Professor Cristina Mussini, director of Infectious Diseases of the Polyclinic and Unimore professor, is among the signatories of an article, published in the New England Journal of Medicine on the causes and effects of the infection: sexual. It is necessary to move in time and on a global scale ‘
Professor Cristina Mussini, Director of Infectious Diseases at the Polyclinic and UNIMORE professor is among the signatories of an article, published in the prestigious New England Journal of Medicine in July, which studied the spread of Monkeypox in humans in 16 countries. The article is the fruit of the work of an international group of clinicians who have collected a large case series to describe the presentation, clinical course and outcomes of monkeypox virus infections confirmed by the polymerase chain reaction.
“Before April 2022 – explained Cristina Mussini – the infection with monkeypox virus in humans was rarely reported outside the African regions where it is endemic. Currently, cases are occurring all over the world. Transmission, risk factors, clinical presentation and outcomes of infection are poorly defined.
The aim of our work is to fill this gap in our knowledge. “
The study analyzed 528 infections diagnosed between April 27 and June 24, 2022, in 43 areas in 16 countries. Overall, 98% of infected people were homosexual or bisexual men; 75% were white and 41% had human immunodeficiency virus infection; the mean age was 38 years.
“One of our first suspicions – adds Mussini – was that the transmission took place sexually. Indeed, we found concurrent sexually transmitted infections with monkeypox in 109 of the 377 people (29%) who were tested. Among 23 people with a clear history of exposure, the median incubation period was 7 days (range, 3 to 20). This data is not yet decisive to affirm with certainty that sexual transmission is the only form of transmission, also because the virus has been found in various biological fluids such as saliva, urine, faeces and blood. “
In particular, the DNA of the Monkeypox virus was detected in 29 of the 32 people in whom the seminal fluid was analyzed. I stress that the biological fluids of some of our patients included in the study were also analyzed at the microbiological laboratory of the IRCCS Sant’Orsola in Bologna directed by Professor Tiziana Lazzarotto. Antiviral treatment was given to 5% of the people in total and 70 (13%) were hospitalized; the reasons for hospitalization were pain management, mainly due to severe anorectal pain (21 people); soft tissue superinfection (18); pharyngitis that limits oral intake (5); eye injuries (2); acute kidney damage (2); myocarditis (2); and infection control purposes (13). No deaths were reported among the participants in this study.
In this case series, monkeypox manifested with a variety of dermatological and systemic clinical findings. Simultaneous identification of cases outside areas where monkeypox has traditionally been endemic highlights the need for rapid identification, rapid case diagnosis to contain further spread in the community, and vaccine prescribing to populations at increased risk.
“This study – concludes Professor Mussini – is a starting point, a brick of a house of knowledge of this disease that has yet to be built. Our sample of cases referred to people who had symptoms that led them to seek medical attention. Therefore, we did not test the asymptomatic. Symptoms were recorded from the time of presentation and therefore early symptoms may have been underestimated, limiting information on the incubation period. As viruses know no borders, the world needs to move cohesively and quickly to fill knowledge gaps and contain the epidemic that has already reached 14,000 cases since the beginning of the year, with 5 deaths. Without widely available treatment or prophylaxis, rapid case identification is vital for containment. “
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