{"id":44245,"date":"2022-10-03T07:23:40","date_gmt":"2022-10-03T07:23:40","guid":{"rendered":"https:\/\/i-base.info\/htb\/?p=44245"},"modified":"2022-11-12T19:56:13","modified_gmt":"2022-11-12T19:56:13","slug":"severe-complication-of-monkeypox-reported-to-the-us-cdc-risks-associated-with-hiv-and-other-causes-of-immunosuppression","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/44245","title":{"rendered":"Severe complication of monkeypox reported to the US CDC: risks associated with HIV and other causes of immunosuppression"},"content":{"rendered":"<div>\n<div>\n<p class=\"HTBsubhead2articletitle\"><strong>Simon Collins, HIV i-Base<\/strong><\/p>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\"><strong><span lang=\"EN-US\"><a href=\"https:\/\/i-base.info\/htb\/wp-content\/uploads\/2022\/06\/typical-MPV-rash-on-hand-2-colour1.png\"><img loading=\"lazy\" decoding=\"async\" class=\" wp-image-43297 alignright\" src=\"https:\/\/i-base.info\/htb\/wp-content\/uploads\/2022\/06\/typical-MPV-rash-on-hand-2-colour1-300x236.png\" alt=\"\" width=\"201\" height=\"160\" \/><\/a>Most cases in the current monkeypox (MPX) outbreak have been upsetting, difficult and are commonly painful, but still generally resolve within 2 to 4 weeks.<\/span><\/strong><\/p>\n<\/div>\n<div>\n<div>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">But there have been reports of extremely serious cases, including penile necrosis, amputation, the need for intensive care and approximately 30 deaths.<\/span><\/p>\n<\/div>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">To highlight the range and severity of complications, the US CDC issued a health alert of cases that had been reported to them until September 2022. [1]<\/span><\/p>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">The alert has particular concerns for people with significant immunosuppression related to HIV and other conditions, especially with low CD4 counts. However, severe cases are also reported in people who are HIV negative.<\/span><\/p>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\">Examples of severe complications included but were not limited to the following conditions.<\/p>\n<\/div>\n<div>\n<ul>\n<li class=\"HTBBODYindent\"><span lang=\"EN-US\">Atypical or persistent rash with coalescing or necrotic lesions, or both, some which have required extensive surgical debridement or amputation of an affected extremity.<\/span><\/li>\n<li class=\"HTBBODYindent\">Lesions on a significant proportion of the total body surface area, which may be associated with oedema and secondary bacterial or fungal infections among other complications.<\/li>\n<li class=\"HTBBODYindent\">Lesions in sensitive areas (including mucosal surfaces such as, oropharynx, urethra, rectum, vagina) resulting in severe pain that interferes with activities of daily living.<\/li>\n<li class=\"HTBBODYindent\">Bowel lesions that are exudative or cause significant tissue oedema, leading to obstruction.<\/li>\n<li class=\"HTBBODYindent\">Severe lymphadenopathy that can be necrotising or obstructing (such as in airways).<\/li>\n<li class=\"HTBBODYindent\">Lesions leading to stricture and scar formation resulting in significant morbidity such as urethral and bowel strictures, phimosis, and facial scarring.<\/li>\n<li class=\"HTBBODYindent\">Involvement of multiple organ systems and associated comorbidities, including:<br \/>\n\u2013 \u00a0 Oropharyngeal lesions inhibiting oral intake.<br \/>\n\u2013 \u00a0 Pulmonary involvement with nodular lesions.<br \/>\n\u2013 \u00a0 Neurologic conditions including encephalitis and transverse myelitis.<br \/>\n\u2013 \u00a0 Cardiac complications including myocarditis and pericardial disease.<br \/>\n\u2013 \u00a0 Ocular conditions including severe conjunctivitis and sight-threatening corneal ulcerations.<br \/>\n\u2013 \u00a0 Urologic involvement including urethritis\u00a0and penile necrosis.