Monkeypox: a new study to describe the characteristics of infected patients
Teams from the infectious and tropical diseases, dermatology, emergency and virology departments of Bichat Claude-Bernard Hospital AP-HP, Inserm and Université Paris Cité* studied the characteristics of patients infected with the monkeypox virus and who were treated at Bichat Hospital between 21 May and 5 July 2022. The objective was to obtain a clearer idea of these characteristics and the complications observed, in order to better understand and manage this new epidemic.
The results of this research were published in Clinical Microbiology and Infection on 23 August 2022.
Since May 2022, an epidemic of monkeypox has been raging in many countries across several continents. Its scale has led the World Health Organization (WHO) to declare an international public health emergency.
The characteristics of the patients infected with the monkeypox virus in this epidemic differ from those of previous epidemics. The objectives of this study were to describe the clinical characteristics and complications of patients with monkeypox.
All patients presenting with monkeypox confirmed by PCR at Bichat - Claude Bernard Hospital, AP-HP in Paris were included in this study. Between 21 May and 5 July 2022, 420 patients were tested for the monkeypox virus, of whom 264 had a positive PCR test result.
Among the patients, 99% (n=262) were men, 95% (n=245) of whom were having sex with men and 42% (n=90) having practiced Chemsex (sex combined with drug use) in the previous three months.
In addition, 29% (n=73) of them were living with HIV and 71% of the other patients were taking pre-exposure prophylaxis (PrEP) to prevent HIV infection. Only 47% of the patients (n=112) had had known contact with a confirmed case of monkeypox. This contact was of a sexual nature in 95% of the cases (86/91).
The majority of the patients had fever (171/253, 68%) and adenopathy (174/251, 69%), i.e. enlarged lymph nodes. The skin lesions affected mainly the genital (135/252, 54%) and perianal areas (100/251, 40%).
A total of 17 patients (17/264, 6%) were hospitalised, all of whom non-immunocompromised adult males. The reasons for hospitalisation were: cellulitis (n=4) and paronychia (n=3) probably related to bacterial superinfection, severe anal and digestive involvement with intense pain (n=4), angina with dysphagia (n=4), and ophthalmologic disorders related to the monkeypox virus – blepharitis (n=1) and keratitis (n=1). Surgery was required for 4 patients in the context of cutaneous superinfections.
This study confirms the particularities of the current epidemic in relation to its predecessors in that: it mainly affects men who have sex with men; it is mainly transmitted through sexual contact; it affects the perineal and anal regions and can lead to severe forms, particularly secondary skin infections, complicated anal and digestive disorders, dysphagia and ophthalmic disorders.
Références : Morgane Mailhe, Anne-Lise Beaumont, Michael Thy, Diane Le Pluart, Ségolène Perrineau, Nadhira Houhou-Fidouh, Laurène Deconinck, Chloé Bertin, Valentine Marie Ferré, Marie Cortier, Clémentine De La Porte Des Vaux, Bao-Chau Phung, Bastien Mollo, Mélanie Cresta, Fabrice Bouscarat, Christophe Choquet, Diane Descamps, Jade Ghosn, François-Xavier Lescure, Yazdan Yazdanpanah, Véronique Joly, Nathan Peiffer-Smadja. Clinical Microbiology and Infection
DOI : 10.1016/j.cmi.2022.08.012
*Clinical study doctors funded by ANRS | Emerging Infectious Diseases had participated in the collection and analysis of data and in the writing of this article.
About Inserm: Founded in 1964, Inserm is a public scientific and technological institute which operates under the joint authority of the French Ministries of Health and Research. The institute is dedicated to biomedical research and human health, and is involved in the entire range of activities from the laboratory to the patient’s bedside. It also partners with the most prestigious research institutions in the world that are committed to scientific challenges and progress in these fields.
About Université Paris Cité: An intensive multidisciplinary research university with the ‘Initiative of Excellence’ label, Université Paris Cité has risen to the highest international level thanks to its research, the diversity of its training courses, its support for innovation, and its active participation in the construction of the European research and training area. Université Paris Cité is made up of three faculties (Health, Sciences and Societies and Humanities), a component institution, the Institut de Physique du Globe de Paris and a partner research organisation, Institut Pasteur. Université Paris Cité has 63,000 students, 7,500 teacher-researchers and researchers, 21 doctoral schools and 119 research units. www.u-paris.fr
About the Paris Public Hospitals Group (AP-HP): Europe's leading hospital and university centre (CHU), the AP-HP and its 38 hospitals are organised into six university hospital groups (AP-HP. Centre – Université Paris Cité; AP-HP. Sorbonne University; AP-HP. North – Université Paris Cité; AP-HP. Paris Saclay University; AP-HP. Henri Mondor University Hospitals and AP-HP. Paris Seine-Saint-Denis University Hospitals) and is structured around five Paris universities. Closely linked to major research organisations, AP-HP has four world-class university hospital institutes (ICM, ICAN, IMAGINE, FOReSIGHT) and the largest French health data warehouse (EDS). A major player in applied research and health innovation, the AP-HP holds a portfolio of 650 active patents, its clinical researchers sign more than 10,000 scientific publications each year and more than 4,000 research projects are currently under development, all sponsors combined. In 2020, the AP-HP obtained the Carnot Institute label, which rewards the quality of its partnership research: Carnot@AP-HP offers applied and clinical research solutions in the field of health to industrial players. In 2015, the AP-HP also created the AP-HP Foundation, which works directly with caregivers to support the organisation of care, hospital staff and research within the AP-HP. http://www.aphp.fr