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Mpox—A Rapidly Evolving Disease

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1 Credit CME
Abstract

The 2022 mpox outbreak has rapidly emerged onto the global medical scene while the world continues to grapple with the COVID-19 pandemic. Unlike COVID-19, however, most patients with mpox present with skin findings, the evolving clinical presentation of which may be mistaken for other common skin diseases, particularly sexually transmitted infections. This Special Communication provides an overview of the evolution of mpox skin findings from its initial description in humans in 1970 to the present-day multinational outbreak.

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Article Information

Accepted for Publication: January 10, 2023.

Published Online: February 9, 2023. doi:10.1001/jamadermatol.2023.0041

Corresponding Author: Edward W. Cowen, MD, MHSc, Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 10 Center Dr, Bethesda, MD 20892 (cowene@mail.nih.gov).

Author Contributions: Dr Cowen had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Cowen, Tkaczyk, Leslie.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Obtained funding: Tkaczyk.

Administrative, technical, or material support: Tkaczyk, Leslie.

Supervision: Cowen, Tkaczyk.

Conflict of Interest Disclosures: Dr Tkaczyk reported receiving grants from the US Department of Veterans Affairs and National Institutes of Health during the conduct of the study. No other disclosures were reported.

Funding/Support: This research was supported by the Intramural Research Program of the National Institute of Arthritis and Musculoskeletal and Skin Diseases and a Career Development Award from US Department of Veterans Affairs Clinical Sciences R&D Service (IK2 CX001785).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank the patient in eFigure 2 for granting permission to publish this information. We also thank Madeline Marks, BS, for her assistance composing Figure 1; Monica Valentin, MD, and Christen Samaan, MD, for assistance composing the Table; and Jason Zucker, MD, for additional clinical images. The individuals were not compensated for these contributions.

