RESUMO
Monkeypox is a zoonotic disease endemic to central and western Africa, where it is a major public health concern. Although Monkeypox virus (MPXV) and monkeypox disease in humans have been well characterized, little is known about its natural history, or its maintenance in animal populations of sylvatic reservoir(s). In 2003, several species of rodents imported from Ghana were involved in a monkeypox outbreak in the United States with individuals of three African rodent genera (Cricetomys, Graphiurus, Funisciurus) shown to be infected with MPXV. Here, we examine the course of MPXV infection in Cricetomys gambianus (pouched Gambian rats) and this rodent species' competence as a host for the virus. We obtained ten Gambian rats from an introduced colony in Grassy Key, Florida and infected eight of these via scarification with a challenge dose of 4X104 plaque forming units (pfu) from either of the two primary clades of MPXV: Congo Basin (C-MPXV: n = 4) or West African (W-MPXV: n = 4); an additional 2 animals served as PBS controls. Viral shedding and the effect of infection on activity and physiological aspects of the animals were measured. MPXV challenged animals had significantly higher core body temperatures, reduced activity and increased weight loss than PBS controls. Viable virus was found in samples taken from animals in both experimental groups (C-MPXV and W-MPXV) between 3 and 27 days post infection (p.i.) (up to 1X108 pfu/ml), with viral DNA found until day 56 p.i. The results from this work show that Cricetomys gambianus (and by inference, probably the closely related species, Cricetomys emini) can be infected with MPXV and shed viable virus particles; thus suggesting that these animals may be involved in the maintenance of MPXV in wildlife mammalian populations. More research is needed to elucidate the epidemiology of MPXV and the role of Gambian rats and other species.
Assuntos
Reservatórios de Doenças , Monkeypox virus/isolamento & purificação , Mpox/veterinária , Doenças dos Roedores/patologia , Doenças dos Roedores/virologia , Roedores/virologia , Animais , Temperatura Corporal , Peso Corporal , Locomoção , Modelos Teóricos , Mpox/patologia , Mpox/virologia , Eliminação de Partículas ViraisRESUMO
Identification of human monkeypox cases during 2005 in southern Sudan (now South Sudan) raised several questions about the natural history of monkeypox virus (MPXV) in Africa. The outbreak area, characterized by seasonally dry riverine grasslands, is not identified as environmentally suitable for MPXV transmission. We examined possible origins of this outbreak by performing phylogenetic analysis of genome sequences of MPXV isolates from the outbreak in Sudan and from differing localities. We also compared the environmental suitability of study localities for monkeypox transmission. Phylogenetically, the viruses isolated from Sudan outbreak specimens belong to a clade identified in the Congo Basin. This finding, added to the political instability of the area during the time of the outbreak, supports the hypothesis of importation by infected animals or humans entering Sudan from the Congo Basin, and person-to-person transmission of virus, rather than transmission of indigenous virus from infected animals to humans.
Assuntos
Surtos de Doenças , Mpox/virologia , Animais , Genes Virais , Humanos , Tipagem Molecular , Mpox/epidemiologia , Mpox/transmissão , Monkeypox virus/classificação , Monkeypox virus/genética , Monkeypox virus/isolamento & purificação , Filogenia , Filogeografia , Análise de Sequência de DNA , Sudão/epidemiologiaRESUMO
In the spring of 2006, four human cases of parapoxvirus infections in Missouri residents were reported to the Centers for Disease Control and Prevention (CDC), two of which were initially diagnosed as cutaneous anthrax. This investigation was conducted to determine the level of recognition of zoonotic parapoxvirus infections and prevention measures, the degree to which veterinarians may be consulted on human infections and what forces were behind this perceived increase in reported infections. Interviews were conducted and clinical and environmental sampling was performed. Swab and scab specimens were analyzed by real-time polymerase chain reaction (PCR), whereas serum specimens were evaluated for parapoxvirus antibodies. Three case patients were found to have fed ill juvenile animals without using gloves. Forty-six percent of veterinarians reported having been consulted regarding suspected human orf infections. Orf virus DNA was detected from five of 25 asymptomatic sheep. Analysis of extracellular envelope gene sequences indicated that sheep and goat isolates clustered in a species-preferential fashion. Parapoxvirus infections are common in Missouri ruminants and their handlers. Infected persons often do not seek medical care; some may seek advice from veterinarians rather than physicians. The initial perception of increased incidence in Missouri may have arisen from a reporting artifact stemming from heightened concern about anthrax. Asymptomatic parapoxvirus infections in livestock may be common and further investigation warranted.
