Role of multi-site sampling in the diagnosis of human Monkeypox

Performance of a Novel Real-Time PCR-Based Assay for Rapid Monkeypox Virus Detection in Human Samples

“…To counterbalance the risk of failing to diagnose mpox, clinicians have been increasingly encouraged to collect more than one sample [13][14][15][16], possibly consisting of the triad of lesion, oropharyngeal swab, and blood samples. With the aim to elucidate the diagnostic role of multisite sampling, Rizzo et al [15] analyzed 966 samples (including 252 lesion samples and 278 oropharyngeal swabs among others) from 625 patients with clinical evidence of mpox.…”

“…To counterbalance the risk of failing to diagnose mpox, clinicians have been increasingly encouraged to collect more than one sample [13][14][15][16], possibly consisting of the triad of lesion, oropharyngeal swab, and blood samples. With the aim to elucidate the diagnostic role of multisite sampling, Rizzo et al [15] analyzed 966 samples (including 252 lesion samples and 278 oropharyngeal swabs among others) from 625 patients with clinical evidence of mpox. Similar to this study, but with a larger sample size (we analyzed 168 samples from 40 patients), the authors found that 15 (5.2%) of 286 patients with MPXV-positive samples had a negative lesion sample (though in the presence of vesicles/pustules/crusts); of 15 patients, 11 had MPXV detected in oropharyngeal swab samples (positive alone in 6 patients or positive together with other sample types in 5 patients) and 4 had MPXV only detected in anal samples (2 in the presence of lesions) [15].…”

“…With the aim to elucidate the diagnostic role of multisite sampling, Rizzo et al [15] analyzed 966 samples (including 252 lesion samples and 278 oropharyngeal swabs among others) from 625 patients with clinical evidence of mpox. Similar to this study, but with a larger sample size (we analyzed 168 samples from 40 patients), the authors found that 15 (5.2%) of 286 patients with MPXV-positive samples had a negative lesion sample (though in the presence of vesicles/pustules/crusts); of 15 patients, 11 had MPXV detected in oropharyngeal swab samples (positive alone in 6 patients or positive together with other sample types in 5 patients) and 4 had MPXV only detected in anal samples (2 in the presence of lesions) [15]. While showing the lesion material as the sample yielding the highest positivity rate for MPXV (93.2% positive of samples tested), which was substantially higher than that observed in our study (48.9% positive of samples tested), according to previous evidence [18], Rizzo et al [15] suggested that oropharynx and anus should be sampled, in combination with the material from lesions, in patients with high suspicion for mpox.…”

“…In one of these studies [11], human samples other than skin lesion material, which remains the preferred clinical sample based on the WHO's mpox laboratory testing guidelines [12], were used. Accordingly, testing multiple samples, including those from the oropharyngeal tract (which the WHO recommends as an additional diagnostic sample [12]) or blood (which the WHO considers as an investigational sample [12]), may be helpful for mpox diagnosis [13][14][15][16].…”

Longitudinal viral shedding and antibody response characteristics of men with acute infection of monkeypox virus: a prospective cohort study

“…Recent studies have found that MPXV can be detected in specimens from multiple sites of Mpox cases, including saliva, rectal swabs, blood, urine and semen 10 – 17 , while skin lesions have been presumed to be the primary source of viral shedding and believed to be optimal for laboratory diagnosis 1 . However, one recent study has found patients negative for MPXV DNA in skin lesions while positive in other sites, highlighting the important role of multi-site sampling in the diagnosis of Mpox 18 . Although some studies have compared the diagnostic accuracy of different sample sites, evaluations with detailed temporal data are currently lacking.…”