Monkeypox outbreak in Genoa, Italy: Clinical, laboratory, histopathologic features, management, and outcome of the infected patients

Abstract

Since May 2022, multiple human Monkeypox cases were identified in nonendemic countries, mainly among men who have sex with men. We aimed to report the features, clinical course, management, and outcome of the Monkeypox cases diagnosed in the Dermatology and Infectious Disease Units of the San Martino Hospital, Genoa, Italy. We performed an observational study of the Monkeypox cases diagnosed from July 1 until August 31, 2022, collecting clinical, laboratory, and histological data. We studied 16 Monkeypox‐infected men (14 homosexual, 2 bisexual) with a median age of 37 years. Three were HIV‐infected. All patients reported multiple sexual partners and/or unprotected sex in the 2 weeks before the diagnosis. Most patients had prodromal signs/symptoms before the appearance of the skin/mucosal eruption, consisting of erythematous papules/vesicles/pustules in the anogenital area, which tended to erode evolving into crusts and ulcers. Lesions were often associated with local and/or systemic symptoms. Histopathology showed overlapping features in all cases: epidermal ulceration and dermal inflammatory infiltrate consisting of lymphocytes and neutrophils with an interstitial and perivascular/peri‐adnexal pattern and endothelial swelling. Concomitant sexually transmitted infections (STIs) (gonococcal/nongonococcal proctitis and anal high‐risk human papillomavirus [HR‐HPV] infection) were frequent. Four patients were hospitalized, and one received specific treatment. The overall outcome was good. At the follow‐up visit, three patients presented skin scars. Our series confirms the features of the current Monkeypox outbreak; however, different from other studies, we found a considerable rate of concomitant STIs, such as anal HR‐HPV infection, that should be kept in mind because this persistent infection is the main cause of anal cancers.

The end of the Monkeypox emergency: Reasons behind the lack of new cases reported in Italy

“…This isolated and not autochthonous case, related to travel abroad, confirms the recent trend of drastic reduction in MPXV diagnoses in Italy. This trend can be related to various factors, 3 first of all, the vaccination campaign that started in Italy in August 2022 with modified vaccinia Ankara-Bavarian Nordic (MVA-BN) vaccine only for individuals at high risk of exposure, including laboratory technicians working with orthopoxviruses and MSM. 4 Another explanation for the drastic reduction of new MPXV diagnoses can be related to herd immunity induced by natural infection.…”

Pan‐microscopic examination of monkeypox virus in trophoblasts cells reveals new insights into virions release through filopodia‐like projections

“…The appearance of lesions accompanied by skin or mouth eruptions and/or pustules (macular, papular, vesicular, or pustular) alters the epithelial cell layers of the skin. The rash first appears as macules, followed by papules, vesicles, and pustules, before crusting over after 7–14 days 2–4 . All the symptoms are often mild, but can also be fatal as in smallpox 1 .…”

Clinical‐epidemiological aspects of the Monkeypox 2022 epidemic: A multicentre study by the Italian SIDeMaST Group of Sexually Transmitted, Infectious and Tropical Diseases

“…7 Screening for STDs is crucial as co-infections are common. 10 The outbreak has substantially declined since September 2022, with only 108 cases identified in the first 4 weeks of 2023. 5 However, sustained vigilance is necessary in case of a resurgence of cases.…”