RESUMO
Smallpox preparedness research has led to development of antiviral therapies for treatment of serious orthopoxvirus infections. Monkeypox virus is an emerging, zoonotic orthopoxvirus which can cause severe and transmissible disease in humans, generating concerns for public health. Monkeypox virus infection results in a systemic, febrile-rash illness closely resembling smallpox. Currently, there are no small-molecule antiviral therapeutics approved to treat orthopoxvirus infections of humans. The prairie dog, using monkeypox virus as a challenge virus, has provided a valuable nonhuman animal model in which monkeypox virus infection closely resembles human systemic orthopoxvirus illness. Here, we assess the efficacy of the antiorthopoxvirus compound ST-246 in prairie dogs against a monkeypox virus challenge of 65 times the 50% lethal dose (LD(50)). Animals were infected intranasally and administered ST-246 for 14 days, beginning on days 0, 3, or after rash onset. Swab and blood samples were collected every 2 days and analyzed for presence of viral DNA by real-time PCR and for viable virus by tissue culture. Seventy-five percent of infected animals that received vehicle alone succumbed to infection. One hundred percent of animals that received ST-246 survived challenge, and animals that received treatment before symptom onset remained largely asymptomatic. Viable virus and viral DNA were undetected or at greatly reduced levels in animals that began treatment on 0 or 3 days postinfection, compared to control animals or animals treated post-rash onset. Animals treated after rash onset manifested illness, but all recovered. Our results indicate that ST-246 can be used therapeutically, following onset of rash illness, to treat systemic orthopoxvirus infections.
Assuntos
Antivirais/administração & dosagem , Benzamidas/administração & dosagem , Isoindóis/administração & dosagem , Monkeypox virus/patogenicidade , Infecções por Poxviridae/tratamento farmacológico , Canal Anal/virologia , Animais , Sangue/virologia , DNA Viral/genética , DNA Viral/isolamento & purificação , Modelos Animais de Doenças , Olho/virologia , Humanos , Orofaringe/virologia , Infecções por Poxviridae/mortalidade , Infecções por Poxviridae/patologia , Sciuridae , Análise de Sobrevida , Resultado do Tratamento , Carga ViralRESUMO
The prairie dog is valuable for the study of monkeypox virus (MPXV) virulence and closely resembles human systemic orthopoxvirus disease. Herein, we utilize a variable dose intranasal challenge with approximately 10(3), 10(4), 10(5), and 10(6)PFU for each clade to further characterize virulence differences between the two MPXV clades. A trend of increased morbidity and mortality as well as greater viral shedding was observed with increasing viral challenge dose. Additionally, there appeared to be a delay in onset of disease for animals challenged with lower dosages of virus. Mathematical calculations were used to determine LD(50) values and based on these calculations, Congo Basin MPXV had approximately a hundred times lower LD(50) value than the West African clade (5.9x10(3) and 1.29x10(5) respectively); reinforcing previous findings that Congo Basin MPXV is more virulent.
