals via respiratory routes. Some animal-to-animal respiratory transmission has been shown in controlled studies, and environmental sampling studies have detected airborne MPXV. Reports from real-life outbreaks demonstrate that transmission is associated with close contact, and although it is difficult to infer the route of MPXV acquisition in individual case reports, so far respiratory transmission has not been specifically implicated. Based on the available evidence, the likelihood of human-to-human MPXV respiratory transmission appears to be low; however, studies should continue to assess this possibility.
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Affiliation(s)
- Amy Beeson
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ashley Styczynski
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christina L Hutson
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Florence Whitehill
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristina M Angelo
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Faisal S Minhaj
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Clint Morgan
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kaitlyn Ciampaglio
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary G Reynolds
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrea M McCollum
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
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22
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Accordini S, Cordioli M, Pomari E, Tacconelli E, Castilletti C. People with asymptomatic or unrecognised infection potentially contribute to monkeypox virus transmission. THE LANCET. MICROBE 2023; 4:e209. [PMID: 36563704 PMCID: PMC9767644 DOI: 10.1016/s2666-5247(22)00379-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Silvia Accordini
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Maddalena Cordioli
- Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy; Division of Infectious Diseases, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Elena Pomari
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Concetta Castilletti
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy.
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23
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The recent re-emergence of human monkeypox: Would it become endemic beyond Africa? J Infect Public Health 2023; 16:332-340. [PMID: 36680848 PMCID: PMC9846899 DOI: 10.1016/j.jiph.2023.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 01/11/2023] [Accepted: 01/15/2023] [Indexed: 01/19/2023] Open
Abstract
Viral outbreaks still become global health challenges, for instance, influenza A viruses, Japanese encephalitis, Ebola virus, Yellow fever, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since 7 May 2022, another outbreak of monkeypox also has been reported in European countries and the United States. Meanwhile, the monkeypox virus is previously endemic only in the western and central parts of Africa. Monkeypox is a zoonotic disease, although the primary animal reservoir remains unknown. This article concisely reviews the monkeypox virus, its transmission, pathogenesis, and clinical manifestation, its changing global epidemiology before and during the current outbreak, and possible driving factors of the recent outbreak. Furthermore, we also discuss whether the monkeypox virus would become endemic beyond Africa. Even though the available data suggests that human-to-human transmission is currently happening and unconnected clusters exist, many efforts have been made to tackle this outbreak, such as active case detection, contact tracing, isolation, and postexposure vaccination.
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24
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Catala A, Riera J, Fuertes I. [Translated article] Mpox - Formerly Monkey Pox - in Dermatology: A Review of Epidemiologic Features, Clinical Presentation, Diagnosis, and Treatment. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T318-T326. [PMID: 36848956 PMCID: PMC9972588 DOI: 10.1016/j.ad.2023.02.012] [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: 11/23/2022] [Accepted: 01/08/2023] [Indexed: 02/27/2023] Open
Abstract
Mpox is an emerging zoonotic disease that has spread rapidly around the world. It has been declared a public health emergency of international concern by the World Health Organization. This review is an update for dermatologists on the epidemiology, clinical presentation, diagnosis, and treatment of Mpox. The primary mode of transmission in the current outbreak is close physical contact during sexual activity. Although most of the initial cases were reported in men who have sex with men, anyone who has close contact with an infected person or contaminated fomites is at risk. Classic prodromal features of Mpox include subclinical manifestations and a mild rash. Complications are common but rarely require hospitalization. Polymerase chain reaction analysis of mucocutaneous lesions is the test of choice for a definitive diagnosis. In the absence of specific treatments, management focuses on symptomatic relief.
