Letter - Tropical/infectious and parasitic dermatology
2022 Mpox (monkeypox) outbreak: a concise review focused on new features of dermatological lesions
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"tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "564" "paginaFinal" => "567" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2322 "Ancho" => 1675 "Tamanyo" => 775108 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Amastigote parasites inside macrophages (yellow arrow; Hematoxylin & eosin, ×400). (B) Amastigote parasites inside macrophages (Hematoxylin & eosin, ×1000).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Cindy Tiemi Matsumoto, Milvia Maria Simões e Silva Enokihara, Marília Marufuji Ogawa, Samira Yarak" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Cindy Tiemi" "apellidos" => "Matsumoto" ] 1 => array:2 [ "nombre" => "Milvia Maria Simões e Silva" "apellidos" => "Enokihara" ] 2 => array:2 [ "nombre" => "Marília Marufuji" "apellidos" => "Ogawa" ] 3 => array:2 [ "nombre" => "Samira" "apellidos" => "Yarak" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275223000590" "doi" => "10.1016/j.abdp.2023.03.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223000590?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623000508?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000004/v1_202307031010/S0365059623000508/v1_202307031010/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Tropical/infectious and parasitic dermatology</span>" "titulo" => "2022 Mpox (monkeypox) outbreak: a concise review focused on new features of dermatological lesions" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "568" "paginaFinal" => "570" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Elena Lucía Pinto-Pulido, Miriam Fernández-Parrado, Francisco José Rodríguez-Cuadrado" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Elena Lucía" "apellidos" => "Pinto-Pulido" "email" => array:1 [ 0 => "elucia.pinto95@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Miriam" "apellidos" => "Fernández-Parrado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Francisco José" "apellidos" => "Rodríguez-Cuadrado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Dermatology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Dermatology, Hospital Universitario de Navarra, Pamplona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Dermatology, Hospital Universitario Puerta de Hierro, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1192 "Ancho" => 1508 "Tamanyo" => 280815 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical image. Perianal whitish papules with a necrotic center (pseudopustules).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Since May 2022, more than 84.000 monkeypox or mpox, confirmed cases have been reported from 110 different countries. Previously, mpox was confined to West and Central Africa, with few cases outside this region, always epidemiologically connected with African countries.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> As well as epidemiological changes, clinical differences have also been reported with respect to the typical clinical picture previously described in endemic countries.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We collected clinical and epidemiologic 2022 mpox data from the World Health Organization (WHO) official website and from PubMed-indexed articles published between June 2022 and January 2023. We selected case series of at least 185 patients which included detailed descriptions of dermatologic findings. We also included studies focusing on the histologic, sonographic, dermatoscopic, and genetic features.</p><p id="par0015" class="elsevierStylePara elsevierViewall">According to data provided by the WHO, 96.6% of 2022 cases are men and among them, 84.2% were Men who have Sex with Men (MSM). Sexual relations were the most reported mechanism of transmission (69.9%) and party setting with sexual contacts was the most likely exposure category (46.8%).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The proportion of MSM infection in large case series is even higher (99.8%‒100% men and 98%‒99% MSM), with an HIV positivity of 35.5%‒42%. Between 29% and 76% had a sexually transmitted concurrent infection.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a> These data, together with the preference of mucocutaneous lesions to settle in genital and perianal areas suggest contact during sexual intercourse as the main transmission mechanism.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Before May 2022, preference for MSM had not been observed. Previously recognized mechanisms of transmission were contact with an infected animal or with respiratory droplets, body fluids, mucosa, skin lesions, and fomites from an infected person.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Classic mpox clinical picture described before this outbreak began with a prodromal phase with fever, malaise, and lymphadenopathy. Afterward, a skin rash appeared, characterized by the sequential synchronous evolution of lesions from macules to papules, vesicles, and pustules.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> A high number of skin lesions was described (mean of 370 in a study from the 2007‒2011 Democratic Republic of the Congo outbreak).<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> According to large 2022 case series reports, the prodromal period was only present in about half of the patients (36%‒61.5%), whereas the rest of them had no systemic symptoms or developed them after or at the same time as skin lesions. Fever was present in 54%‒62% and lymphadenopathy in 56%‒57.9%. Preferred localization for mucocutaneous lesions was genital or genitoanal area (53%‒56.4% genital, 34%‒41.6% perianal, 73%‒88.3% genital and/or perianal lesions).<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> A median of 5 lesions was reported<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> with less than 20‒25 lesions in the majority of patients (85%‒93%).<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">A significant number of patients (35.5%‒47%) showed cutaneous lesions at different stages.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Catala et al. described lesions in the likely inoculation areas as whitish papules that simulate pustules (pseudopustules), with a necrotic center (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). They are not true pustules as they have solid content instead of liquid purulent content.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Ultrasound descriptions support this appreciation as they do not show liquid but solid inflammatory lesions with marked intralesional vascularity (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Dermatoscopic features of these pseudopustules consist of a reddish-crusted hemorrhagic center with a whitish ring surrounded by an erythematous area (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Histologically, the aforementioned lesions are characterized by full-thickness epidermal necrosis, keratinocyte ballooning and eosinophilic cytoplasmic inclusions (Guarnieri’s inclusion bodies), together with a significant predominantly lymphocytic inflammatory infiltrate (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> After these initial lesions, an eruption of vesicular and true small pustular lesions can occur, while macular rashes are rarer.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> WHO has reported 81 deaths,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> considerably less than previously reported mortality of 3.3%‒10.6%.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Genome sequencing indicates that the monkeypox virus responsible for the 2022 outbreak corresponds to clade IIb (West African clade) and has phylogenetic linkage with previous 2018‒2019 cases. However, it constitutes a distinct phylogenetic branch (lineage B.1) with a higher number of genetic mutations than expected for Orthopoxviruses.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> This could be a concern in terms of immunization after suffering the disease and vaccination efficacy in future outbreaks. However, based on the course of the outbreak with a quick decrease in the number of cases, it appears that the smallpox vaccine provides cross-immunity, as theoretical studies had already suggested.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, as well as epidemiological changes, clinical differences have also been reported with respect to the clinical picture previously described in endemic countries. It remains to be determined whether these changes are due to virus genetic mutations, a different mechanism of transmission, distinct baseline characteristics of affected patients compared to those of endemic countries, or, more likely, by a combination of all these factors. Detailed dermatological description of lesions is essential for an accurate diagnosis since pseudopustules with a necrotic-hemorrhagic center are infrequent in other dermatological disorders.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors' contributions</span><p id="par0045" class="elsevierStylePara elsevierViewall">Elena Lucía Pinto-Pulido: Approval of the final version of the manuscript; critical literature review; data collection, analysis, and interpretation; effective participation in research orientation; preparation and writing of the manuscript; study conception and planning.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Miriam Fernández-Parrado: Approval of the final version of the manuscript; critical literature review; data collection, analysis, and interpretation; effective participation in research orientation; manuscript critical review; study conception and planning.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Francisco José Rodríguez-Cuadrado: Approval of the final version of the manuscript; critical literature review; data collection, analysis, and interpretation; effective participation in research orientation; manuscript critical review; study conception and planning.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors' contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-01-23" "fechaAceptado" => "2023-02-14" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Hospital Universitario Príncipe de Asturias, Madrid, Spain; Hospital Universitario de Navarra, Pamplona, Spain and Hospital Universitario Puerta de Hierro, Madrid, Spain.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1192 "Ancho" => 1508 "Tamanyo" => 280815 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical image. Perianal whitish papules with a necrotic center (pseudopustules).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1684 "Ancho" => 1675 "Tamanyo" => 309666 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Ultrasound findings (22<span class="elsevierStyleHsp" style=""></span>Hz). Color-Doppler of a pseudopustule that highlights the marked intralesional vascularization, together with dermo-epidermal thickening and focal dermo-hypodermal hypoechogenicity.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1231 "Ancho" => 1508 "Tamanyo" => 315153 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0045" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dermatoscopic image. Pubic pseudopustule with reddish crusted center surrounded by a whitish ring.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1258 "Ancho" => 1675 "Tamanyo" => 616109 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0050" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Histologic features (Hematoxylin & eosin, ×400). Epidermal keratinocytes with balloon cell degeneration together with a predominantly lymphocytic inflammatory infiltrate at the edges of the lesion.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "worldhealthorg.shinyapps [Internet]. Genebra. World Health Organization. 2022 Mpox (monkeypox) outbreak: global trends. [cited 2023 Jan 23]. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 18 | 3 | 21 |
| 2024 Outubro | 127 | 64 | 191 |
| 2024 Setembro | 155 | 73 | 228 |
| 2024 Agosto | 186 | 111 | 297 |
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| 2024 Abril | 113 | 83 | 196 |
| 2024 Março | 78 | 71 | 149 |
| 2024 Fevereiro | 107 | 87 | 194 |
| 2024 Janeiro | 73 | 40 | 113 |
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| 2023 Novembro | 77 | 91 | 168 |
| 2023 Outubro | 92 | 90 | 182 |
| 2023 Setembro | 81 | 92 | 173 |
| 2023 Agosto | 92 | 36 | 128 |
| 2023 Julho | 212 | 74 | 286 |
| 2023 Junho | 88 | 44 | 132 |
| 2023 Maio | 58 | 22 | 80 |
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