Assuntos
Monkeypox virus/patogenicidade , Mpox/veterinária , Animais , Modelos Animais de Doenças , Feminino , Dose Letal Mediana , Masculino , Mpox/mortalidade , Mpox/patologia , Mpox/virologia , Sciuridae , Análise de Sobrevida , Virulência , Eliminação de Partículas ViraisRESUMO
Human monkeypox has never been reported in Ghana, but rodents captured in forested areas of southern Ghana were the source of the monkeypox virus introduced into the United States in 2003. Subsequent to the outbreak in the United States, 204 animals were collected from two commercial trapping sites in Ghana. Animal tissues were examined for the presence of orthopoxvirus (OPXV) DNA using a real-time polymerase chain reaction, and sera were assayed for antibodies against OPXV. Animals from five genera (Cricetomys, Graphiurus, Funiscirus, and Heliosciurus) had antibodies against OPXV, and three genera (Cricetomys, Graphiurus, and Xerus) had evidence of OPXV DNA in tissues. Additionally, 172 persons living near the trapping sites were interviewed regarding risk factors for OPXV exposure, and their sera were analyzed. Fifty-three percent had IgG against OPXV; none had IgM. Our findings suggest that several species of forest-dwelling rodents from Ghana are susceptible to naturally occurring OPXV infection, and that persons living near forests may have low-level or indirect exposure to OPXV-infected animals, possibly resulting in sub-clinical infections.
Assuntos
Anticorpos Antivirais/imunologia , Orthopoxvirus/imunologia , Infecções por Poxviridae/imunologia , Adolescente , Adulto , Animais , Criança , DNA Viral/isolamento & purificação , Gana/epidemiologia , Humanos , Imunoglobulina G/isolamento & purificação , Infecções por Poxviridae/sangue , Infecções por Poxviridae/virologia , Fatores de Risco , Roedores/imunologia , Estudos Soroepidemiológicos , Adulto JovemRESUMO
The data presented herein support the North American orthopoxviruses (NA OPXV) in a sister relationship to all other currently described Orthopoxvirus (OPXV) species. This phylogenetic analysis reaffirms the identification of the NA OPXV as close relatives of "Old World" (Eurasian and African) OPXV and presents high support for deeper nodes within the Chordopoxvirinae family. The natural reservoir host(s) for many of the described OPXV species remains unknown although a clear virus-host association exists between the genus OPXV and several mammalian taxa. The hypothesized host associations and the deep divergence of the OPXV/NA OPXV clades depicted in this study may reflect the divergence patterns of the mammalian faunas of the Old and New World and reflect a more ancient presence of OPXV on what are now the American continents. Genes from the central region of the poxvirus genome are generally more conserved than genes from either end of the linear genome due to functional constraints imposed on viral replication abilities. The relatively slower evolution of these genes may more accurately reflect the deeper history among the poxvirus group, allowing for robust placement of the NA OPXV within Chordopoxvirinae. Sequence data for nine genes were compiled from three NA OPXV strains plus an additional 50 genomes collected from Genbank. The current, gene sequence based phylogenetic analysis reaffirms the identification of the NA OPXV as the nearest relatives of "Old World" OPXV and presents high support for deeper nodes within the Chordopoxvirinae family. Additionally, the substantial genetic distances that separate the currently described NA OPXV species indicate that it is likely that many more undescribed OPXV/NA OPXV species may be circulating among wild animals in North America.
Assuntos
Orthopoxvirus/classificação , Orthopoxvirus/genética , DNA Mitocondrial/genética , DNA Viral/genética , Bases de Dados Factuais , Ecologia , Ecossistema , Evolução Molecular , Especiação Genética , Geografia , América do Norte , Filogenia , Análise de Sequência de DNA , Especificidade da EspécieRESUMO
Multiple monkeypox virus (MPXV) animal models have been discussed in previous studies, but no small animal models, nor most non-human primate models, demonstrated the protracted asymptomatic incubation phase seen in systemic human orthopoxvirus illness. Herein, we characterize a black-tailed prairie dog (PD) (Cynomys ludovicianus) model of infection, via intranasal and intradermal exposures, with the two MPXV clades. Daily observations of the animals were made (food consumption, general symptoms, disease presentation), while weights and virus evaluations (ocular, nasal, oropharyngeal, faeces, blood) were obtained/made every third day. Generalized rash became apparent 9-12 days post-infection for all animals. Individual animals demonstrated a range of symptoms consistent with human monkeypox disease. Measurable viraemias and excretas were similar for both clade-representative strains and persisted until at least day 21. Greater morbidity was observed in Congo Basin strain-challenged animals and mortality was observed only in the Congo Basin strain-challenged animals. The PD model is valuable for the study of strain-dependent differences in MPXV. Additionally, the model closely mimics human systemic orthopoxvirus disease and may serve as a valuable non-human surrogate for investigations of antivirals and next generation orthopoxvirus vaccines.