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Affiliation(s)
- A Catala
- Servicio de Dermatología y Venereología, Hospital Clínic, Barcelona, Spain.
| | - J Riera
- Servicio de Dermatología y Venereología, Hospital Clínic, Barcelona, Spain
| | - I Fuertes
- Servicio de Dermatología y Venereología, Hospital Clínic, Barcelona, Spain
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25
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Martins-Filho PR, Menezes Dorea FC, Brito Bezerra GV, Dos Santos CA. Differences in cycle threshold values in RT-PCR tests between children and adults with monkeypox: Results from a community-based cross-sectional study. Travel Med Infect Dis 2023; 52:102560. [PMID: 36822386 PMCID: PMC9951697 DOI: 10.1016/j.tmaid.2023.102560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/25/2023]
Affiliation(s)
| | - Fernanda Cardoso Menezes Dorea
- Government of Sergipe State, Health Foundation Parreiras Horta, Central Laboratory of Public Health (LACEN/SE), Aracaju, Sergipe, Brazil
| | - Gabriela Vasconcelos Brito Bezerra
- Government of Sergipe State, Health Foundation Parreiras Horta, Central Laboratory of Public Health (LACEN/SE), Aracaju, Sergipe, Brazil
| | - Cliomar Alves Dos Santos
- Government of Sergipe State, Health Foundation Parreiras Horta, Central Laboratory of Public Health (LACEN/SE), Aracaju, Sergipe, Brazil
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26
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Elbaz M, Halutz O, Ali Y, Adler A. Diagnosis of Monkeypox infection: Validation of two diagnostic kits for viral detection using RT-PCR. J Virol Methods 2023; 312:114653. [PMID: 36395919 PMCID: PMC9661602 DOI: 10.1016/j.jviromet.2022.114653] [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: 09/06/2022] [Revised: 11/10/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022]
Abstract
Monkeypox virus, a zoonotic Orthopox DNA virus was rarely reported outside of African regions until April 2022. Since then, thousands of cases have been reported worldwide. In order to cope with the increasing need for laboratory diagnosis, the availability of reliable commercial PCR assays is of paramount importance. In this study we compared the diagnostic performance of two commercial real-time (RT)-PCR assays, the Novaplex™ MPXV Assay and the Bio-Speedy® Monkeypox Virus qPCR Kit, for the detection of Monkeypox virus (MPXV) DNA from 154 human samples. These assays were compared to a recently published in-house assay that included a general MPXV target (G2T) and a West African specific target (genericWA). All assays demonstrated 100% specificity. While sensitivity of the Novpalex assay was 100% the sensitivity of the other assays was lower; 94% for the Bio-speedy assay and G2R assay and 88% for the genericWA assay. The sensitivity differences between the methods manifested almost entirely in those pharyngeal samples in which the Ct values were high (≥35). The Novaplex™ MPXV Assay showed higher Ct values compared with the other methods with a median of 27.1 compared with the Bio-Speedy assay (median 15.8, p < 0.001), the G2R assay (median 23.5, p < 0.001) and the genericWA assay (median 23.6, p < 0.001). For all 4 methods, the Ct values were higher in samples taken from oropharynx compared with samples from rectal and pustule swabs.
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Affiliation(s)
- Meital Elbaz
- Infectious disease unit, Tel Aviv Sourasky Medical Center, Israel.
| | - Ora Halutz
- Clinical Microbiology Laboratory, Tel Aviv Sourasky Medical Center, Israel
| | - Yaniv Ali
- Clinical Microbiology Laboratory, Tel Aviv Sourasky Medical Center, Israel
| | - Amos Adler
- Clinical Microbiology Laboratory, Tel Aviv Sourasky Medical Center, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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27
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Colavita F, Mazzotta V, Rozera G, Abbate I, Carletti F, Pinnetti C, Matusali G, Meschi S, Mondi A, Lapa D, Vita S, Minosse C, Aguglia C, Gagliardini R, Specchiarello E, Bettini A, Nicastri E, Girardi E, Vaia F, Antinori A, Maggi F. Kinetics of viral DNA in body fluids and antibody response in patients with acute Monkeypox virus infection. iScience 2023; 26:106102. [PMID: 36748085 PMCID: PMC9893533 DOI: 10.1016/j.isci.2023.106102] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/18/2022] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
We report the follow-up laboratory investigation of three MPXV cases infected in May-June 2022 from diagnosis to disease resolution, monitoring viral shedding in different body fluids and antibody kinetics. Out of 138 non-lesion samples, viral DNA was found in 92.3% saliva, 85.7% semen, 86.2% oropharyngeal swabs, 51.7% plasma, 46.1% stool, and 9.5% urine samples. Viral load quantified by digital PCR widely varied, but tend to be higher in oropharyngeal swabs, saliva, and stool. Replication competent virus was recovered from four out of seventeen samples, including 1 saliva, 1 oropharyngeal swabs, 1 semen, and 1 stool. The analysis of the antibody kinetics revealed that IgM, IgA, and IgG antibodies were detected within two weeks post-symptoms onset for all three patients, with IgG detected early on at day 4-8 and IgM and IgA showing lower titers along the time frame of the study. Antibody levels increased during the second week of illness with IgG reaching high titers.
