Epidemiologic characteristics and clinical features of patients with monkeypox virus infection from a hospital in Peru between July and September 2022.

OBJECTIVES: Monkeypox (Mpox) recent outbreak has changed in terms of predominant transmission route and typical presentation. Describing current epidemiological and clinical characteristics is crucial to identifying cases and halting transmission. METHODS: An observational study was conducted at a Peruvian tertiary-level hospital and included all individuals with Mpox virus infection between July 01 and September 03, 2022. RESULTS: Among 205 confirmed cases, 99% (202/205) were men, 94% (192/205) were men who have sex with men or bisexual, and 66% (136/205) were living with HIV. Regarding sexual behavior, 87% (179/205) had a sexual encounter 21 days before consultation, although only 8% (17/205) identified sexual contact with a Mpox confirmed case; 65% (133/205) had sexual intercourse with casual partners, 55% (112/205) reported a last sexual partner unknown, and 21.5% (44/205) continued having sexual intercourse with symptoms. Systemic symptoms were fever (162/205, 79%), malaise (123/205, 60%), headache (119/205, 58%), fatigue (105/205, 52%), and lymphadenopathy (111/205, 54%). The distribution of skin lesions was generalized (166/205, 81%), located in the anogenital area (160/205, 78%), polymorphic (174/205, 85%), and it was the first symptom identified in 46% (94/205) of cases. Overall, 10% (21/205) required hospitalization, of whom 85.7% (18/205) have HIV infection. Complications included bacterial superinfection (n = 18), proctitis (n = 6), balanitis (n = 4), and necrosis of skin lesions (n = 3). CONCLUSION: In 2022, Mpox mainly affects men who have sex with men and People living with HIV/AIDS. It presents with skin lesions localized to the anogenital area and can lead to severe complications requiring hospitalization.

[Coinfection of dengue and leptospirosis in a girl from the peruvian amazon]. / Coinfección por dengue y leptospirosis en una niña de la amazonía peruana.

We report the case of a 10 year old girl, born and raised in the city of Iquitos in Peru who presented with headache, fever, chills, musculoskeletal pain, mild epigastric pain, epistaxis and hematemesis. On physical examination, the patient was afebrile and in good general condition. Serological tests confirmed infection of dengue and leptospirosis. The patient received intravenous hydration with sodium chloride 0.9% and penicillin G sodium, achieving a favorable clinical course such that she was discharged a few days after admission to the hospital. Although these diseases are common in the Peruvian Amazon, the simultaneous presence of both in the pediatric population is little documented; therefore, a good clinical history and laboratory tests are important for diagnosis and treatment.

Coinfección por dengue y leptospirosis en una niña de la Amazonía Peruana / Coinfection of dengue and leptospirosis in a girl from the Peruvian Amazon

Se reporta el caso de una niña de 10 años, natural y procedente de la ciudad de Iquitos en Perú que presentó cefalea, fiebre, escalofríos, dolor osteomuscular, leve dolor en epigastrio, epistaxis y hematemesis. Al examen físico la paciente se encontraba afebril y en regular estado general. Por medio de pruebas serológicas se confirmó la infección por dengue y leptospirosis. La paciente recibió hidratación endovenosa con cloruro de sodio al 0,9% y penicilina G sódica, logrando una evolución clínica favorable por lo que fue dada de alta a los pocos días de su ingreso al hospital. Aunque estas dos enfermedades son comunes en la Amazonía peruana, la presencia simultánea de ambas en la población pediátrica es poco documentada; por ello, una buena historia clínica y exámenes de laboratorio son importantes para el diagnóstico y tratamiento oportuno.

We report the case of a 10 year old girl, born and raised in the city of Iquitos in Peru who presented with headache, fever, chills, musculoskeletal pain, mild epigastric pain, epistaxis and hematemesis. On physical examination, the patient was afebrile and in good general condition. Serological tests confirmed infection of dengue and leptospirosis. The patient received intravenous hydration with sodium chloride 0.9% and penicillin G sodium, achieving a favorable clinical course such that she was discharged a few days after admission to the hospital. Although these diseases are common in the Peruvian Amazon, the simultaneous presence of both in the pediatric population is little documented; therefore, a good clinical history and laboratory tests are important for diagnosis and treatment.

[Clinical characteristics of patients admitted to hospital "Cesar Garayar García", Iquitos during the dengue epidemic, January-February 2011]. / Características clínicas de pacientes internados en el Hospital de Apoyo de Iquitos "César Garayar García" durante la epidemia de dengue, enero-febrero de 2011.

We conducted a clinical description of confirmed dengue cases admitted to the Hospital " César Garayar García" in Iquitos from January 25 to February 5, 2011. According to current WHO classification, major warning signs leading to hospitalization were: abdominal pain (28/28) and persistent vomiting (15/28), the causes of severity were: hypotension (9 / 13), severe bleeding (6 / 13) and plasma extravasation with respiratory distress (4 / 13). The median patient age was 22 years, however, 8 / 13 patients classified as severe dengue were under 16 years. In conclusion, unlike previous epidemics, we found a high involvement of young people and severity in the clinical presentation predominating a high frequency of shock (hypotension) and vascular leakage, which could be related to the circulation of an emerging variant DENV-2 which is more virulent.

Características clínicas de pacientes internados en el Hospital de Apoyo de Iquitos "César Garayar García" durante la epidemia de dengue, enero-febrero de 2011 / Clinical characteristics of patients admitted to hospital "Cesar Garayar García", Iquitos during the dengue epidemic, January-February 2011

Se realizó una descripción clínica de pacientes con dengue confirmado internados en el Hospital de Apoyo de Iquitos "César Garayar García" desde el 25 de enero al 05 de febrero de 2011. Según la actual clasificación de la OMS, los principales signos de alarma que motivaron hospitalización fueron: dolor abdominal (28/28) y vómitos persistentes (15/28); las causas de gravedad fueron: hipotensión (9/13), sangrado grave (6/13) y extravasación de plasma con dificultad respiratoria (4/13). La mediana de edad de los pacientes fue 22 años, sin embargo, 8/13 pacientes clasificados como dengue grave fueron menores de 16 años. En conclusión, se evidencia una mayor afectación de la población joven y gravedad en la presentación clínica a diferencia de epidemias anteriores, predominando el shock (hipotensión) por extravasación vascular, lo cual podría estar relacionado con la circulación de una variante emergente del DENV-2 con mayor virulencia.

We conducted a clinical description of confirmed dengue cases admitted to the Hospital " César Garayar García" in Iquitos from January 25 to February 5, 2011. According to current WHO classification, major warning signs leading to hospitalization were: abdominal pain (28/28) and persistent vomiting (15/28), the causes of severity were: hypotension (9 / 13), severe bleeding (6 / 13) and plasma extravasation with respiratory distress (4 / 13). The median patient age was 22 years, however, 8 / 13 patients classified as severe dengue were under 16 years. In conclusion, unlike previous epidemics, we found a high involvement of young people and severity in the clinical presentation predominating a high frequency of shock (hypotension) and vascular leakage, which could be related to the circulation of an emerging variant DENV-2 which is more virulent.