Assuntos
Monkeypox virus/patogenicidade , Infecções por Poxviridae/fisiopatologia , Sciuridae/virologia , África Ocidental , Animais , Antivirais/uso terapêutico , Sangue/virologia , Modelos Animais de Doenças , Olho/virologia , Fezes/virologia , Humanos , Monkeypox virus/isolamento & purificação , Boca/virologia , Nariz/virologia , Infecções por Poxviridae/imunologia , Infecções por Poxviridae/mortalidade , Infecções por Poxviridae/prevenção & controle , Vacinas ViraisRESUMO
On March 3, 2007, a 2-year-old boy was hospitalized with eczema vaccinatum. His two siblings, one with eczema, were subsequently removed from the home. Swabs of household items obtained on March 13th were analyzed for orthopoxvirus DNA signatures with real-time PCR. Virus culture was attempted on positive specimens. Eight of 25 household samples were positive by PCR for orthopoxvirus; of these, three yielded viable vaccinia virus in culture. Both siblings were found to have serologic evidence of orthopoxvirus exposure. These findings have implications for smallpox preparedness, especially in situations where some household members are not candidates for vaccination.
Assuntos
Fômites/virologia , Erupção Variceliforme de Kaposi/transmissão , Vacina Antivariólica/efeitos adversos , Vaccinia virus/isolamento & purificação , Anticorpos Antivirais/sangue , Pré-Escolar , DNA Viral/genética , Feminino , Humanos , Masculino , Reação em Cadeia da Polimerase/métodosRESUMO
During a suspected monkeypox outbreak in the Republic of Congo, we documented transmission of varicella-zoster virus (VZV) infection with palm and sole manifestations among 5 family members. Genotyping results confirmed the VZV strain European E2, a genotype not previously reported in Africa. VZV with palm and sole involvement should be considered when differentiating a monkeypox diagnosis.
Assuntos
Mãos/patologia , Herpes Zoster/fisiopatologia , Herpes Zoster/transmissão , Perna (Membro)/patologia , Adolescente , Adulto , Criança , Congo/epidemiologia , DNA Viral/genética , Diagnóstico Diferencial , Saúde da Família , Feminino , Genótipo , Herpes Zoster/diagnóstico , Herpes Zoster/epidemiologia , Herpesvirus Humano 3/classificação , Herpesvirus Humano 3/genética , Herpesvirus Humano 3/isolamento & purificação , Humanos , Lactente , Masculino , Mpox/diagnóstico , FilogeniaRESUMO
Naturally occurring infections of Vaccinia virus (VACV) have been recognized in Brazil during the past 10 years. Human Brazilian Vaccinia virus (BVV) infections typically occur as a zoonosis transferred from affected dairy cows to their handlers. Outbreaks have caused notable economic losses to the rural community in the region. The origins of BVV are unclear but previous analyses have shown that at least two distinct clades of BVV exist. The aim of this study was to develop a rapid and inexpensive process for identification and differentiation of BVV that should facilitate epidemiological and ecological investigations including the improved diagnosis of Brazilian Orthopoxvirus infections. A SYBR green quantitative real-time polymerase chain reaction (PCR) targeting the hemagglutinin gene was developed to identify different populations of BVV, VACV vaccine strains used in Brazil during the smallpox eradication campaign (Vaccinia Lister (VACV-LIS) and New York City Board of Health (VACV-NYCBH)), and currently available vaccines (VACV-NYCBH DRYVAX and VACV-NYCBH Acambis 2000). Three primer combinations (one to amplify many orthopoxviruses including all vaccinia viruses described so far; one to differentiate BVV from vaccine strains (VACV-LIS, VACV-NYCBH DRYVAX and VACV-NYCBH Acambis 2000); and one to differentiate BVV clades) were designed to work at the same annealing temperature and reaction conditions. In addition, these methods were able to detect orthopoxvirus viral DNA in lesion biopsy material without the need for DNA extraction.
