#Monkeypox Virus Infection in Humans across 16 Countries, NEJM

Authors report 528 infections diagnosed in 16 countries.
75% were White.
41% had human immunodeficiency virus infection
The median age was 38 years.
1/
👇
DOI: 10.1056/NEJMoa2207323 Image
Transmission was suspected to have occurred through sexual activity in 95% of the persons with infection.

Overall, 98% of the persons with infection were gay or bisexual men.
2/

#monkeypox
In this case series, 95% of the persons presented with a rash (with 64% having <10 lesions), 73% had anogenital lesions, and 41% had mucosal lesions (with 54 having a single genital lesion).

3/
#MonkeypoxVirus Image
Most common anatomical sites:
- the anogenital area (73%);
- the trunk, arms, or legs (55%);
- the face (25%); and
- the palms and soles (10%).

Lesions: macular, pustular, vesicular, and crusted lesions, and in multiple phases simultaneously (58% vesiculopustular).
4/
Mucosal lesions, in 41% of the persons.
Oropharyngeal symptoms were reported as the initial symptoms in 26 persons; these symptoms included pharyngitis, odynophagia, epiglottitis, and oral or tonsillar lesions.
5/

#MONKEYPOXSYMPTOMS Image
Involvement of the anorectal mucosa was reported as the presenting symptom in 61 persons; this involvement was associated with anorectal pain, proctitis, tenesmus, or diarrhea (or a combination of these symptoms).
6/

#MONKEYPOXSYMPTOMS Image
Common systemic features preceding the rash included fever (62%), lethargy (41%), myalgia (31%), and headache (27%); lymphadenopathy was also common (reported in 56%).
Concomitant sexually transmitted infections were reported in 109 of 377 persons (29%) who were tested.
7/
Among the 23 persons with a clear exposure history, the median incubation period was 7 days (range, 3 to 20).

#MonkeypoxVirus DNA was detected in 29 of the 32 persons in whom seminal fluid was analyzed.
8/
70 (13%) were hospitalized.

Most frequent reasons for hospitalization:
- pain management, mostly for severe anorectal pain (21 persons)
- soft-tissue superinfection (18)
- pharyngitis limiting oral intake (5)

No deaths were reported.
9/

#monkeypox

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More from @guerreroespejo

Jul 29
51-YO🧔‍♂️alcoholic homeless living with dog in southern France: fever, confusión, a maculopapular rash on the trunk (A), hypotension, disorientation, an eschar on his right shoulder (B), & several tiny black spots
Platelet:⬇️
AST, ALT, GGT, LDH:⬆️
1/

doi.org/10.1086/420747
#MedEd ImageImage
Careful examination: these spots were actually #ticks (a total of 22) attached on the skin; they were removed

During 25 h, he was examined by diferente doctors. Dermatologic examination was woefully incomplete, as often occurs when unhygienic, homeless, &/or drunken patients
2/
All ticks were identified as #Rhipicephalus sanguineus, the brown dog tick, including 1 female (A) and nymphs (B).

MEDITERRANEAN SPOTTED FEVER IN ITS MALIGNANT FORM
3/

doi.org/10.1086/420751
#IDtwitter #dermatolgy ImageImage
Read 5 tweets
Jul 28
Se sugiere que el enigma de la #hepatitis aguda grave de etiología desconocida en #niños lo explica la coinfección con #adenovirus y virus adenoasociado de tipo 2 (AAV2), y con menos frecuencia el virus del herpes 6 (HHV6)
1/
👇
espanol.medscape.com/verarticulo/59…
Dos estudios independientes: Un estudio fue dirigido por la University of Glasgow, en Glasgow, y el otro por el Great Ormond Street Hospital de Londres, ambos en Reino Unido.
2/
Los investigadores del estudio de Glasgow usando secuenciación y PCR, confirmaron la presencia de virus adenoasociado de tipo 2 en el plasma de los 9 casos de hepatitis de inicio agudo y en el hígado de los 4 pacientes analizados.
3/
Read 6 tweets
Jul 28
Mystery #hepatitis cases in #kids linked to unexpected viral suspect

Two preliminary studies finding #adeno-associated viruses in pediatric hepatitis cases suggest a child's genetic background and other virusesall act in concert
1/
👇
science.org/content/articl…
Researchers found high adeno-associated virus 2 (AAV2) levels in the blood or liver cells in 24 of 25 children with unexplained hepatitis.

In a group of kids without this condition, almost none had AAV2, even those with #adenovirus.
2/
The young #hepatitis patients were also much likelier to have a #genetic variant that may make their immune systems overreact to viruses.
3/
Read 7 tweets
Jul 27
A 28-YO👨‍🦰traveling through Africa & Asia: a pruritic, erythematous rash on his back, trunk, buttocks, genitals, & lower limbs; dry cough & wheeze

X-ray: bilateral reticulonodular infiltrates
Eosinophilia
1/

doi.org/10.1093/cid/ci…
#IDtwitter #MedTwitter #dermatology ImageImageImage
CUTANEOUS LARVA MIGRANS (CLM) & LOEFFLER SYNDROME

The “creeping” skin lesions are diagnostic of CLM

The pustular rash across the patient’s buttocks & back is likely secondary to CLM folliculitis—a rarer, but well-described skin manifestation of CLM
2/

#Doctor #MedEd ImageImage
The patient’s cough and chest radiograph findings are characteristic of Loeffler syndrome, a recognized but rare complication of CLM.

CLM is caused by the infective stage larvae of animal hookworms from the family Ancylostomidae.
3/

#MedStudentTwitter #resident Image
Read 7 tweets
Jul 26
42-YO African American man, AIDS, CD4 57 cells/ mm3: 18-mth of progressively multiple papules coalescing into large exophytic nodules & plaques on face, scalp, & neck (A & B); & several lesions in in the groin, penis, & RUE
🔬:?
1/

doi.org/10.1093/cid/ci…
#dermatology #idtwitter ImageImage
GIANT MOLLUSCUM CONTAGIOSUM

Molluscum contagiosum is a benign skin tumor caused by molluscum contagiosum virus.

Lesions >1 cm diameter are known as giant molluscum
2/

#Virology #MedEd #MedTwitter
Well-circumscribed intraepidermal lobules containing molluscum bodies (arrow)
These structures, which are composed of viral particles & cellular debris, are pathognomonic for this condition
Molluscum bodies enlarge and rise to the surface as cells age
3/

#Doctor #dermatologia Image
Read 8 tweets
Jul 16
3 cause of eosinophilic #meningitis:
1⃣Angiostrongylus,
2⃣Baylisascaris, and
3⃣Gnathostomiasis.

#MedEd #IDTwitter
1) Angiostrongylus cantonensis: a common cause of human eosinophilic meningitis (neural angiostrongyliasis) and occasionally ocular disease.

#neurology #IDtwitter #MedTwitter
2) Baylisascaris procyonis, the raccoon roundworm, is a rare but serious cause of neurologic and ocular disease in humans.

#neurology #IDtwitter #MedTwitter
Read 4 tweets

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