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Affiliation(s)
- Francesca Colavita
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Valentina Mazzotta
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Gabriella Rozera
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Isabella Abbate
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Fabrizio Carletti
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Carmela Pinnetti
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Giulia Matusali
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy,Corresponding author
| | - Silvia Meschi
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Annalisa Mondi
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Daniele Lapa
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Serena Vita
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Claudia Minosse
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Camilla Aguglia
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Roberta Gagliardini
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Eliana Specchiarello
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Aurora Bettini
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Emanuele Nicastri
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Francesco Vaia
- General Direction, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Andrea Antinori
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Fabrizio Maggi
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy,Corresponding author
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Català A, Riera J, Fuertes I. Mpox - Formerly Monkey Pox - in Dermatology: A Review of Epidemiologic Features, Clinical Presentation, Diagnosis, and Treatment. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:318-326. [PMID: 36682683 PMCID: PMC9854265 DOI: 10.1016/j.ad.2023.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/27/2022] [Accepted: 01/08/2023] [Indexed: 01/22/2023] Open
Abstract
Mpox is an emerging zoonotic disease that has spread rapidly around the world. It has been declared a public health emergency of international concern by the World Health Organization. This review is an update for dermatologists on the epidemiology, clinical presentation, diagnosis, and treatment of Mpox. The primary mode of transmission in the current outbreak is close physical contact during sexual activity. Although most of the initial cases were reported in men who have sex with men, anyone who has close contact with an infected person or contaminated fomites is at risk. Classic prodromal features of Mpox include subclinical manifestations and a mild rash. Complications are common but rarely require hospitalization. Polymerase chain reaction analysis of mucocutaneous lesions is the test of choice for a definitive diagnosis. In the absence of specific treatments, management focuses on symptomatic relief.
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Ragan IK, Hartson LM, Sullivan EJ, Bowen RA, Goodrich RP. Pathogen reduction of monkeypox virus in plasma and whole blood using riboflavin and UV light. PLoS One 2023; 18:e0278862. [PMID: 36662705 PMCID: PMC9857991 DOI: 10.1371/journal.pone.0278862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/25/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Monkeypox virus has recently emerged from endemic foci in Africa and, since October 20, 2022, more than 73,000 human infections have been reported by the CDC from over 100 countries that historically have not reported monkeypox cases. The detection of virus in skin lesions, blood, semen, and saliva of infected patients with monkeypox infections raises the potential for disease transmission via routes that have not been previously documented, including by blood and plasma transfusions. Methods for protecting the blood supply against the threats of newly emerging disease agents exist and include Pathogen Reduction Technologies (PRT) which utilize photochemical treatment processes to inactivate pathogens in blood while preserving the integrity of plasma and cellular components. Such methods have been employed broadly for over 15 years, but effectiveness of these methods under routine use conditions against monkeypox virus has not been reported. STUDY DESIGN AND METHODS Monkeypox virus (strain USA_2003) was used to inoculate plasma and whole blood units that were then treated with riboflavin and UV light (Mirasol Pathogen Reduction Technology System, Terumo BCT, Lakewood, CO). The infectious titers of monkeypox virus in the samples before and after riboflavin + UV treatment were determined by plaque assay on Vero cells. RESULTS The levels of spiked virus present in whole blood and plasma samples exceeded 103 infectious particles per dose, corresponding to greater than 105 DNA copies per mL. Treatment of whole blood and plasma units under standard operating procedures for the Mirasol PRT System resulted in complete inactivation of infectivity to the limits of detection. This is equivalent to a reduction of ≥ 2.86 +/- 0.73 log10 pfu/mL of infectivity in whole blood and ≥ 3.47 +/-0.19 log10 pfu/mL of infectivity in plasma under standard operating conditions for those products. CONCLUSION Based on this data and corresponding studies on infectivity in patients with monkeypox infections, use of Mirasol PRT would be expected to significantly reduce the risk of transfusion transmission of monkeypox.