Assuntos
Doenças dos Bovinos/virologia , Reação em Cadeia da Polimerase/métodos , Vaccinia virus/isolamento & purificação , Vacínia/veterinária , Animais , Sequência de Bases , Brasil/epidemiologia , Bovinos , Doenças dos Bovinos/genética , Primers do DNA , Hemaglutininas Virais/genética , Humanos , Dados de Sequência Molecular , Orthopoxvirus/classificação , Orthopoxvirus/genética , Sensibilidade e Especificidade , Alinhamento de Sequência , Vacínia/transmissão , Vacínia/virologia , Vaccinia virus/classificação , Vaccinia virus/genéticaRESUMO
BACKGROUND: We report the first confirmed case of eczema vaccinatum in the United States related to smallpox vaccination since routine vaccination was discontinued in 1972. A 28-month-old child with refractory atopic dermatitis developed eczema vaccinatum after exposure to his father, a member of the US military who had recently received smallpox vaccine. The father had a history of inactive eczema but reportedly reacted normally to the vaccine. The child's mother also developed contact vaccinia infection. METHODS: Treatment of the child included vaccinia immune globulin administered intravenously, used for the first time in a pediatric patient; cidofovir, never previously used for human vaccinia infection; and ST-246, an investigational agent being studied for the treatment of orthopoxvirus infection. Serological response to vaccinia virus and viral DNA levels, correlated with clinical events, were utilized to monitor the course of disease and to guide therapy. Burn patient-type management was required, including skin grafts. RESULTS: The child was discharged from the hospital after 48 days and has recovered with no apparent systemic sequelae or significant scarring. CONCLUSION: This case illustrates the need for careful screening prior to administration of smallpox vaccine and awareness by clinicians of the ongoing vaccination program and the potential risk for severe adverse events related to vaccinia virus.
Assuntos
Erupção Variceliforme de Kaposi/tratamento farmacológico , Vacina Antivariólica , Anticorpos Antivirais/sangue , Anticorpos Antivirais/uso terapêutico , Benzamidas/uso terapêutico , Pré-Escolar , Cidofovir , Citosina/análogos & derivados , Citosina/uso terapêutico , DNA Viral/sangue , Dermatite Atópica/complicações , Saúde da Família , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Imunoglobulinas Intravenosas/uso terapêutico , Isoindóis/uso terapêutico , Erupção Variceliforme de Kaposi/patologia , Erupção Variceliforme de Kaposi/cirurgia , Masculino , Organofosfonatos/uso terapêutico , Plasma/química , Transplante de Pele , Estados UnidosRESUMO
At the onset of the 2003 US monkeypox outbreak, virologic data were unavailable regarding which animal species were involved with virus importation and/or subsequent transmission to humans and whether there was a risk for establishment of zoonotic monkeypox in North America. Similarly, it was unclear which specimens would be best for virus testing. Monkeypox DNA was detected in at least 33 animals, and virus was cultured from 22. Virus-positive animals included three African species associated with the importation event (giant pouched rats, Cricetomys spp.; rope squirrels, Funisciuris sp.; and dormice, Graphiuris sp.). Virologic evidence from North American prairie dogs (Cynomys sp.) was concordant with their suspected roles as vectors for human monkeypox. Multiple tissues were found suitable for DNA detection and/or virus isolation. These data extend the potential host range for monkeypox virus infection and supports concern regarding the potential for establishment in novel reservoir species and ecosystems.
