In a recent study in The Lancet Infectious Diseases, Nicolò Moschetta and colleagues compared the neutralising antibody response of individuals at 6 months after mpox (formerly known as monkeypox) ...infection or Modified Vaccinia Ankara–Bavarian Nordic (MVA-BN) vaccination, finding that people receiving vaccination had lower concentrations of mpox neutralising antibodies than individuals with mpox infection.1 In this Correspondence, we report a case of mpox infection in an individual who was enrolled in the aforementioned study, received MVA-BN vaccination, and did not develop a neutralising antibody response at 6 months after vaccination. With a titre of less than 1/10, the patient was one of the ten (12%) of 85 individuals who did not have detectable antibodies, and was thus assigned to the low neutralising antibody titre group (ie, ≤1/10).1 In October, 2023, 12 days after multiple condomless anal intercourses with several partners during a sexual event, the patient reported the appearance of perianal clustered pustular lesions, clinically consistent with mpox, and pharyngodynia. All data collected in the study are available upon reasonable request, after approval of the proposal, to the corresponding author (bottanelli.martina@hsr.it).
Between May and November, 2022, global outbreaks of human monkeypox virus infection have been reported in more than 78 000 people worldwide, predominantly in men who have sex with men. We describe ...the epidemiological and clinical characteristics of monkeypox virus infection in cisgender (cis) and transgender (trans) women and non-binary individuals assigned female sex at birth to improve identification and understanding of risk factors.
International collaborators in geographical locations with high numbers of diagnoses of monkeypox virus infection were approached and invited to contribute data on women and non-binary individuals with confirmed monkeypox virus infection. Contributing centres completed deidentified structured case-report spreadsheets, adapted and developed by participating clinicians, to include variables of interest relevant to women and non-binary individuals assigned female at birth. We describe the epidemiology and clinical course observed in the reported infections.
Collaborators reported data for a total of 136 individuals with monkeypox virus infection who presented between May 11 and Oct 4, 2022, across 15 countries. Overall median age was 34 years (IQR 28–40; range 19–84). The cohort comprised 62 trans women, 69 cis women, and five non-binary individuals (who were, because of small numbers, grouped with cis women to form a category of people assigned female at birth for the purpose of comparison). 121 (89%) of 136 individuals reported sex with men. 37 (27%) of all individuals were living with HIV, with a higher proportion among trans women (31 50% of 62) than among cis women and non-binary individuals (six 8% of 74). Sexual transmission was suspected in 55 (89%) trans women (with the remainder having an unknown route of transmission) and 45 (61%) cis women and non-binary individuals; non-sexual routes of transmission (including household and occupational exposures) were reported only in cis women and non-binary individuals. 25 (34%) of 74 cis women and non-binary individuals submitted to the case series were initially misdiagnosed. Overall, among individuals with available data, rash was described in 124 (93%) of 134 individuals and described as anogenital in 95 (74%) of 129 and as vesiculopustular in 105 (87%) of 121. Median number of lesions was ten (IQR 5-24; range 1–200). Mucosal lesions involving the vagina, anus, or oropharynx or eye occurred in 65 (55%) of 119 individuals with available data. Vaginal and anal sex were associated with lesions at those sites. Monkeypox virus DNA was detected by PCR from vaginal swab samples in all 14 samples tested. 17 (13%) individuals were hospitalised, predominantly for bacterial superinfection of lesions and pain management. 33 (24%) individuals were treated with tecovirimat and six (4%) received post-exposure vaccinations. No deaths were reported.
The clinical features of monkeypox in women and non-binary individuals were similar to those described in men, including the presence of anal and genital lesions with prominent mucosal involvement. Anatomically, anogenital lesions were reflective of sexual practices: vulvovaginal lesions predominated in cis women and non-binary individuals and anorectal features predominated in trans women. The prevalence of HIV co-infection in the cohort was high.
None.
Over 80 000 mpox (formerly known as monkeypox) cases have been confirmed worldwide and recovered individuals are considered protected against reinfection.1–3 However, an individual with apparent ...reinfection has been recently reported.4 In this Comment we describe two individuals with potential monkeypox virus reinfection at San Raffaele Hospital, Milan, Italy (figure; see appendix for details on testing and results). Monkeypox virus PCR was positive for lesion, rectal, and oropharyngeal swabs with cycle threshold values ranging between 18 and 32, with concurrent chlamydia proctitis. Anoscopy revealed mucosal congestion with erosions and ulcerations, and a rectal swab was positive for both monkeypox virus with a cycle threshold value of 37, and for chlamydia.
•M. marinum infections occur in both immunocompetent and immunocompromised hosts.•Diagnosis and management are still challenging.•Risk factors and recreational/occupational exposure should be careful ...assessed.•Molecular identification and mycobacterial culture are the milestones of diagnosis.•Treatment is not standardized yet, but should include rifampin and a macrolide (two- or three-drug regimen depending on disease severity).
Mycobacterium marinum (M. marinum) is a free-living, slow grower nontuberculous mycobacteria (NTM), strictly related to Mycobacterium tuberculosis, that causes disease in fresh and saltwater fish and it is one of the causes of extra-pulmonary mycobacterial infections, ranging in human from simple cutaneous lesions to disseminated forms in immunocompromised hosts.
The first human cases of M. marinum infection were reported from skin lesions of swimmers in a contaminated pool, in 1951, in Sweden by Norden and Linell.
Two conditions are required to develop M. marinum infection: (1) skin solution of continuity and (2) exposure to the contaminated water or direct contact with fish or shellfish.
The so-called “fish-tank granuloma”, the most frequent cutaneous manifestation of M. marinum infection, is characterized by a single papulonodular, verrucose and/or ulcerated granulomatous lesion in the inoculum site.
Careful patient's history collection, high clinical suspicion and appropriate sample (e.g. cutaneous biopsy) for microbiological culture are crucial for a timely diagnosis.
The treatment is not standardized yet and relies on administration of two active antimycobacterial agents, always guided by antimicrobial susceptibility test on culture, with macrolides and rifampin as pivotal drugs, as well as prompt surgery when feasible.
In this narrative review, we provide to Clinicians an updated report of epidemiology, microbiological characteristics, clinical presentation, diagnosis, and management of M. marinum infection.