<\/li>\n<\/ul>\n<\/div>\n<div>\n<h3 class=\"HTBcommenttitle\"><span lang=\"EN-US\">comment<\/span><\/h3>\n<\/div>\n<div>\n<p class=\"HTBBODYtext\"><strong><span lang=\"EN-US\">Several reports to the MMWR include more details on neurological and ocular complications, including in people living with HIV with very low CD4 counts, sometimes not on ART. [2. 3]<\/span><\/strong><\/p>\n<div>\n<p class=\"HTBBODYtext\"><strong><span lang=\"EN-US\">Neurological complications are also reviewed in a paper in JAMA. [4]<\/span><\/strong><\/p>\n<p><strong>Shortly after this report was first published, two MPX-related deaths were reported from New York, in people who were immunocompromised or who had other underlying health conditions. [5]<\/strong><\/p>\n<p><strong>This shows the urgency of comprehensive vaccination programmes that produce optimum protection, however many shots are shown to be needed.<\/strong><\/p>\n<\/div>\n<\/div>\n<div>\n<p class=\"HTBreference-noindent\"><span lang=\"EN-US\">References<\/span><\/p>\n<\/div>\n<div>\n<ol>\n<li class=\"HTBreference-noindent\"><span lang=\"EN-US\">US CDC Health Advisory. <\/span><span lang=\"EN-US\">Severe Manifestations of Monkeypox among People who are Immunocompromised Due to HIV or Other Conditions<\/span><span lang=\"EN-US\">. (29 September 2022).<br \/>\n<\/span><a href=\"https:\/\/emergency.cdc.gov\/han\/2022\/han00475.asp\">https:\/\/emergency.cdc.gov\/han\/2022\/han00475.asp<\/a><\/li>\n<li class=\"HTBreference-noindent\">Pastula DM et al. Two cases of monkeypox-associated encephalomyelitis \u2014 Colorado and the District of Columbia, July\u2013August 2022. MMWR Morb Mortal Wkly Rep 2022;71:1212\u20131215.<br \/>\n<a href=\"http:\/\/dx.doi.org\/10.15585\/mmwr.mm7138e1\" rel=\"noopener\">http:\/\/dx.doi.org\/10.15585\/mmwr.mm7138e1<\/a><\/li>\n<li class=\"HTBreference-noindent\">Cash-Goldwasser S et al. Ocular monkeypox \u2014 United States, July\u2013September 2022. MMWR Morb Mortal Wkly Rep. ePub: 17 October 2022. DOI:\u00a010.15585\/mmwr.mm7142e1.<br \/>\n<a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/71\/wr\/mm7142e1.htm\">https:\/\/www.cdc.gov\/mmwr\/volumes\/71\/wr\/mm7142e1.htm<\/a><\/li>\n<li class=\"HTBreference-noindent\">Billioux J et al. Neurologic complications of smallpox and monkeypox A review. JAMA Neurol. doi: 10.1001\/jamaneurol.2022.3491. (20 September 2022).<br \/>\n<a href=\"https:\/\/jamanetwork.com\/journals\/jamaneurology\/fullarticle\/2796513\">https:\/\/jamanetwork.com\/journals\/jamaneurology\/fullarticle\/2796513<\/a><\/li>\n<li>\n<p class=\"article-headline\">NBC news. NYC Announces First 2 Monkeypox-Linked Deaths \u2014 and Gives Virus a New Acronym. (21 October 2022).<br \/>\n<a href=\"https:\/\/www.nbcnewyork.com\/news\/local\/2-deaths-in-new-york-city-linked-to-monkeypox-officials-say\/3917779\">https:\/\/www.nbcnewyork.com\/news\/local\/2-deaths-in-new-york-city-linked-to-monkeypox-officials-say\/3917779<\/a><\/p>\n<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<div>\n<ol>\n<li class=\"HTBreference-noindent\"><\/li>\n<\/ol>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Simon Collins, HIV i-Base Most cases in the current monkeypox (MPX) outbreak have been upsetting, difficult and are commonly painful, but still generally resolve within 2 to 4 weeks. But there have been reports of extremely serious cases, including penile &hellip;<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[323],"tags":[],"class_list":["post-44245","post","type-post","status-publish","format-standard","hentry","category-mpox"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/44245","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=44245"}],"version-history":[{"count":14,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/44245\/revisions"}],"predecessor-version":[{"id":44370,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/44245\/revisions\/44370"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=44245"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=44245"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=44245"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}