Mpox: an updated review of dermatological manifestations in the current outbreak

Abstract

Monkeypox (mpox) is a disease caused by a double-stranded DNA orthopoxvirus discovered in 1958. In 2022 an outbreak on an unprecedented scale marked its transition from neglected, zoonotic disease circulating almost exclusively within African borders to sexually transmitted infection (STI) of international concern. Although phylogenetic evidence suggests progressive evolution from the strain associated with the 2018 outbreak in Nigeria, epidemiological links with previous cases are still incompletely elucidated. Clinically, mpox presents with systemic symptoms, such as fever, headache, malaise, and a characteristic cutaneous eruption, similar to that of cognate viruses (e.g., smallpox). Mpox pseudo-pustules evolve through several stages, including umbilication and crusting, and resolve in the span of 2-3 weeks. Disproportionate affection of men that have sex with men, an often localized cutaneous picture and a significant burden in terms of concomitant STIs were the hallmarks setting the 2022 outbreak apart from classic mpox. Investigations into the disease pathogenesis, related immune response, clinical and dermoscopic features, as well as studies aimed at defining novel management strategies, have advanced mpox knowledge considerably. Herein, recent findings on mpox are reviewed, with a keen focus on dermatological manifestations and their implications in the current diagnostic scenario, reinforcing the pivotal role of dermatologists in managing suspect cases and preventing further spread of the contagion.

Comparison of clinical course of Mpox among HIV‐negative and HIV‐positive patients: A 2022 cohort of hospitalized patients in Central Europe

“…Based on the knowledge available to the authors, genetic sequencing of hMPXV1, as well as serological, histopathological, immunohistochemical, and electron microscopy examinations of biological materials have not been performed in Poland. That kind of research could have a significant impact on the understanding of the current and potential future trends of mpox, as well as of other Orthopoxvirus infections 37,38 …”

Monkeypox: An Italian, multicentre study of 104 cases

“…9,10 This is in keeping with the current concept of disease progression, whereby lesions initially form at the site of inoculation, may be followed by the development of systemic symptoms and subsequently disseminate. 3,10 On the contrary, vaccine status appeared to exert some degree of protection against systemic involvement.…”

“…Clinical and epidemiological features proved consistent with those reported in the main series published during the 2022 outbreak. 3 Evidence on the role of HIV status in determining mpox clinical expressivity is conflicting. Indeed, well-controlled HIV does not appear to result in a markedly aggravated clinical picture 3,[7][8][9][10] but may be associated with greater dissemination of lesions.…”

“…3 Evidence on the role of HIV status in determining mpox clinical expressivity is conflicting. Indeed, well-controlled HIV does not appear to result in a markedly aggravated clinical picture 3,[7][8][9][10] but may be associated with greater dissemination of lesions. 4 In the present study, no clear association emerged between HIV status and lesional extent or disease severity, casting doubt on the influence of HIV status on mpox course.…”

“…1,2 Factors associated with disease severity, however, are still incompletely understood. 3 A multicentre, retrospective study was conducted (i) to characterize the epidemiological and clinical features of patients with polymerase chain reaction (PCR)-proven mpox seen from 1 June 2022 to 31 October 2022 across five dermatology referral centres in Italy and (ii) to assess differences in presentation and lesional extent based on factors hypothesized to influence mpox clinical expressivity, including HIV status, 4 oropharyngeal swab positivity on PCR 5 and previous anti-smallpox vaccination. 6 Comparisons of clinical features between groups were performed using chi-square/Fisher's exact tests for categorical variables, as appropriate.…”