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Affiliation(s)
- Izabela K. Ragan
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado, United States of America
- Infectious Disease Research Center, Colorado State University, Fort Collins, Colorado, United States of America
| | - Lindsay M. Hartson
- Infectious Disease Research Center, Colorado State University, Fort Collins, Colorado, United States of America
| | - Elizabeth J. Sullivan
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado, United States of America
| | - Richard A. Bowen
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado, United States of America
| | - Raymond P. Goodrich
- Infectious Disease Research Center, Colorado State University, Fort Collins, Colorado, United States of America
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
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Epidemiological, Clinical, and Virological Investigation of the First Four Cases of Monkeypox in Cartagena during the 2022 Outbreak. Pathogens 2023; 12:pathogens12020159. [PMID: 36839431 PMCID: PMC9961119 DOI: 10.3390/pathogens12020159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/20/2023] Open
Abstract
Since early May 2022, numerous cases of Monkeypox (Mpox) have been reported globally in non-endemic areas. However, despite numerous reports worldwide, the epidemiological and genomic information related to the 2022 multi-country outbreak remains scarce in South America. By late June 2022, the first Mpox cases were detected in Colombia. Cartagena is a Colombian Caribbean city with high domestic and international connectivity, and, therefore, is vulnerable to the introduction of the Monkeypox virus (MPXV). This report provides an in-depth description of the epidemiological, clinical, and virological characteristics of the first four cases detected in Cartagena including three cases with no history of recent travel and one imported case. Using various laboratory tools based on PCR, next-generation sequencing, and viral isolation and quantification methods, the MPXV clade IIB was detected and isolated. Importantly, infectious viral particles were identified in lesion swabs collected from all cases and in oropharyngeal swabs collected from two cases. Blood samples tested negative using PCR and isolation. In summary, our work contributes complete genomic, clinical, and epidemiological information that will be useful for a number of studies going forward, and it also documents local information that contributes to our understanding of Mpox at the local level.
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Colavita F, Antinori A, Nicastri E, Focosi D, Girardi E, Vaia F, Maggi F. Monkeypox virus in human body sites and fluids: evidence for transmission. THE LANCET. INFECTIOUS DISEASES 2023; 23:6-8. [PMID: 36183708 PMCID: PMC9534141 DOI: 10.1016/s1473-3099(22)00639-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Francesca Colavita
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Andrea Antinori
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Emanuele Nicastri
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Pisa, Italy
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Francesco Vaia
- General Direction, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
| | - Fabrizio Maggi
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome 00149, Italy
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A complicated case of monkeypox and viral shedding characteristics. J Infect 2023; 86:66-117. [PMID: 36273642 PMCID: PMC9584764 DOI: 10.1016/j.jinf.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 10/16/2022] [Indexed: 02/04/2023]
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Lim CK, Roberts J, Moso M, Liew KC, Taouk ML, Williams E, Tran T, Steinig E, Caly L, Williamson DA. Mpox diagnostics: Review of current and emerging technologies. J Med Virol 2023; 95:e28429. [PMID: 36571266 PMCID: PMC10108241 DOI: 10.1002/jmv.28429] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/12/2022] [Accepted: 12/21/2022] [Indexed: 12/27/2022]
Abstract
Mpox is a zoonotic disease caused by monkeypox virus (MPXV) from the Orthopoxvirus genus. Unprecedented transmission events have led to more than 70 000 cases reported worldwide by October 2022. The change in mpox epidemiology has raised concerns of its ability to establish endemicity beyond its traditional geographical locations. In this review, we discuss the current understanding of mpox virology and viral dynamics that are relevant to mpox diagnostics. A synopsis of the traditional and emerging laboratory technologies useful for MPXV detection and in guiding "elimination" strategies is outlined in this review. Importantly, development in MPXV genomics has rapidly advanced our understanding of the role of viral evolution and adaptation in the current outbreak.
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Affiliation(s)
- Chuan Kok Lim
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jason Roberts
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Moso
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kwee Chin Liew
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mona L Taouk
- Department of Infectious Diseases, Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
| | - Eloise Williams
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas Tran
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
| | - Eike Steinig
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
| | - Leon Caly
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Ann Williamson
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
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Yim HS, Um J, Kim HS, Jeon J, Kim JS, Choi JP, Kim MK, Kim Y, Park JS, Chin B. A Case of Human Mpox with Isolated Perianal Ulcers Development in Convalescent Phase. Infect Chemother 2023; 55:128-132. [PMID: 37021428 PMCID: PMC10079442 DOI: 10.3947/ic.2023.0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
A 35-year-old man who returned from Germany developed fever, generalized pain, severe anal pain, and generalized skin rash, confirmed to be monkeypox (mpox). While he was previously confirmed to be human immunodeficiency virus infected, antiretroviral therapy ensured his immunocompetence. The mpox-related prodromal symptoms disappeared before isolation, and subsequent several vesicular skin lesions healed after admission. While moderate anal pain persisted for a few days, it improved during hospitalization. The mpox virus was no longer detected in samples taken from the upper respiratory tract and skin by polymerase chain reaction upon admission. However, isolated perianal ulcers developed after admission without any other mpox-related symptoms or signs, and a viable mpox virus was isolated from these ulcers. Considering the novel feature of asynchronous mucocutaneous lesion development in the current mpox epidemic, meticulous physical examination of newly developing lesions, especially in anogenital areas, should be performed during mpox management.
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Affiliation(s)
- Hong Soon Yim
- Research Institute for Public Healthcare, National Medical Center, Seoul, Korea
| | - Jihye Um
- Research Institute for Public Healthcare, National Medical Center, Seoul, Korea
| | - Hyang Su Kim
- Research Institute for Public Healthcare, National Medical Center, Seoul, Korea
| | - Jaehyun Jeon
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Jin Seok Kim
- Emerging Infectious Disease Team, Seoul Metropolitan Government Research Institute of Public Health and Environment, Seoul, Korea
| | - Jae-Phil Choi
- Division of Infectious Diseases, Seoul Medical Center, Seoul, Korea
| | - Min-Kyung Kim
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Yeonjae Kim
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Jun-Sun Park
- Research Institute for Public Healthcare, National Medical Center, Seoul, Korea.
| | - BumSik Chin
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea.
