Monkeypox in HIV Infected Cases: A Summary on Clinical Presentation of 27 Cases

Mungmunpuntipantip, Rujittika; Wiwanitkit, Viroj

doi:10.3947/ic.2022.0104

Cited by 40 publications

(26 citation statements)

References 7 publications

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“…Mpox can infect HIV-positive individuals independent of CD4+ count [ 17 ]. Classic mpox presents with fever, lymphadenopathy, and generalized skin rash, which is characterized as firm, deep-seated, well-circumscribed, painful, and umbilicated lesions, which can include palms and soles, but in HIV patients, this infection tends to present with a lack of fever and predominant anogenital lesions [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Successful Outcome after Treatment with Cidofovir, Vaccinia, and Extended Course of Tecovirimat in a Newly-Diagnosed HIV Patient with Severe Mpox: A Case Report

Martinez

Frattaroli

et al. 2023

Vaccines

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Purpose: To report a case of severe mpox in a newly diagnosed HIV patient concerning Immune Reconstitution Inflammatory Syndrome (IRIS) and/or tecovirimat resistance and/or tecovirimat resistance and to describe the management approach in the setting of refractory disease. Case: 49-year-old man presented with 2 weeks of perianal lesions. He tested positive for mpox PCR in the emergency room and was discharged home with quarantine instructions. Three weeks later, the patient returned with disseminated firm, nodular lesions in the face, neck, scalp, mouth, chest, back, legs, arms, and rectum, with worsening pain and purulent drainage from the rectum. The patient reported being on 3 days of tecovirimat treatment, which was prescribed by the Florida department of health (DOH). During this admission, he was found to be HIV positive. A pelvic CT scan revealed a 2.5 cm perirectal abscess. Treatment with tecovirimat was continued for 14 days, along with an empiric course of antibiotics for treatment of possible superimposed bacterial infection upon discharge. He was seen in the outpatient clinic and initiated antiretroviral therapy (ART) with TAF/emtricitabine/bictegravir. Two weeks after starting ART, the patient was readmitted for worsening mpox rash and rectal pain. Urine PCR also returned positive for chlamydia, for which the patient was prescribed doxycycline. He was discharged on a second course of tecovirimat and antibiotic therapy. Ten days later, the patient was readmitted for the second time due to worsening symptoms and blockage of the nasal airway from progressing lesions. At this point, there were concerns for tecovirimat resistance, and after discussion with CDC, tecovirimat was reinitiated for the third time, with the addition of Cidofovir and Vaccinia, and showed an improvement in his symptoms. He received three doses of cidofovir and two doses of Vaccinia, and the patient was then discharged to complete 30 days of tecovirimat. Outpatient follow-up showed favorable outcomes and near resolution. Conclusion: We reported a challenging case of worsening mpox after Tecovirimat treatment in the setting of new HIV and ART initiation concerning IRIS vs. Tecovirimat resistance. Clinicians should consider the risk of IRIS and weigh the pros and cons of initiating or delaying ART. In patients not responding to first-line treatment with tecovirimat, resistance testing should be performed, and alternative options should be considered. Future research is needed to establish guidance on the role of Cidofovir and Vaccinia immune globulin and the continuation of tecovirimat for refractory mpox.

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Section: Discussionmentioning

confidence: 99%

Successful Outcome after Treatment with Cidofovir, Vaccinia, and Extended Course of Tecovirimat in a Newly-Diagnosed HIV Patient with Severe Mpox: A Case Report

Martinez

Frattaroli

et al. 2023

Vaccines

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“…In non-HIV infected cases, the patients usually present with generalized skin rash. For the HIV infected cases, there might be the more skin lesion at genital or perinatal areas ( Hammerschlag et al, 2022 ; Mungmunpuntipantip and Wiwanitkit, 2022 ). In a retrospective review of hospital records of 40 human mpox cases from Nigeria, the HIV type 1-coinfected cases showed more prolonged illness, larger lesions, and higher rates of both secondary bacterial skin infections and genital ulcers ( Ogoina et al, 2020 ).…”

Section: High Ratio Of Mpox-hiv Co-infectionmentioning

confidence: 99%

How and when does monkeypox (mpox) transmit: Implications for prevention and treatments

et al. 2023

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“…Sexual transmission has now been well documented, following both the epidemiological evidence and the documentation of the virus on seminal fluids [1,4,5]. Moreover, several Mpox virus infections were also detected among people with HIV (PWH) [1][2][3]5,6]. Since the beginning of the outbreak, the European AIDS Society has raised concerns regarding Mpox among PWH, later discussing on the importance of collecting data regarding clinical outcomes [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

HIV viral load monitoring during monkeypox virus infection among people with HIV

Raccagni

Mileto²,

Galli³

et al. 2023

Aids

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Monkeypox in HIV Infected Cases: A Summary on Clinical Presentation of 27 Cases

Cited by 40 publications

References 7 publications

Successful Outcome after Treatment with Cidofovir, Vaccinia, and Extended Course of Tecovirimat in a Newly-Diagnosed HIV Patient with Severe Mpox: A Case Report

Successful Outcome after Treatment with Cidofovir, Vaccinia, and Extended Course of Tecovirimat in a Newly-Diagnosed HIV Patient with Severe Mpox: A Case Report

How and when does monkeypox (mpox) transmit: Implications for prevention and treatments

HIV viral load monitoring during monkeypox virus infection among people with HIV

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