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Letter to the Editor
Skin lesions due to monkeypox virus in a well-controlled HIV patient
Lesiones cutáneas por virus de la viruela del mono en un paciente VIH bien controlado
Francisco Javier Melgosa Ramosa,
Corresponding author
javimelgo2017@gmail.com

Corresponding author.
, Marina Parra Civerab, Jesús José Pons Fusterc
a Department of Dermatology, University Hospital Doctor Peset, Valencia, Spain
b Department of Microbiology, University Hospital Doctor Peset, Valencia, Spain
c Department of Emergency Services, University Hospital Doctor Peset, Valencia, Spain
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Fifteen days after the unprotected anal-sex he developed the lesions accompanied by cough and low-grade-fever&#46; Three months ago&#44; he was also diagnosed of primary syphilis&#44; receiving a single dose of 2&#46;4 million units of benzathine penicillin G administered intramuscularly&#46; Human immunodeficiency virus infection &#40;HIV&#41; had been established 3 years earlier and treated with combined elvitegravir&#47;cobicistat&#47;emtricitabine&#47;tenofovir alafenamide&#44; having an undetectable viral load&#46; He was unvaccinated for smallpox&#46; A physical examination revealed well-circumscribed&#44; bright yellow pustules and vesicles on his face and upper limbs&#44; with mild cervical lymphadenopathy &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Blood test was not remarkable&#46; A serological test for chickenpox was requested&#44; which was negative for IgM and positive for IgG&#46; PCR tests of cytomegalovirus and herpes were also negative&#46; A monkeypox polymerase chain reaction &#40;PCR&#41; from an open pustule was performed&#44; obtaining a positive laboratory-confirmed result&#46; Patient was isolated for 5 weeks and immediately notified to the public health services&#46; He received symptomatic treatment with acetaminophen&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Human monkeypox is an emerging global health threat&#46; Monkeypox is an uncommon zoonosis caused by an Orthopoxvirus recognized as a distinct infection in humans by the 1970s in the Democratic Republic of the Congo&#44;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#8211;3</span></a> and rarely seen outside of West and Central Africa&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Recently&#44; few emerging outbreaks have been reported in developed non-endemic countries&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> Monkeypox virus can be transmitted to humans through direct contact &#40;sexual or skin-to-skin&#41;&#44; respiratory droplets&#44; and virus-contaminated fomites&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;4&#44;5</span></a> Monkeypox is often a self-limiting infection&#46; Mean incubation period ranges from 1 to 4 weeks&#46; An initial febrile prodrome is usually accompanied by asthenia&#44; cutaneous lesions and generalized lymphadenopathy &#40;prior or concomitant with the skin lesions&#41;&#46; Lymphadenopathy could help in the differential diagnosis with smallpox and chickenpox&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;5</span></a> Fever often declines between 1 or 3 days after rash onset&#46; Typical skin lesions include macules&#44; papules&#44; vesicles and pustules&#44; sometimes healing with scar&#46; A wide spectrum of complications has been described &#40;e&#46;g&#46;&#44; diarrhea&#44; keratitis&#44; pneumonia&#41;&#44; and severe complications were found to be more common among unvaccinated than vaccinated patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;3&#44;5</span></a> Case fatality rates vary substantially&#44; ranging from 1&#37; to 10&#37; in the Congo Basin&#44; and less than 3&#37; in Nigeria and developed countries&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;3</span></a> To date&#44; mortality rate seems to be slightly higher in children&#44; immunocompromised and HIV-patients&#46; Cross-reactivity between orthopoxviruses might be a substantial barrier to serological diagnosis of human monkeypox&#44; especially in patients vaccinated to smallpox&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> PCR is the preferred laboratory test given its accuracy and sensitivity&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;5</span></a> Optimal diagnostic samples for monkeypox are vesicles&#44; pustules&#44; and dry crusts&#46; A specific monkeypox vaccine is not available yet&#44;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;5</span></a> but data suggest that prior immunization with smallpox vaccine may have a protective effect against monkeypox virus and may improve clinical prognosis&#46; In most cases of monkeypox supportive care is typically sufficient while antivirals such as tecovirimat&#44; brincidofovir&#44; cidofovir and immune globulin can be considered in severe disease or compromised areas&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;3&#44;5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors&#8217; contributions</span><p id="par0020" class="elsevierStylePara elsevierViewall">All authors have contributed to this research&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Article information
ISSN: 23870206
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos