Purpose of Review We reviewed the available literature on mpox in People with HIV (PWH). We highlight special considerations of mpox infection related to epidemiology, clinical presentation, diagnostic and treatment considerations, prevention, and public health messaging in PWH. Recent Findings During the 2022 mpox outbreak, PWH were disproportionally impacted worldwide. Recent reports suggest that the disease presentation, management, and prognosis of these patients, especially those with advanced HIV disease, can widely differ from those without HIV-associated immunodeficiency. Summary Mpox can often be mild and resolve on its own in PWH with controlled viremia and higher CD4 counts. However, it can be severe, with necrotic skin lesions and protracted healing; anogenital, rectal, and other mucosal lesions; and disseminated organ systems involvement. Higher rates of healthcare utilization are seen in PWH. Supportive, symptomatic care and single or combination mpox-directed antiviral drugs are commonly used in PWH with severe mpox disease. Data from randomized clinical control trials on the efficacy of therapeutic and preventive tools against mpox among PWH are needed to better guide clinical decisions.

Mpox represents a diagnostic challenge due to varied clinical presentations and multiple mimics. A commercially available multiplex PCR panel accurately detects mpox virus as well as common mimics (HSV, VZV) in clinical specimens and could be used in routine clinical, surveillance, and outbreak settings.

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Background Evaluation for endocarditis is an essential step in the management of patients with Staphylococcus aureus bacteremia (SAB). A common approach, consistent with preeminent national guidelines, is to perform transthoracic echocardiography (TTE) followed by transesophageal echocardiography (TEE) in the majority of patients with SAB. It is unclear how often patient management decisions are influenced by the results of TTE versus TEE. Methods This retrospective chart review of 180 subjects evaluated adult veterans at a single large Veterans Affairs medical center who had SAB and completed both TTE and TEE. Institution-specific guidelines at this medical center, which were in place throughout the study time period, recommended completion of both TTE and TEE for all patients diagnosed with SAB if able to tolerate both studies. The timing of key patient-management decisions was correlated to the timing of each patient’s TTE and TEE. It was then inferred whether each decision would have been informed by TTE alone versus TTE plus subsequent TEE. Management decisions included: initiation of synergistic antibiotics, documentation of antibiotic treatment duration, consultation of specialists such as Cardiology or Cardiac Surgery, and performance of valve surgery. Results Preliminary results show that management decisions were typically not performed until patients had undergone both echocardiography studies. In 18% of patients, management was deemed to be influenced in any capacity following TTE, compared to 91% following both TTE and TEE. Conclusion Our findings question the utility of performing a TTE in patients with SAB who are planned to also undergo a subsequent TEE. Disclosures All Authors: No reported disclosures

Background In patients with Staphylococcus aureus bacteremia (SAB), endocarditis evaluation includes transthoracic echocardiography (TTE) and, in patients at increased risk of endocarditis, subsequent transesophageal echocardiography (TEE). In patients deemed to warrant TEE, it has not been well-studied whether performing TTE prior to TEE influences clinicians’ decision-making. Methods This retrospective case series studied clinician behavior at a large Veterans Affairs medical center regarding the care of adult patients diagnosed with SAB who completed both TTE and TEE (n = 206 episodes of SAB). The timing of key patient management decisions were compared to the timing of the patient’s TTE and TEE. It was inferred whether each management decision could have been informed by TTE alone versus TTE plus subsequent TEE. Management decisions included: documentation of antibiotic treatment duration, initiation of synergistic antibiotics, consultation of relevant specialists, ordering of relevant imaging studies, and performance of valve surgery or cardiac device explanation. Results The primary outcome (any of the above five management decisions taking place) occurred after completion of TTE but prior to TEE in 13 SAB episodes (6.3%). The primary outcome occurred after completion of both TTE and TEE in 178 SAB episodes (86.4%). Documentation of antibiotic treatment duration accounted for the large majority of observed management decisions. Conclusion Among patients with SAB who are deemed to warrant TEE for endocarditis evaluation, TTE results alone rarely prompt clinical management decisions.