Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series

BMJ, The - Trang e072410
Aatish Patel1, Julia Bilinska1, Jerry C H Tam1, Dayana Da Silva Fontoura1, Claire Y Mason1, Anna Daunt1, Luke B. Snell1, Jamie Murphy1, Jack Potter1, Cecilia Tuudah1, Rohan Sundramoorthi1, Movin Abeywickrema1, Caitlin Pley1, Vasanth V Naidu1, Gaia Nebbia1, Emma Aarons1, Alina Botgros1, Sam Douthwaite1, Claire van Nispen tot Pannerden1, Helen Winslow1, Aisling Brown1, Daniella Chilton1, Achyuta Nori1
1Guys and St Thomas’ NHS Foundation Trust, London, SE1 7EH, UK

Tóm tắt

AbstractObjectiveTo characterise the clinical features of monkeypox infection in humans.DesignDescriptive case series.SettingA regional high consequences infectious disease centre with associated primary and secondary care referrals, and affiliated sexual health centres in south London between May and July 2022.Participants197 patients with polymerase chain reaction confirmed monkeypox infection.ResultsThe median age of participants was 38 years. All 197 participants were men, and 196 identified as gay, bisexual, or other men who have sex with men. All presented with mucocutaneous lesions, most commonly on the genitals (n=111 participants, 56.3%) or in the perianal area (n=82, 41.6%). 170 (86.3%) participants reported systemic illness. The most common systemic symptoms were fever (n=122, 61.9%), lymphadenopathy (114, 57.9%), and myalgia (n=62, 31.5%). 102/166 (61.5%) developed systemic features before the onset of mucocutaneous manifestations and 64 (38.5%) after (n=4 unknown). 27 (13.7%) presented exclusively with mucocutaneous manifestations without systemic features. 71 (36.0%) reported rectal pain, 33 (16.8%) sore throat, and 31 (15.7%) penile oedema. 27 (13.7%) had oral lesions and 9 (4.6%) had tonsillar signs. 70/195 (35.9%) participants had concomitant HIV infection. 56 (31.5%) of those screened for sexually transmitted infections had a concomitant sexually transmitted infection. Overall, 20 (10.2%) participants were admitted to hospital for the management of symptoms, most commonly rectal pain and penile swelling.ConclusionsThese findings confirm the ongoing unprecedented community transmission of monkeypox virus among gay, bisexual, and other men who have sex with men seen in the UK and many other non-endemic countries. A variable temporal association was observed between mucocutaneous and systemic features, suggesting a new clinical course to the disease. New clinical presentations of monkeypox infection were identified, including rectal pain and penile oedema. These presentations should be included in public health messaging to aid early diagnosis and reduce onward transmission.

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BMJ, The

e072410

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