Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study

In May, 2022, several European countries reported autochthonous cases of monkeypox, which rapidly spread globally. Early reports suggest atypical presentations. We aimed to investigate clinical and virological characteristics of cases of human monkeypox in Spain. This multicentre, prospective, obser...

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Published in:	The Lancet (British edition) 2022-08, Vol.400 (10353), p.661-669
Main Authors:	Tarín-Vicente, Eloy José, Alemany, Andrea, Agud-Dios, Manuel, Ubals, Maria, Suñer, Clara, Antón, Andrés, Arando, Maider, Arroyo-Andrés, Jorge, Calderón-Lozano, Lorena, Casañ, Cristina, Cabrera, José Miguel, Coll, Pep, Descalzo, Vicente, Folgueira, María Dolores, García-Pérez, Jorge N, Gil-Cruz, Elena, González-Rodríguez, Borja, Gutiérrez-Collar, Christian, Hernández-Rodríguez, Águeda, López-Roa, Paula, de los Ángeles Meléndez, María, Montero-Menárguez, Julia, Muñoz-Gallego, Irene, Palencia-Pérez, Sara Isabel, Paredes, Roger, Pérez-Rivilla, Alfredo, Piñana, María, Prat, Nuria, Ramirez, Aída, Rivero, Ángel, Rubio-Muñiz, Carmen Alejandra, Vall, Martí, Acosta-Velásquez, Kevin Stephen, Wang, An, Galván-Casas, Cristina, Marks, Michael, Ortiz-Romero, Pablo L, Mitjà, Oriol
Format:	Article
Language:	eng
Subjects:	Adult Anogenital Bisexuality CD4 antigen Clinical outcomes Cohort analysis Complications Demographics Diagnosis Disease transmission Edema Epidemiology Female Gays & lesbians Gonorrhea HIV HIV Infections Homosexuality, Male Hospitals Human immunodeficiency virus Humans Immunization Infections Laboratories Lesions Male Men Mens health Monkeypox Monkeypox virus Mpox (monkeypox) Observational studies Oropharynx Orthopoxvirus Patients Penis Pharynx Proctitis Prospective Studies Risk analysis Risk factors Serology Sex Sexual and Gender Minorities Sexual Behavior Sexual health Sexually Transmitted Diseases Signs and symptoms Skin Skin diseases Skin lesions Skin tests Smallpox Spain STD Syphilis Tonsillitis Vaccination Vaccines
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Summary:	In May, 2022, several European countries reported autochthonous cases of monkeypox, which rapidly spread globally. Early reports suggest atypical presentations. We aimed to investigate clinical and virological characteristics of cases of human monkeypox in Spain. This multicentre, prospective, observational cohort study was done in three sexual health clinics in Madrid and Barcelona, Spain. We enrolled all consecutive patients with laboratory-confirmed monkeypox from May 11 to June 29, 2022. Participants were offered lesion, anal, and oropharynx swabs for PCR testing. Participant data were collected by means of interviews conducted by dermatologists or specialists in sexually transmitted infections and were recorded using a standard case report form. Outcomes assessed in all participants with a confirmed diagnosis were demographics, smallpox vaccination, HIV status, exposure to someone with monkeypox, travel, mass gathering attendance, risk factors for sexually transmitted infections, sexual behaviour, signs and symptoms on first presentation, virological results at multiple body sites, co-infection with other sexually transmitted pathogens, and clinical outcomes 14 days after the initial presentation. Clinical outcomes were followed up until July 13, 2022. 181 patients had a confirmed monkeypox diagnosis and were enrolled in the study. 166 (92%) identified as gay men, bisexual men, or other men who have sex with men (MSM) and 15 (8%) identified as heterosexual men or heterosexual women. Median age was 37·0 years (IQR 31·0–42·0). 32 (18%) patients reported previous smallpox vaccination, 72 (40%) were HIV-positive, eight (11%) had a CD4 cell count less than 500 cells per μL, and 31 (17%) were diagnosed with a concurrent sexually transmitted infection. Median incubation was 7·0 days (IQR 5·0–10·0). All participants presented with skin lesions; 141 (78%) participants had lesions in the anogenital region, and 78 (43%) in the oral and perioral region. 70 (39%) participants had complications requiring treatment: 45 (25%) had a proctitis, 19 (10%) had tonsillitis, 15 (8%) had penile oedema, six (3%) an abscess, and eight (4%) had an exanthem. Three (2%) patients required hospital admission. 178 (99%) of 180 swabs from skin lesions collected tested positive, as did 82 (70%) of 117 throat swabs. Viral load was higher in lesion swabs than in pharyngeal specimens (mean cycle threshold value 23 [SD 4] vs 32 [6], absolute difference 9 [95% CI 8–10]; p
ISSN:	0140-6736 1474-547X