Monkeypox: Clinical Characteristics and Common Complications

Results of a study published in Clinical Microbiology and Infection found that the current outbreak of monkeypox virus in France occurred predominantly among men who have sex with men (MSM) and was spread by sexual contact.

Data for this observational study were sourced from the Bichat Claude Bernard University Hospital in France between May and July 2022. Patients (N=264) diagnosed with polymerase chain reaction (PCR)-confirmed monkeypox virus infection were evaluated to describe the clinical characteristics and complications associated with monkeypox infection.

Among patients included in the study, 99% were men, the median age was 35 (IQR, 30-41) years, 95% were MSM, 29% were HIV-positive, 73% were receiving HIV pre-exposure prophylaxis, and 89% were previously diagnosed with a sexually transmitted infection.

Nearly half of the patients (47%) had contact with an individual with confirmed monkeypox infection, with contact occurring at a median of 6 days prior to symptom onset. The contact was sexual in nature in the majority of patients (95%).

The most common symptoms among the patients included adenopathy (69%), fever (68%), and headache (35%); pharyngitis (20%), angina (16%), and respiratory-related symptoms (12%) were also noted. In 53% of patients, symptoms were observed before the occurrence of skin lesions.

There was a median of 5 lesions observed per patient, with vesicles noted in 57% of patients, papules in 34%, ulcerations in 34%, pustular papules in 33%, scabs in 24%, and skin rash in 9%. The affected areas among the patients most commonly included the genitals (54%), followed by the limbs (48%), torso (42%), perianal area (40%), face (35%), and palmoplantar area (14%).

Monkeypox-related complications were observed in approximately 36% of the patients, the most common of which included anal pain (18%), cellulitis (10%), urinary signs (4%), ocular disease (4%), abscess (3%), lymphangitis (2%), and paronychia (2%).

The majority of patients (76%) received multidisciplinary care, and a minority (6%) were hospitalized at a median of 7 days after symptom onset. Hospitalizations occurred due to skin infection in 6 patients, gastrointestinal symptoms in 4, severe noncardiac angina in 4, ocular impairment in 2, and respiratory impairment in 1 patient. The median length of hospitalization was 3 days.

Among 258 patients who underwent PCR testing of the skin, 98% were positive for monkeypox infection, with a median cycle threshold (Ct) value of 23 (IQR, 21-26). Oropharyngeal PCR was performed among 197 patients, of whom 76% had a positive result with a median Ct value of 32 (IQR, 27-35). Of 192 patients who underwent both skin and oropharyngeal PCR testing, results were positive for both tests in 72%.

All patients achieved full symptom resolution, with the exception of 1 who had keratitis.

This study was limited by its single-center setting, potential recruitment bias, and the inability to evaluate patients for active sexually transmitted infections.

According to the researchers, “these results confirm the transmission of [monkeypox virus] within the MSM community and provide data on the clinical characteristics of the disease and particularly on the severe infections found during the current epidemic.”

Disclosure: One author declared affiliations with industry. Please see the original article for a full list of disclosures.

Reference

Mailhe M, Beaumont A-L, Thy M, et al. Clinical characteristics of ambulatory and hospitalised patients with monkeypox virus infection: an observational cohort study. Clin Microbiol Infect. 2022;S1198-743X(22)00428-1. doi:10.1016/j.cmi.2022.08.012