西班牙德意志大学Trias i Pujol大学医院Oriol Mitjà团队研究了西班牙确诊的人猴痘病毒病例的临床表现和病毒学评估。该研究于2022年8月8日发表在《柳叶刀》杂志上。
2022年5月，几个欧洲国家报道了猴痘的本地病例，并迅速在全球传播。早期的报告提示非典型表现。该研究旨在调查西班牙人类猴痘病例的临床和病毒学特征。
这项多中心、前瞻性、观察性队列研究在西班牙马德里和巴塞罗那的三家性健康诊所进行。研究组招募了2022年5月11日至6月29日期间实验室确诊的所有连续猴痘患者，为参与者提供病变、肛门和口咽拭子的PCR检测。参与者数据通过皮肤科医生或性传播感染专家进行的访谈来收集，并使用标准病例报告表记录。
在所有确诊参与者中评估的结果包括人口统计学、天花疫苗接种、艾滋病毒状况、与猴痘患者的接触、旅行、群众聚会出席情况、性传播感染的危险因素、性行为、首次出现时的体征和症状、多个身体部位的病毒学结果、与其他性传播病原体的共同感染、以及首次出现症状14天后的临床结局。
181名患者确诊为猴痘，并被纳入研究。166人（92%）被认定为男同性恋、双性恋或其他男男性行为者，15人（8%）被认定是异性恋男性或异性恋女性。中位年龄为37.0岁。32名（18%）患者报道曾接种过天花疫苗，72名（40%）患者为HIV阳性，8名（11%）患者的CD4细胞计数低于每μL 500个细胞，31名（17%）患者被诊断为并发性传播感染。中位潜伏期为7.0天。
所有参与者均出现皮肤损伤；141名（78%）患者在肛门生殖区有病变，78名（43%）在口腔和口周区有病变。70名（39%）参与者有需要治疗的并发症：45名（25%）患有直肠炎，19名（10%）患有扁桃体炎，15名（8%）患有阴茎水肿，6名（3%）患有脓肿，8名（4%）患有皮疹。3名患者（2%）需要入院。收集的180份皮损拭子中有178份（99%）呈阳性，117份咽喉拭子中有82份（70%）呈阳性。
病变拭子中的病毒载量显著高于咽拭子（平均循环阈值分别为23与32）。166名男男性行为者中有108人（65%）报告了肛交。进行肛交性行为的108名男同性恋者中有41名（38%）出现直肠炎，67名（62%）出现皮疹前的全身症状，均显著高于未进行肛交的男同性恋者（分别为7%与28%）。19名扁桃体炎患者中有18名（95%）报告进行了口交。从病变开始到形成干燥结痂的中位时间为10天。
研究结果表明，在该队列中，猴痘引起生殖器、肛周和口腔病变以及包括直肠炎和扁桃体炎在内的并发症。由于临床表现的多样性，临床医生对猴痘的疑似阈值应较低。皮损病变拭子显示出最高的病毒载量，结合性接触史和病变分布，研究结果表明亲密接触可能是当前猴痘疫情的主要传播途径。
附：英文原文
Title: Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study
Author: Eloy José Tarín-Vicente, Andrea Alemany, Manuel Agud-Dios, Maria Ubals, Clara Suer, Andrés Antón, Maider Arando, Jorge Arroyo-Andrés, Lorena Calderón-Lozano, Cristina Casa, José Miguel Cabrera, Pep Coll, Vicente Descalzo, María Dolores Folgueira, Jorge N García-Pérez, Elena Gil-Cruz, Borja González-Rodríguez, Christian Gutiérrez-Collar, águeda Hernández-Rodríguez, Paula López-Roa, María de los ángeles Meléndez, Julia Montero-Menárguez, Irene Muoz-Gallego, Sara Isabel Palencia-Pérez, Roger Paredes, Alfredo Pérez-Rivilla, María Piana, Nuria Prat, Aída Ramirez, ángel Rivero, Carmen Alejandra Rubio-Muiz, Martí Vall, Kevin Stephen Acosta-Velásquez, An Wang, Cristina Galván-Casas, Michael Marks, Pablo L Ortiz-Romero, Oriol Mitjà
Issue&Volume: 2022-08-08
Abstract:
Background
In May, 2022, several European countries reported autochthonous cases of monkeypox, which rapidly spread globally. Early reports suggest atypical presentations. We aimed to investigate clinical and virological characteristics of cases of human monkeypox in Spain.
