Clinical features and management of human monkeypox: a retrospective observational study in the UK.
Clinical features and management of human monkeypox: a retrospective observational study in the UK.
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DOI：
10.1016/s1473-3099(22)00228-6
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发表时间：
2022-08
影响因子：
56.3
通讯作者：
Price, Nicholas M.
中科院分区：
文献类型：
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作者：
Adler, Hugh;Gould, Susan;Hine, Paul;Snell, Luke B.;Wong, Waison;Houlihan, Catherine F.;Osborne, Jane C.;Rampling, Tommy;Beadsworth, Mike Bj;Duncan, Christopher Ja;Dunning, Jake;Fletcher, Tom E.;Hunter, Ewan R.;Jacobs, Michael;Khoo, Saye H.;Newsholme, William;Porter, David;Porter, Robert J.;Ratcliffe, Libuse;Schmid, Matthias L.;Semple, Malcolm G.;Tunbridge, Anne J.;Wingfield, Tom;Price, Nicholas M.
人类猴痘病例很少在西非和中非以外的地区出现。关于病毒动力学或病毒脱落持续时间的数据很少，也没有获得许可的治疗方法。两种口服药物，布林多福韦和替考维玛，已经被批准用于治疗天花，并在动物身上证明了对猴痘的疗效。我们的目的是描述猴痘在高收入环境下的纵向临床过程，以及病毒动力学，以及与新的抗病毒疗法相关的任何不良事件。在这项回顾性观察研究中，我们报告了2018至2021年间在英国被诊断为猴痘的7名患者的临床特征、纵向病毒学发现和对标签外抗病毒药物的反应，这些患者是通过回顾病例笔记确定的。这项研究包括了在利物浦、伦敦和纽卡斯尔的专门的高后果传染病(HCID)中心接受管理的所有患者，这些中心通过一个国家高后果传染病网络进行协调。我们审查了自2018年8月15日至2021年9月10日HCID(机载)网络成立以来的所有病例，确定了7名患者。在这七名患者中，四名是男性，三名是女性。在英国有三名获得性猴痘：一名患者是通过医院感染病毒的卫生保健工作者，一名在国外感染病毒的患者将病毒传播给了他们家庭集群中的一名成年人和儿童。显著的疾病特征包括病毒血症、上呼吸道拭子中持续的猴痘病毒DNA检测、反应性情绪低落，以及一名患者有猴痘病毒PCR阳性的深层组织脓肿。5名患者由于PCR阳性时间延长，隔离时间超过3周(22-39天)。三名患者接受了布伦多福韦(200毫克，每周一次)的治疗，所有患者的肝酶都升高，导致治疗停止。与其他6名患者相比，1名患者接受了Tecovirimat治疗(每天2次，每次600毫克，口服2周)，没有出现不良反应，病毒脱落和患病时间(10天住院)更短。1例患者在出院6周后轻度复发。人类猴痘构成了独特的挑战，即使是对拥有HCID网络的资源充足的卫生保健系统也是如此。皮损消退后上呼吸道病毒DNA长时间脱落对当前的感染预防和控制指南提出了挑战。迫切需要对这种疾病的抗病毒药物进行前瞻性研究。没有。
Cases of human monkeypox are rarely seen outside of west and central Africa. There are few data regarding viral kinetics or the duration of viral shedding and no licensed treatments. Two oral drugs, brincidofovir and tecovirimat, have been approved for treatment of smallpox and have demonstrated efficacy against monkeypox in animals. Our aim was to describe the longitudinal clinical course of monkeypox in a high-income setting, coupled with viral dynamics, and any adverse events related to novel antiviral therapies. In this retrospective observational study, we report the clinical features, longitudinal virological findings, and response to off-label antivirals in seven patients with monkeypox who were diagnosed in the UK between 2018 and 2021, identified through retrospective case-note review. This study included all patients who were managed in dedicated high consequence infectious diseases (HCID) centres in Liverpool, London, and Newcastle, coordinated via a national HCID network. We reviewed all cases since the inception of the HCID (airborne) network between Aug 15, 2018, and Sept 10, 2021, identifying seven patients. Of the seven patients, four were men and three were women. Three acquired monkeypox in the UK: one patient was a health-care worker who acquired the virus nosocomially, and one patient who acquired the virus abroad transmitted it to an adult and child within their household cluster. Notable disease features included viraemia, prolonged monkeypox virus DNA detection in upper respiratory tract swabs, reactive low mood, and one patient had a monkeypox virus PCR-positive deep tissue abscess. Five patients spent more than 3 weeks (range 22–39 days) in isolation due to prolonged PCR positivity. Three patients were treated with brincidofovir (200 mg once a week orally), all of whom developed elevated liver enzymes resulting in cessation of therapy. One patient was treated with tecovirimat (600 mg twice daily for 2 weeks orally), experienced no adverse effects, and had a shorter duration of viral shedding and illness (10 days hospitalisation) compared with the other six patients. One patient experienced a mild relapse 6 weeks after hospital discharge. Human monkeypox poses unique challenges, even to well resourced health-care systems with HCID networks. Prolonged upper respiratory tract viral DNA shedding after skin lesion resolution challenged current infection prevention and control guidance. There is an urgent need for prospective studies of antivirals for this disease. None.