References
1.
Reed  KD , Melski  JW , Graham  MB ,  et al.  The detection of monkeypox in humans in the Western Hemisphere.   N Engl J Med. 2004;350(4):342-350. doi:10.1056/NEJMoa032299PubMedGoogle ScholarCrossref
2.
Sale  TA , Melski  JW , Stratman  EJ .  Monkeypox: an epidemiologic and clinical comparison of African and US disease.   J Am Acad Dermatol. 2006;55(3):478-481. doi:10.1016/j.jaad.2006.05.061PubMedGoogle ScholarCrossref
3.
Reynolds  MG , Yorita  KL , Kuehnert  MJ ,  et al.  Clinical manifestations of human monkeypox influenced by route of infection.   J Infect Dis. 2006;194(6):773-780. doi:10.1086/505880PubMedGoogle ScholarCrossref
4.
Happi  C , Adetifa  I , Mbala  P ,  et al.  Urgent need for a non-discriminatory and non-stigmatizing nomenclature for monkeypox virus.   PLoS Biol. 2022;20(8):e3001769. doi:10.1371/journal.pbio.3001769PubMedGoogle ScholarCrossref
5.
von Magnus  P , Andersen  EK , Petersen  KB , Birch-Andersen  A .  A pox-like disease in cynomolgus monkeys.   Acta Pathologica Microbiologica Scandinavica. 1959;46(2):156-176. doi:10.1111/j.1699-0463.1959.tb00328.xGoogle ScholarCrossref
6.
Gessain  A , Nakoune  E , Yazdanpanah  Y .  Monkeypox.   N Engl J Med. 2022;387(19):1783-1793. doi:10.1056/NEJMra2208860PubMedGoogle ScholarCrossref
7.
Bunge  EM , Hoet  B , Chen  L ,  et al.  The changing epidemiology of human monkeypox—a potential threat? a systematic review.   PLoS Negl Trop Dis. 2022;16(2):e0010141. doi:10.1371/journal.pntd.0010141PubMedGoogle ScholarCrossref
8.
Tarín-Vicente  EJ , Alemany  A , Agud-Dios  M ,  et al.  Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study.   Lancet. 2022;400(10353):661-669. doi:10.1016/S0140-6736(22)01436-2PubMedGoogle ScholarCrossref
9.
Gigante  CM , Korber  B , Seabolt  MH ,  et al.  Multiple lineages of monkeypox virus detected in the United States, 2021-2022.   Science. 2022;378(6619):560-565. doi:10.1126/science.add4153PubMedGoogle ScholarCrossref
10.
Centers for Disease Control and Prevention. Additional testing of biopsy tissues in severe mpox infections. Updated October 31, 2022. Accessed January 19, 2023. https://www.cdc.gov/poxvirus/monkeypox/clinicians/prep-collection-specimens/biopsies.html
11.
Pittman  R , Martin  JW , Kingebeni  PM ,  et al.  Clinical characterization of human monkeypox infections in the Democratic Republic of the Congo.   medRxiv. Preprint posted online May 29, 2022. doi:10.1101/2022.05.26.22273379Google Scholar
12.
Kozlov  M .  How deadly is monkeypox? what scientists know.   Nature. 2022;609(7928):663. doi:10.1038/d41586-022-02931-1PubMedGoogle ScholarCrossref
13.
World Health Organization. 2022 Mpox (monkeypox) outbreak: global trends. Updated December 27, 2022. Accessed December 27, 2022. https://worldhealthorg.shinyapps.io/mpx_global/
14.
Likos  AM , Sammons  SA , Olson  VA ,  et al.  A tale of two clades: monkeypox viruses.   J Gen Virol. 2005;86(Pt 10):2661-2672. doi:10.1099/vir.0.81215-0PubMedGoogle ScholarCrossref
15.
Jezek  Z , Fenner  F .  Human monkeypox.   Monogr Virol. 1988;17:1-140.Google ScholarCrossref
16.
Tecovirimat for treatment of monkeypox virus. ClinicalTrials.gov identifier: NCT05559099. Updated October 27, 2022. Accessed January 19, 2023. https://clinicaltrials.gov/ct2/show/NCT05559099
17.
McNeil  AJ , House  DW , Mbala-Kingebeni  P ,  et al.  Counting monkeypox lesions in patient photographs: limits of agreement of manual counts and artificial intelligence.   J Invest Dermatol. Published online September 15, 2022. doi:10.1016/j.jid.2022.08.044PubMedGoogle ScholarCrossref
18.
Thornhill  JP , Barkati  S , Walmsley  S ,  et al; SHARE-net Clinical Group.  Monkeypox virus infection in humans across 16 countries—April-June 2022.   N Engl J Med. 2022;387(8):679-691. doi:10.1056/NEJMoa2207323PubMedGoogle ScholarCrossref
19.
Rojek  A , Dunning  J , Olliaro  P .  Monkeypox: how will we know if the treatments work?   Lancet Infect Dis. 2022;22(9):1269-1270. doi:10.1016/S1473-3099(22)00514-XPubMedGoogle ScholarCrossref
20.
Mols  JF , Ledent  E , Heineman  TC .  Sampling of herpes zoster skin lesion types and the impact on viral DNA detection.   J Virol Methods. 2013;188(1-2):145-147. doi:10.1016/j.jviromet.2012.12.013PubMedGoogle ScholarCrossref
21.
Centers for Disease Control and Prevention. Tips for adequate collection of a lesion specimen from a suspect monkeypox virus case. Accessed December 27, 2022. https://www.cdc.gov/poxvirus/monkeypox/pdf/mpox-adequatespecimencollection_508.pdf
22.
