posted 08 Jul, 2022

Describing patient journeys of monkeypox in a developed country, as it is manifested in the current outbreak, as well as rapidly sharing information as a lesson from the early days of the SARS-CoV-2 pandemic....


Tal Patalon1 Galit Perez1 Guy Melamed1 Tamar Wolf1 Sivan Gazit1

Abstract

Describing patient journeys of monkeypox in a developed country, as it is manifested in the current outbreak, as well as rapidly sharing information as a lesson from the early days of the SARS-CoV-2 pandemic.

Case Report

Both patients were Israeli men in their 30s who have sex with men (MSM). Neither had received the smallpox vaccine or anti-viral treatment administered for monkeypox.

Patient 1 had a normal Body Mass Index (BMI), suffered from hemorrhoids, and had a history of Condyloma Acuminatum a year prior to the current infection, followed by inoculation with the human papillomavirus (HPV) vaccine, the last dose of which was administered a month prior to infection. Additionally, he was once infected and twice vaccinated against SARS-CoV-2 roughly a year before diagnosis.

The first reported symptom was a painless sensation of skin textural change in the perianal region, where no visible lesions were detected by a primary care physician (Fig. 1). A day later a clinical picture of viral infection ensued with a low-grade fever of 37.5 degrees Celsius, mild muscle aches and fatigue.

A possible chain of transmission was identified, as Patient 1 reported having unprotected sexual intercourse with his partner up to a day prior to symptom onset, while the partner (who was confirmed for monkeypox several days prior to Patient 1) had previously engaged in unprotected intercourse with a traveler from Europe. No further transmissions were identified, and following diagnosis, Patient 1 practiced self-quarantine and had no other close contacts. ...

... The second case refers to an HIV-positive male, treated with a combination of abacavir, dolutegravir and lamivudine, with a CD4 + T-cell count of over 500 cells/mm3 (normal range 436–1394). Patient 2 also used Apixaban, following a Venous thromboembolism (VTE) event. Similarly to Patient 1, Patient 2 had a normal BMI, and had a history of Condyloma Acuminatum and was administered the human papillomavirus (HPV) vaccine, with the last dose administered several weeks prior to infection.

Malaise, dysuria, penile pruritis and unilateral inguinal lymphadenopathy were the first symptoms to appear, with no definite source of transmission (Fig. 1). Symptoms began two weeks after a reported unprotected intercourse with a traveler from Europe. Over the next two days, a single lesion with central umbilication was identified on the glans penis. On day 4, in light of continuous symptoms and an increase in the number of lesions (from 1 to 10), the patient sought medical attention.

Describing patient journeys of monkeypox in a developed country, as it is manifested in the current outbreak, as well as rapidly sharing information as a lesson from the early days of the SARS-CoV-2 pandemic....