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León-Figueroa DA, Barboza JJ, Saldaña-Cumpa HM, Moreno-Ramos E, Bonilla-Aldana DK, Valladares-Garrido MJ, Sah R, Rodriguez-Morales AJ. Detection of Monkeypox Virus according to The Collection Site of Samples from Confirmed Cases: A Systematic Review. Trop Med Infect Dis 2022; 8:tropicalmed8010004. [PMID: 36668911 PMCID: PMC9865842 DOI: 10.3390/tropicalmed8010004] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Due to the rapid evolution of the monkeypox virus, the means by which the monkeypox virus is spread is subject to change. Therefore, the present study aims to analyze the detection of the monkeypox virus according to the collection site of samples from confirmed monkeypox cases. A systematic literature review was performed using PubMed, Scopus, Web of Science, and Embase databases until 5 October 2022. A total of 1022 articles were retrieved using the search strategy. After removing duplicates (n = 566) and examining by title, abstract, and full text, 65 studies reporting monkeypox case reports were included with a detailed description of risk factors, sexually transmitted infections (STIs), site of monkeypox virus-positive specimens, location of skin lesions, and diagnostic test. A total of 4537 confirmed monkeypox cases have been reported, of which 98.72% of the cases were male with a mean age of 36 years, 95.72% had a sexual behavior of being men who have sex with men, and 28.1% had human immunodeficiency virus (HIV). The most frequent locations of lesions in patients diagnosed with monkeypox were: 42.85% on the genitalia and 37.1% in the perianal region. All confirmed monkeypox cases were diagnosed by reverse transcriptase polymerase chain reaction (RT-PCR), and the most frequent locations of samples collected for diagnosis that tested positive for monkeypox virus were: 91.85% from skin lesions, 20.81% from the oropharynx, 3.19% from blood, and 2.43% from seminal fluid. The disease course of the cases with monkeypox was asynchronous, with no severe complications, and most patients did not report specific treatment but simply followed a symptomatic treatment.
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Affiliation(s)
- Darwin A. León-Figueroa
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 15011, Peru
- Centro de Investigación en Atención Primaria en Salud, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | - Joshuan J. Barboza
- Vicerrectorado de Investigación, Universidad Norbert Wiener, Lima 15046, Peru
- Correspondence: ; Tel.: +51-99-2108-520
| | - Hortencia M. Saldaña-Cumpa
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 15011, Peru
- Centro de Investigación en Atención Primaria en Salud, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | | | | | - Mario J. Valladares-Garrido
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 15011, Peru
- Oficina de Epidemiología, Hospital Regional Lambayeque, Chiclayo 14012, Peru
- Facultad de Medicina, Universidad Cesar Vallejo, Piura 20002, Peru
| | - Ranjit Sah
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu 44600, Nepal
- Dr. D.Y Patil Medical College, Hospital and Research Center, Dr. D.Y. Patil Vidyapeeth, Pune 411018, Maharashtra, India
| | - Alfonso J. Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundacion Universitaria Autonoma de las Americas, Pereira 660001, Risaralda, Colombia
- Latin American Network of Monkeypox Virus Research (LAMOVI), Pereira 660003, Risaralda, Colombia
- Master of Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur, Lima 15067, Peru
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut 1102, Lebanon
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Evaluation of Five Buffers for Inactivation of Monkeypox Virus and Feasibility of Virus Detection Using the Panther Fusion® Open Access System. Viruses 2022; 14:v14102227. [PMID: 36298782 PMCID: PMC9610623 DOI: 10.3390/v14102227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/08/2022] [Accepted: 10/08/2022] [Indexed: 11/25/2022] Open
Abstract
Rapid diagnosis is key to containing viral outbreaks. However, for the current monkeypox outbreak the major deterrent to rapid testing is the requirement for higher biocontainment of potentially infectious monkeypox virus specimens. The current CDC guidelines require the DNA extraction process before PCR amplification to be performed under biosafety level 3 unless vaccinated personnel are performing assays. This increases the turn-around time and makes certain laboratories insufficiently equipped to handle specimens from patients with suspected monkeypox infection. We investigated the ability of five commercially available lysis buffers and heat for inactivation of monkeypox virus. We also optimized the use of monkeypox virus in Hologic® Panther Specimen Lysis Buffer for detection of virus in the Panther Fusion® Open Access System using published generic and clade specific monkeypox virus primers and probes.
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Huang B, Zhao H, Song J, Zhao L, Deng Y, Wang W, Lu R, Wang W, Ren J, Ye F, Tian H, Wu G, Ling H, Tan W. Isolation and Characterization of Monkeypox Virus from the First Case of Monkeypox — Chongqing Municipality, China, 2022. China CDC Wkly 2022; 4:1019-1024. [DOI: 10.46234/ccdcw2022.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
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