Mendoza  R , Petras  JK , Jenkins  P ,  et al.  Monkeypox virus infection resulting from an occupational needlestick—Florida, 2022.   MMWR Morb Mortal Wkly Rep. 2022;71(42):1348-1349. doi:10.15585/mmwr.mm7142e2PubMedGoogle ScholarCrossref
23.
Carvalho  LB , Casadio  LVB , Polly  M ,  et al.  Monkeypox virus transmission to healthcare worker through needlestick injury, Brazil.   Emerg Infect Dis. 2022;28(11):2334-2336. doi:10.3201/eid2811.221323PubMedGoogle ScholarCrossref
24.
Del Río García  V , Palacios  JG , Morcillo  AM , Duran-Pla  E , Rodríguez  BS , Lorusso  N .  Monkeypox outbreak in a piercing and tattoo establishment in Spain.   Lancet Infect Dis. 2022;22(11):1526-1528. doi:10.1016/S1473-3099(22)00652-1PubMedGoogle ScholarCrossref
25.
Scotti  B , Piraccini  BM , Gaspari  V .  Hypertrophic verrucous lesions after monkeypox virus infection.   Lancet Infect Dis. Published online October 26, 2022. doi:10.1016/S1473-3099(22)00695-8PubMedGoogle ScholarCrossref
26.
Miller  MJ , Cash-Goldwasser  S , Marx  GE ,  et al; CDC Severe Monkeypox Investigations Team.  Severe monkeypox in hospitalized patients—United States, August 10-October 10, 2022.   MMWR Morb Mortal Wkly Rep. 2022;71(44):1412-1417. doi:10.15585/mmwr.mm7144e1PubMedGoogle ScholarCrossref
27.
Centers for Disease Control and Prevention. 2022 Mpox outbreak global map. Updated December 22, 2022. Accessed December 23, 2022. https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html
28.
Golden  MR , Wasserheit  JN .  Monkeypox—a sobering sentinel for pandemic preparedness and sexual health system capacity.   N Engl J Med. 2022;387(20):1826-1829. doi:10.1056/NEJMp2212262PubMedGoogle ScholarCrossref
29.
Perez Duque  M , Ribeiro  S , Martins  JV ,  et al.  Ongoing monkeypox virus outbreak, Portugal, 29 April to 23 May 2022.   Euro Surveill. 2022;27(22):2200424. doi:10.2807/1560-7917.ES.2022.27.22.2200424PubMedGoogle ScholarCrossref
30.
Yinka-Ogunleye  A , Aruna  O , Dalhat  M ,  et al; CDC Monkeypox Outbreak Team.  Outbreak of human monkeypox in Nigeria in 2017-18: a clinical and epidemiological report.   Lancet Infect Dis. 2019;19(8):872-879. doi:10.1016/S1473-3099(19)30294-4PubMedGoogle ScholarCrossref
31.
Angelo  KM , Smith  T , Camprubí-Ferrer  D ,  et al; GeoSentinel Network Collaborators.  Epidemiological and clinical characteristics of patients with monkeypox in the GeoSentinel Network: a cross-sectional study.   Lancet Infect Dis. 2022;S1473-3099(22)00651-X. doi:10.1016/S1473-3099(22)00651-XPubMedGoogle ScholarCrossref
32.
Rao  AK , Petersen  BW , Whitehill  F ,  et al.  Use of JYNNEOS (smallpox and monkeypox vaccine, live, nonreplicating) for preexposure vaccination of persons at risk for occupational exposure to orthopoxviruses: recommendations of the Advisory Committee on Immunization Practices—United States, 2022.   MMWR Morb Mortal Wkly Rep. 2022;71(22):734-742. doi:10.15585/mmwr.mm7122e1PubMedGoogle ScholarCrossref
33.
JYNNEOS. Package insert. Updated April 2022. Accessed December 27, 2022. https://www.fda.gov/media/131078/download
34.
Centers for Disease Control and Prevention. JYNNEOS vaccine. Updated December 22, 2022. Accessed December 27, 2022. https://www.cdc.gov/poxvirus/monkeypox/interim-considerations/jynneos-vaccine.html
35.
Payne  AB , Ray  LC , Kugeler  KJ ,  et al.  Incidence of monkeypox among unvaccinated persons compared with persons receiving ≥1 JYNNEOS vaccine dose—32 US jurisdictions, July 31-September 3, 2022.   MMWR Morb Mortal Wkly Rep. 2022;71(40):1278-1282. doi:10.15585/mmwr.mm7140e3PubMedGoogle ScholarCrossref
36.
Centers for Disease Control and Prevention. Interim clinical considerations for use of JYNNEOS and ACAM2000 vaccines during the 2022 US mpox outbreak. Updated October 19, 2022. Accessed December 23, 2022. https://www.cdc.gov/poxvirus/monkeypox/clinicians/vaccines/vaccine-considerations.html
37.
Webb  E , Rigby  I , Michelen  M ,  et al.  Availability, scope and quality of monkeypox clinical management guidelines globally: a systematic review.   BMJ Glob Health. 2022;7(8):e009838. doi:10.1136/bmjgh-2022-009838PubMedGoogle ScholarCrossref
38.
Centers for Disease Control and Prevention. Guidance for tecovirimat use. Updated September 15, 2022. Accessed December 23, 2022. https://www.cdc.gov/poxvirus/monkeypox/clinicians/Tecovirimat.html
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

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It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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