Assuntos
Surtos de Doenças , Monkeypox virus/isolamento & purificação , Mpox/epidemiologia , Zoonoses/epidemiologia , Zoonoses/virologia , Animais , DNA Viral , Ouriços/sangue , Ouriços/virologia , Herpestidae/sangue , Herpestidae/virologia , Macropodidae/sangue , Macropodidae/virologia , Monodelphis/sangue , Monodelphis/virologia , Guaxinins/sangue , Guaxinins/virologia , Roedores/sangue , Roedores/virologia , Estados Unidos/epidemiologiaRESUMO
Monkeypox virus is a zoonotic orthopoxvirus (OPX) of west and central sub-Saharan Africa. We conducted a cross-sectional serosurvey in Likouala region, Republic of Congo to assess exposure to OPX. Whole blood was collected using Nobuto blood filter strips (NBFS). Titers of IgM and IgG to OPX were assessed using an enzyme-linked immunosorbent assay. Demographic and clinical characteristics were compared with serostatus using the chi-square test or Fisher's exact test. Multivariate logistic regression was performed to evaluate factors for independent association with serostatus. A total of 994 specimens were analyzed; the overall seroprevalence for OPX IgM was 1.7%. Age < 25 years reduced the likelihood of OPX exposure, and persons living in Ngangania village had independently higher odds (odds ratio = 33.5, 95% confidence interval = 7.2-166). Blood collection for serosurveys using NBFS is feasible and practical. Adult activities such as hunting and carcass preparation may play an important role in exposure to Monkeypox virus.
Assuntos
Anticorpos Antivirais/sangue , Orthopoxvirus/imunologia , Infecções por Poxviridae/epidemiologia , Adulto , Animais , Congo/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Mpox/epidemiologia , Mpox/imunologia , Monkeypox virus/imunologia , Monkeypox virus/isolamento & purificação , Análise Multivariada , Razão de Chances , Orthopoxvirus/isolamento & purificação , Vigilância da População , Infecções por Poxviridae/imunologia , Estudos Soroepidemiológicos , Zoonoses/epidemiologiaRESUMO
Two distinct smallpox vaccine formulations were exposed to temperatures beyond the ranges specified by the manufacturers for vaccine maintenance and shipping. Under the conditions investigated, titers of both Dryvax smallpox vaccine and Aventis Pasteur smallpox vaccine remained at or above the titers recommended for successful vaccination. From these data it can be inferred that vaccine efficacy would not be expected to be adversely affected by unintended fluctuations of temperature, within the ranges studied, for a 4-day period.
Assuntos
Vacina Antivariólica , Estabilidade de Medicamentos , Armazenamento de Medicamentos , Temperatura , Ensaio de Placa ViralRESUMO
Human monkeypox was first recognized outside Africa in 2003 during an outbreak in the USA that was traced to imported monkeypox virus (MPXV)-infected West African rodents. Unlike the smallpox-like disease described in the Democratic Republic of the Congo (DRC; a Congo Basin country), disease in the USA appeared milder. Here, analyses compared clinical, laboratory and epidemiological features of confirmed human monkeypox case-patients, using data from outbreaks in the USA and the Congo Basin, and the results suggested that human disease pathogenicity was associated with the viral strain. Genomic sequencing of USA, Western and Central African MPXV isolates confirmed the existence of two MPXV clades. A comparison of open reading frames between MPXV clades permitted prediction of viral proteins that could cause the observed differences in human pathogenicity between these two clades. Understanding the molecular pathogenesis and clinical and epidemiological properties of MPXV can improve monkeypox prevention and control.
Assuntos
DNA Viral/genética , Genoma Viral , Monkeypox virus/classificação , Filogenia , Infecções por Poxviridae/epidemiologia , Animais , Dados de Sequência Molecular , Monkeypox virus/genética , Fases de Leitura Aberta , Infecções por Poxviridae/diagnóstico , Homologia de Sequência de Aminoácidos , Homologia de Sequência do Ácido NucleicoRESUMO
CONTEXT: During a mass smallpox immunization campaign, vaccine may be exposed to ambient temperatures for extended periods of time. OBJECTIVE: To determine the viability of undiluted and 5x diluted DryVax smallpox vaccine after cycling vaccine in and out of refrigeration for 2 weeks, as might occur during an immunization campaign. DESIGN: Two vials of Dryvax vaccine were reconstituted as per manufacturer's instructions (1x) and two vials were reconstituted using 5x the recommended diluent (5x). Every 12h over 2 weeks, vials were cycled between refrigeration and room temperature (1x-RT, 5x-RT) or ice bath (1x-cold, 5x-cold). Each vial was sampled in triplicate at time of reconstitution and thereafter at 24 or 48 h intervals. MAIN OUTCOME MEASURES: Viability measured by viral plaque forming units per ml (pfu/ml). RESULTS: All four vaccine vials showed a decline in virus titer over the 2-week period but remained well above 10(7)pfu/ml. Compared with titers on the day of reconstitution (day 0), titers at the end of the study (day 14) had declined by 0.4--0.6l og in all vials (Table 1). Linear regression analysis suggested that decay in viral titer occurred more rapidly in vials exposed to room temperature compared with vials kept on ice and in vaccine diluted 1x compared with vaccine diluted 5x. CONCLUSIONS: After 2 weeks, viability was greater than 10(7)pfu/ml, the titer suggested by Frey et al. as necessary to ensure successful vaccination in more than 97% of vaccinees. When removed from refrigeration, keeping the vaccine on ice lowers the decline in titer.
