Tecovirimat is an antiviral drug initially developed against variola virus (VARV) to treat smallpox infection. Due to its mechanism of action, it has activity against the family of orthopoxviruses, ...including vaccinia and the human monkeypox virus (HMPXV). Efficacy studies have thus far been limited to animal models, with human safety trials showing no serious adverse events. Currently approved by the FDA only for the treatment of smallpox, tecovirimat shows promise for the treatment of HMPXV. Tecovirimat has been prescribed via an expanded access for an investigational new drug protocol during the 2022 outbreak. This review will examine the literature surrounding tecovirimat's mechanism of action, pharmacokinetics, safety, efficacy, and potential for resistance.
Mpox is a viral infection, which primarily caused sporadic outbreaks in West and Central Africa until causing a global epidemic in 2022. The disease has disproportionately affected people with human ...immunodeficiency virus and men who have sex with men. Transmission is through close physical contact, including sexual contact. Infection presents with a characteristic rash, with frequent anogenital involvement-polymerase chain reaction of skin lesions is diagnostic. Vaccination is available for primary prevention and postexposure prophylaxis. Treatment consists of supportive care, with antiviral medications available via clinical trials and/or for patients with severe disease.
ABSTRACTAs the COVID-19 pandemic causes upheaval in New York City (NYC), 1 consequence is the accessibility of sexual health services. The NYC STD Prevention Training Center at Columbia University ...administered an online provider survey to understand how the COVID-19 pandemic is affecting the availability of sexual health care services regionally.
Since the Mpox (formerly known as Monkeypox virus) global outbreak, there have been limited reports on the clinical course and management of genital lesions related to Mpox infections. Genital ...lesions have been reported to manifest in almost 50% of patients infected with Mpox. We set out to describe the clinical manifestations, management, and outcomes of a large cohort of subjects undergoing treatment with tecovirimat with intermediate follow-up.
This was a retrospective case series of patients with genital Mpox lesions undergoing treatment with tecovirimat under the Centers for Disease Control and Prevention Emergency Authorization-Investigational protocol at a single, quaternary referral center. Fisher's exact tests were used to assess the association between Mpox-related genital skin changes and selected categorical variables.
A total of 68 subjects were included. The mean age was 34.9 years, and all participants were assigned male sex at birth. The mean follow-up period was 20.3 days. Management consisted of supportive care, antibiotic treatment for bacterial superinfection, medical debridement with collagenase for severe lesions. Urological consultation was obtained in 5 (7.4%) cases. Sixteen (23.5%) patients had significant penile skin changes at final follow-up, which was significantly associated with lesion size (
= .001). No subjects in this cohort required surgical interventions.
We report this large series of Mpox-related genital lesions in men undergoing treatment with tecovirimat. Urologists are not required for the routine diagnosis and treatment of these lesions, but are important in determining appropriate treatment for severe lesions.
The progression of clinical manifestations in patients with coronavirus disease 2019 (COVID-19) highlights the need to account for symptom duration at the time of hospital presentation in ...decision-making algorithms.
We performed a nested case-control analysis of 4103 adult patients with COVID-19 and at least 28 days of follow-up who presented to a New York City medical center. Multivariable logistic regression and classification and regression tree (CART) analysis were used to identify predictors of poor outcome.
Patients presenting to the hospital earlier in their disease course were older, had more comorbidities, and a greater proportion decompensated (<4 days, 41%; 4-8 days, 31%; >8 days, 26%). The first recorded oxygen delivery method was the most important predictor of decompensation overall in CART analysis. In patients with symptoms for <4, 4-8, and >8 days, requiring at least non-rebreather, age ≥ 63 years, and neutrophil/lymphocyte ratio ≥ 5.1; requiring at least non-rebreather, IL-6 ≥ 24.7 pg/mL, and D-dimer ≥ 2.4 µg/mL; and IL-6 ≥ 64.3 pg/mL, requiring non-rebreather, and CRP ≥ 152.5 mg/mL in predictive models were independently associated with poor outcome, respectively.
Symptom duration in tandem with initial clinical and laboratory markers can be used to identify patients with COVID-19 at increased risk for poor outcomes.
Among 1376 patients with Covid-19 admitted to a New York City hospital, 59% were treated with hydroxychloroquine. Patients selected for treatment were more severely ill. After adjustment for ...patients’ baseline characteristics, there was no significant association between hydroxychloroquine use and intubation or death (hazard ratio, 1.04; 95% CI, 0.82 to 1.32).
Mpox: What Practicing Gastroenterologists Need to Know Sultan, Shahnaz; Zucker, Jason; Weinberg, David S.
Gastroenterology (New York, N.Y. 1943),
April 2023, 2023-04-00, 20230401, Letnik:
164, Številka:
4
Journal Article
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