CDC - Severe Manifestations of Monkeypox among People who are Immunocompromised Due to HIV or Other Conditions

[Mary Wilson]

September 29, 2022 02:15 PM ET

Summary
The purpose of this Centers for Disease Control and Prevention (CDC) Health Alert Network (HAN) Health Advisory is to inform healthcare providers that

1. Severe manifestations of monkeypox have been observed in the United States in the current outbreak.
2. People who are immunocompromised due to HIV or other conditions are at higher risk for severe manifestations of monkeypox than people who are immunocompetent.
3. Because people with HIV-associated immunocompromise are at risk for severe manifestations of monkeypox, the HIV status of all sexually active adults and adolescents with suspected or confirmed monkeypox should be determined.
4. There are diagnostic and clinical management strategies that may help address severe manifestations of monkeypox. ...

... During the current outbreak, CDC has received reports of people with monkeypox who have severe manifestations of disease, including but not limited to

• Atypical or persistent rash with coalescing or necrotic lesions, or both, some which have required extensive surgical debridement or amputation of an affected extremity.
• Lesions on a significant proportion of the total body surface area, which may be associated with edema and secondary bacterial or fungal infections among other complications.
• Lesions in sensitive areas (including mucosal surfaces such as, oropharynx, urethra, rectum, vagina) resulting in severe pain that interferes with activities of daily living.
• Bowel lesions that are exudative or cause significant tissue edema, leading to obstruction.
• Severe lymphadenopathy that can be necrotizing or obstructing (such as in airways).
• Lesions leading to stricture and scar formation resulting in significant morbidity such as urethral and bowel strictures, phimosis, and facial scarring.
• Involvement of multiple organ systems and associated comorbidities, including:
  • Oropharyngeal lesions inhibiting oral intake
  • Pulmonary involvement with nodular lesions
  • Neurologic conditions including encephalitis and transverse myelitis
  • Cardiac complications including myocarditis and pericardial disease
  • Ocular conditions including severe conjunctivitis and sight-threatening corneal ulcerations
  • Urologic involvement including urethritis and penile necrosis

https://emergency.cdc.gov/han/2022/han00475.asp