Methods
This multicentre, prospective, observational cohort study was done in three sexual health clinics in Madrid and Barcelona, Spain. We enrolled all consecutive patients with laboratory-confirmed monkeypox from May 11 to June 29, 2022. Participants were offered lesion, anal, and oropharynx swabs for PCR testing. Participant data were collected by means of interviews conducted by dermatologists or specialists in sexually transmitted infections and were recorded using a standard case report form. Outcomes assessed in all participants with a confirmed diagnosis were demographics, smallpox vaccination, HIV status, exposure to someone with monkeypox, travel, mass gathering attendance, risk factors for sexually transmitted infections, sexual behaviour, signs and symptoms on first presentation, virological results at multiple body sites, co-infection with other sexually transmitted pathogens, and clinical outcomes 14 days after the initial presentation. Clinical outcomes were followed up until July 13, 2022.
Findings
181 patients had a confirmed monkeypox diagnosis and were enrolled in the study. 166 (92%) identified as gay men, bisexual men, or other men who have sex with men (MSM) and 15 (8%) identified as heterosexual men or heterosexual women. Median age was 37·0 years (IQR 31·0–42·0). 32 (18%) patients reported previous smallpox vaccination, 72 (40%) were HIV-positive, eight (11%) had a CD4 cell count less than 500 cells per μL, and 31 (17%) were diagnosed with a concurrent sexually transmitted infection. Median incubation was 7·0 days (IQR 5·0–10·0). All participants presented with skin lesions; 141 (78%) participants had lesions in the anogenital region, and 78 (43%) in the oral and perioral region. 70 (39%) participants had complications requiring treatment: 45 (25%) had a proctitis, 19 (10%) had tonsillitis, 15 (8%) had penile oedema, six (3%) an abscess, and eight (4%) had an exanthem. Three (2%) patients required hospital admission. 178 (99%) of 180 swabs from skin lesions collected tested positive, as did 82 (70%) of 117 throat swabs. Viral load was higher in lesion swabs than in pharyngeal specimens (mean cycle threshold value 23 [SD 4] vs 32 [6], absolute difference 9 [95% CI 8–10]; p<0·0001). 108 (65%) of 166 MSM reported anal-receptive sex. MSM who engaged in anal-receptive sex presented with proctitis (41 [38%] of 108 vs four [7%] of 58, absolute difference 31% [95% CI 19–44]; p<0·0001) and systemic symptoms before the rash (67 [62%] vs 16 [28%], absolute difference 34% [28–62]; p<0·0001) more frequently than MSM who did not engage in anal-receptive sex. 18 (95%) of 19 participants with tonsillitis reported practising oral-receptive sex. The median time from onset of lesions to formation of a dry crust was 10 days (IQR 7–13).
Interpretation
In our cohort, monkeypox caused genital, perianal, and oral lesions and complications including proctitis and tonsillitis. Because of the variability of presentations, clinicians should have a low threshold for suspicion of monkeypox. Lesion swabs showed the highest viral loads, which, combined with the history of sexual exposure and the distribution of lesions, suggests close contact is probably the dominant transmission route in the current outbreak.
DOI: 10.1016/S0140-6736(22)01436-2
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01436-2/fulltext
LANCET：《柳叶刀》，创刊于1823年。隶属于爱思唯尔出版社，最新IF：202.731
官方网址：http://www.thelancet.com/
投稿链接：http://ees.elsevier.com/thelancet
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