Monkeypox and ocular implications in humans

Ng, Faye Yu Ci; Yeh, Steven; Smit, Derrick; Ng, Oon Tek; Vasoo, Shawn; Curi, André Luiz Land; Agrawal, Rupesh

doi:10.1016/j.jtos.2022.10.005

Cited by 8 publications

(5 citation statements)

References 6 publications

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“…Conjunctivitis, blepharitis, and photophobia are the most commonly reported uncomplicated manifestations. There are also mpox-related symptoms, such as eye redness, frontal headache, periocular and orbital rash, lacrimation and ocular discharge, subconjunctival nodules, and less frequently, keratitis, corneal ulceration, opacification, and perforation [ 126 ]. Ocular manifestations were less common and probably less severe in the current outbreak.…”

Section: Discussionmentioning

confidence: 99%

Demographic, Epidemiologic, and Clinical Characteristics of Human Monkeypox Disease Pre- and Post-2022 Outbreaks: A Systematic Review and Meta-Analysis

et al. 2023

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(1) Background: In early May 2022, an increasing number of human monkeypox (mpox) cases were reported in non-endemic disparate regions of the world, which raised concerns. Here, we provide a systematic review and meta-analysis of mpox-confirmed patients presented in peer-reviewed publications over the 10 years before and during the 2022 outbreak from demographic, epidemiological, and clinical perspectives. (2) Methods: A systematic search was performed for relevant studies published in Pubmed/Medline, Embase, Scopus, and Google Scholar from 1 January 2012 up to 15 February 2023. Pooled frequencies with 95% confidence intervals (CIs) were assessed using the random or fixed effect model due to the estimated heterogeneity of the true effect sizes. (3) Results: Out of 10,163 articles, 67 met the inclusion criteria, and 31 cross-sectional studies were included for meta-analysis. Animal-to-human transmission was dominant in pre-2022 cases (61.64%), but almost all post-2022 reported cases had a history of human contact, especially sexual contact. The pooled frequency of MSM individuals was 93.5% (95% CI 91.0–95.4, I2: 86.60%) and was reported only in post-2022 included studies. The male gender was predominant in both pre- and post-2022 outbreaks, and the mean age of confirmed cases was 29.92 years (5.77–41, SD: 9.38). The most common clinical manifestations were rash, fever, lymphadenopathy, and malaise/fatigue. Proctalgia/proctitis (16.6%, 95% CI 10.3–25.6, I2: 97.76) and anal/perianal lesions (39.8%, 95% CI 30.4–49.9, I2: 98.10) were the unprecedented clinical manifestations during the 2022 outbreak, which were not described before. Genitalia involvement was more common in post-2022 mpox patients (55.6%, 95% CI 51.7–59.4, I2: 88.11). (4) Conclusions: There are speculations about the possibility of changes in the pathogenic properties of the virus. It seems that post-2022 mpox cases experience a milder disease with fewer rashes and lower mortality rates. Moreover, the vast majority of post-2022 cases are managed on an outpatient basis. Our study could serve as a basis for ongoing investigations to identify the different aspects of previous mpox outbreaks and compare them with the current ones.

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Section: Discussionmentioning

confidence: 99%

Demographic, Epidemiologic, and Clinical Characteristics of Human Monkeypox Disease Pre- and Post-2022 Outbreaks: A Systematic Review and Meta-Analysis

et al. 2023

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“…Skin lesions start as macular with its natural evolution to papules, vesicles, and pustules that posteriorly turn into crusts before healing, sometimes mimicking a varicella-zoster rash. 7 Generalized swelling of the lymph nodes has not been commonly seen; however, regional lymphadenopathy is often associated with a skin rash. 5 Ocular Mpox can occur when MPXV is introduced into the eye (eg, from autoinoculation).…”

Section: Discussionmentioning

confidence: 99%

Adjuvant Topical Interferon Alpha 2b for the Treatment of Monkeypox Ocular Manifestations

