sharon sanders
Editor-in-Chief & President
Second clinical episode of hMPX virus in a man having sex with men
A 36-year-old man attended our hospital with an 8-day history of two vesiculopustular lesions on his penis (figure); he reported no fever or inguinal lymphadenopathy. The patient had no previous history of note; he had not been immunised against smallpox. Over the past 3 years he said that he regularly took pre-exposure prophylaxis (PrEP) against HIV.
4 weeks before the lesions appeared, the patient reported having condomless penetrative and receptive anal intercourse with approximately 30 male partners. None of his known partners had notified him of having developed similar symptoms.
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97 days after the first consultation, 50 vesicular lesions, associated with very painful inguinal lymphadenopathy, developed over 24 h on the patient's penis (figure); he reported no prodromal symptoms. 2 days later, he developed an influenza-like illness with a fever—temperature 38·5°C—fatigue, myalgias, and headache; the symptoms resolved spontaneously 9 days after onset. Laboratory investigations showed negative HIV serology and HIV-1 RNA PCR was less than 20 copies per mL, but immunoglobulin G against hepatitis A and hepatitis B, Epstein-Barr virus, and cytomegalovirus were positive. PCR on a sample from a penile swab was negative for herpes simplex virus types 1 and 2, and varicella zoster virus, although a concurrent pharyngeal gonorrhoea infection was found. Two hMPX virus PCRs on samples of cutaneous swabs obtained at the second-episode consultation (Ct 30·3) and 7 days later (Ct 33·21) confirmed the diagnosis. During the month preceding the second episode, the patient reported having unprotected sex with approximately 50 male partners from European countries, where he had attended mass gatherings and sex parties.
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In conclusion, we believe our patient was reinfected with a different hMPX. Vaccination may be considered on a case-by-case basis for people at very high risk of repeatedly contracting the disease.
https://www.thelancet.com/journals/l.../fulltext?s=08
- eremy Zeggagh, MD
- Olivier Ferraris, PhD
- Maud Salmona, PhD
- Arnaud Tarantola, PhD
- Prof Jean-Michel Molina, MD
- Prof Constance Delaugerre, PhD
A 36-year-old man attended our hospital with an 8-day history of two vesiculopustular lesions on his penis (figure); he reported no fever or inguinal lymphadenopathy. The patient had no previous history of note; he had not been immunised against smallpox. Over the past 3 years he said that he regularly took pre-exposure prophylaxis (PrEP) against HIV.
4 weeks before the lesions appeared, the patient reported having condomless penetrative and receptive anal intercourse with approximately 30 male partners. None of his known partners had notified him of having developed similar symptoms.
snip
97 days after the first consultation, 50 vesicular lesions, associated with very painful inguinal lymphadenopathy, developed over 24 h on the patient's penis (figure); he reported no prodromal symptoms. 2 days later, he developed an influenza-like illness with a fever—temperature 38·5°C—fatigue, myalgias, and headache; the symptoms resolved spontaneously 9 days after onset. Laboratory investigations showed negative HIV serology and HIV-1 RNA PCR was less than 20 copies per mL, but immunoglobulin G against hepatitis A and hepatitis B, Epstein-Barr virus, and cytomegalovirus were positive. PCR on a sample from a penile swab was negative for herpes simplex virus types 1 and 2, and varicella zoster virus, although a concurrent pharyngeal gonorrhoea infection was found. Two hMPX virus PCRs on samples of cutaneous swabs obtained at the second-episode consultation (Ct 30·3) and 7 days later (Ct 33·21) confirmed the diagnosis. During the month preceding the second episode, the patient reported having unprotected sex with approximately 50 male partners from European countries, where he had attended mass gatherings and sex parties.
more...
In conclusion, we believe our patient was reinfected with a different hMPX. Vaccination may be considered on a case-by-case basis for people at very high risk of repeatedly contracting the disease.
https://www.thelancet.com/journals/l.../fulltext?s=08