Assuntos
Vacina Antivariólica , Estabilidade de Medicamentos , Armazenamento de Medicamentos , Refrigeração , Temperatura , Vaccinia virus/isolamento & purificação , Ensaio de Placa ViralRESUMO
BACKGROUND: The outbreak of monkeypox in the Midwestern United States during June 2003 marks the first documented human infection in the Western Hemisphere. Consistent with those in outbreaks in Africa, most cases in this outbreak were associated with febrile rash illness. We describe a cluster of monkeypox in a family with a spectrum of clinical illness, including encephalitis, and outline the laboratory confirmation of monkeypox. METHODS: Standardized patient information was collected by questionnaire and medical chart review; all cases described were laboratory confirmed. Laboratory methods included nucleic acid detection, viral culture, serologic testing, histopathologic evaluation, and immunohistochemical testing. RESULTS: Of 3 family members with monkeypox, 2 had rash illness only, and 1 required hospitalization for severe encephalitis. The family member with the mildest clinical course had previously received smallpox vaccination. Diagnostic testing by both polymerase chain reaction and culture revealed infectious monkeypox virus in skin lesions of all 3 patients; 2 patients had orthopoxvirus detected by immunohistochemistry in skin lesions. The patient with encephalitis had orthopoxvirus-reactive immunoglobulin M (IgM) in cerebrospinal fluid. All patients had detectable IgM responses to orthopoxvirus antigens. CONCLUSIONS: These 3 patients illustrate a spectrum of clinical illness with monkeypox despite a common source of exposure; manifestation and severity of illness may be affected by age and prior smallpox vaccination. We report that monkeypox, in addition to causing febrile rash illness, causes severe neurologic infection, and we discuss the use of novel laboratory tests for its diagnosis.
Assuntos
Mpox , Adulto , Anticorpos Antivirais/sangue , Criança , Análise por Conglomerados , Encefalite Viral/virologia , Ensaio de Imunoadsorção Enzimática , Exantema , Saúde da Família , Feminino , Febre , Humanos , Imunoglobulina M/sangue , Masculino , Meio-Oeste dos Estados Unidos , Mpox/diagnóstico , Mpox/epidemiologia , Mpox/patologia , Mpox/virologia , Monkeypox virus/isolamento & purificação , Reação em Cadeia da Polimerase , Pele/patologia , Cultura de VírusRESUMO
Carrion's disease is caused by infection with the alpha-proteobacterium Bartonella bacilliformis. Distribution of the disease is considered coincident with the distribution of its known vector, the sand fly Lutzomyia verrucarum. Recent epidemics of B. bacilliformis infections associated with atypical symptomatology in nonendemic regions have raised questions regarding the historic and present distribution of this bacterium and the scope of disease that infection causes. Phylogenetic relationships and genomic diversity of 18 B. bacilliformis isolates (10 isolates from a region where Carrion's disease is epidemic, Cuzco, Peru, and 8 isolates from a region where Carrion's disease is endemic, Caraz, Peru) were assessed using genomic data generated by infrequent restriction site PCR and gene sequence analysis of the flagellin gltA and ialB genes. A population genetic analysis of the genomic diversity suggests that what was once considered an epidemic region of Peru did not result from the recent introduction of B. bacilliformis.