Arteaga-Rivera,

Vigderovich-Cielak,

Ramirez-Miranda

et al. 2023

Cornea

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Purpose: The aim of this study was to report a case of ocular Mpox that responded favorably to treatment with topical interferon and oral doxycycline. Methods: This is a case report of a previously healthy 24-year-old woman who developed a pustular rash, headache, fever, arthralgia, sore throat, and asthenia 3 weeks before attending to our clinic. Her main complaint at the moment of the visit was pain, photophobia, foreign body sensation, blurred vision, red eye, and discharge on the left eye. The slit-lamp examination of the left eye showed severe conjunctival hyperemia associated with tarsal follicles, 360 degrees ciliary injection, diffuse corneal epithelial edema with white linear epithelial infiltrates, pigmented and nonpigmented keratic precipitates, and two 1-mm peripheral corneal ulcers with white infiltrates, associated with positive fluorescein staining. Anterior chamber cellularity and flare were mildly present. Results: Mpox with ocular manifestations diagnosis was confirmed by real-time quantitative reverse transcription polymerase chain reaction assay (qRT-PCR) testing; samples were taken from corneal, conjunctival, and nasopharynx swab as well as a skin scab. Topical interferon alpha 2b 1 MIU/mL every 6 hours for 1 month and oral doxycycline 100 mg BID were administered along with other medications with consequent decrease of inflammation and malaise symptoms 1 week later, associated with uncorrected visual acuity improvement. Conclusions: Alternative and efficacious treatment options for Mpox ocular manifestations are needed to prevent further disease progression and sequelae in countries with no access to the gold-standard therapy. Topical interferon alpha 2b and oral doxycycline have shown adequate response as shown with this patient.

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“…External manifestations are more common in eye lesions during a monkeypox infection. The eyelids may be severely affected, sometimes unable to open for a few days due to a generalized pustular rash, discharges, and dried secretions [135]. Conjunctival pustules, often accompanied by photophobia, lacrimation, and pain, are also present [136].…”

Section: Ocular Manifestation and Therapymentioning

confidence: 99%

Monkeypox Virus Immune Evasion and Eye Manifestation: Beyond Eyelid Implications

Lucena-Neto,

Falcão,

Vieira-Junior

et al. 2023

Viruses

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Monkeypox virus (MPXV), belonging to the Poxviridae family and Orthopoxvirus genus, is closely related to the smallpox virus. Initial prodromal symptoms typically include headache, fever, and lymphadenopathy. This review aims to detail various ocular manifestations and immune evasion associated with the monkeypox viral infection and its complications, making it appropriate as a narrative review. Common external ocular manifestations of MPXV typically involve a generalized pustular rash, keratitis, discharges, and dried secretions related to conjunctival pustules, photophobia, and lacrimation. Orthopoxviruses can evade host immune responses by secreting proteins that antagonize the functions of host IFNγ, CC and CXC chemokines, IL-1β, and the complement system. One of the most important transcription factors downstream of pattern recognition receptors binding is IRF3, which controls the expression of the crucial antiviral molecules IFNα and IFNβ. We strongly recommend that ophthalmologists include MPXV as part of their differential diagnosis when they encounter similar cases presenting with ophthalmic manifestations such as conjunctivitis, blepharitis, or corneal lesions. Furthermore, because non-vaccinated individuals are more likely to exhibit these symptoms, it is recommended that healthcare administrators prioritize smallpox vaccination for at-risk groups, including very young children, pregnant women, older adults, and immunocompromised individuals, especially those in close contact with MPXV cases.

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Monkeypox and ocular implications in humans

Cited by 8 publications

References 6 publications

Demographic, Epidemiologic, and Clinical Characteristics of Human Monkeypox Disease Pre- and Post-2022 Outbreaks: A Systematic Review and Meta-Analysis

Demographic, Epidemiologic, and Clinical Characteristics of Human Monkeypox Disease Pre- and Post-2022 Outbreaks: A Systematic Review and Meta-Analysis

Adjuvant Topical Interferon Alpha 2b for the Treatment of Monkeypox Ocular Manifestations

Monkeypox Virus Immune Evasion and Eye Manifestation: Beyond Eyelid Implications

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