Clinical characterization of human monkeypox infections in the Democratic Republic of the Congo

Abstract

We describe the results of a prospective observational study of the clinical natural history of human monkeypox virus (MPXV) infections at the remote General Hospital in Kole, DRC (Kole hospital), the rainforest of the Congo River basin of the Democratic Republic of the Congo (DRC) from March 2007 until August 2011. The research was conducted jointly by the Institute National de Recherche Biomedical (INRB) and the US Army Medical Research Institute of Infectious Diseases (USAMRIID). The Kole hospital was one of the two previous WHO Monkeypox (MPX) study sites (1981-1986). The hospital is staffed by the Missionaries of Christ Jesus, a Spanish Order of Catholic Sisters who have continued the treatment of patients with a clinical diagnosis of MPXV infection. Of 244 patients admitted with a clinical diagnosis of MPXV infection, 216 were positive in both the Pan-Orthopox and MPX specific PCR. The cardinal observations of these 216 patients are summarized in this report. There were three deaths (3/216) among these hospitalized patients; fetal death occurred in 4 of 5 (80%) patients who were pregnant at admission. The most common complaints were rash (96.8%), malaise (85.2%), sore throat (78.2%), and lymphadenopathy/adenopathy (57.4%). The most common physical exam findings were MPX rash (99.5%) and lymphadenopathy (98.6%). Age group of less than 5 years had the highest lesion count. Primary household cases tended to have higher lesion counts than secondary or later same household cases. Of the 216 patients, 200 were tested for IgM & IgG antibodies (Abs) to Orthopoxviruses. All 200 patients had anti-orthopoxvirus IgG Abs; whereas 189/200 were positive for IgM. Patients with hypoalbuminemia had a high risk of severe disease. Patients with fatal disease had significantly higher maximum geometric mean values than survivors for the following variables, respectively: viral DNA in blood (DNAemia, p=0.0072); maximum lesion count (p=0.0025); day of admission mean AST and ALT (p=0.0002 and p = 0.0224, respectively, adjusted p-values).

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

“… 23 24 More recently, outbreaks of the West African and Congo Basin clades have affected both adults and children, with male patients being disproportionately represented in some reports in West and Central Africa. 10 22 25 26 In contrast with previous reports, the current cohort comprised men only, and most (99.5%) identified as gay, bisexual, or other men who have sex with men. Only one participant had recently travelled to an endemic region; this study therefore further corroborates ongoing autochthonous transmission within the UK.…”

“… 8 9 Several animal species are susceptible to the infection, and animal to human transmission through handling and ingesting wild game animals has been identified as the primary route of infection in African outbreaks, followed by human to human transmission through close contact with infected individuals. 10 Spread of respiratory droplets and direct contact with skin lesions and scabs have been described as the predominant routes of transmission between humans, but transmission can also occur via fomites. 11 In 2003, the first monkeypox outbreak in the Western hemisphere was reported in 11 people in the United States who had been in close contact with infected prairie dogs.…”

Neurological and psychiatric presentations associated with human monkeypox virus infection: a systematic review and meta-analysis

“…The long-term neurocognitive effects of MPX infection also remain elusive. Pittman and colleagues (2022) 32 reported a case of confusion and lethargy still present at discharge. Given the range of neuropsychiatric effects that occur in a proportion of people after several viral illnesses 48–50 it may be worthwhile ascertaining whether these symptoms persist in MPX.…”

Monkeypox: From Past to Present Outbreak

“…The orthologs of the virulence proteins COP-B7R and BR-203 are present in monkeypox but absent in the variola virus [61]. BR-209 (IL-1 binding protein) are full-length in certain Central African strains and fragmented in others; nevertheless, the variola virus homologue of this gene is absent [62]. The orthologs of COP-C3L (complement control protein), COP-C10L (IL-1 antagonist protein), COP-E3L [interferon (IFN)-resistance protein], and COP-K3L (eIF-2 homolog protein) are absent/fragmented in monkeypox virus but present in full length in variola virus [63].…”