The CDC have issued a warning of severe manifestations of monkeypox seen in some patients.
Since May 2022, more than 25,000 monkeypox cases have been identified in the United States.
Some patients with monkeypox in the United States have experienced prolonged hospitalizations or substantial morbidity; deaths have occurred.
During the current outbreak, CDC has received reports of people with monkeypox who have severe manifestations of disease, including but not limited to
- Atypical or persistent rash with coalescing or necrotic lesions, or both, some which have required extensive surgical debridement or amputation of an affected extremity.
- Lesions on a significant proportion of the total body surface area, which may be associated with edema and secondary bacterial or fungal infections among other complications.
- Lesions in sensitive areas (including mucosal surfaces such as, oropharynx, urethra, rectum, vagina) resulting in severe pain that interferes with activities of daily living.
- Bowel lesions that are exudative or cause significant tissue edema, leading to obstruction.
- Severe lymphadenopathy that can be necrotizing or obstructing (such as in airways).
- Lesions leading to stricture and scar formation resulting in significant morbidity such as urethral and bowel strictures, phimosis, and facial scarring.
- Involvement of multiple organ systems and associated comorbidities, including:
- Oropharyngeal lesions inhibiting oral intake
- Pulmonary involvement with nodular lesions
- Neurologic conditions including encephalitis and transverse myelitis
- Cardiac complications including myocarditis and pericardial disease
- Ocular conditions including severe conjunctivitis and sight-threatening corneal ulcerations
- Urologic involvement including urethritis and penile necrosis
Healthcare providers should be aware of risk factors for severe manifestations of monkeypox and should conduct HIV testing for people with confirmed or suspected monkeypox. In prior monkeypox outbreaks in Nigeria, co-infection with HIV was associated with worse clinical outcomes, including severe manifestations of monkeypox, hospitalization, and death.2 Providers should also consider other immunocompromising conditions* and medications that may increase risk of severe manifestation of monkeypox.
CDC: Possible Occupational Infection of Healthcare Workers with Monkeypox Virus, Brazil
On August 3 (5 days after collecting the patient specimens), HCW-1 exhibited a single lesion on her left ring finger, a small macula with central umbilication. qPCR of a specimen collected from HCW-1 on August 4 confirmed MPXV infection. We observed no systemic symptoms or additional lesions until August 10, when HCW-1 experienced increased hyperemia and a small papule appeared lateral to the initial lesion. By August 12, HCW-1 exhibited lymphangitis in her left upper arm and worsened hyperemia; in addition, the lesion on her finger became a bleeding papule. On August 13, HCW-1 still had lymphangitis and a small papule had appeared on her forearm. By August 15, lesion fibrin had increased, and by August 23, fibrin reabsorption with crust formation had occurred.
Long-term Household Contamination With Monkeypox Virus Investigated
An investigation by CDC and state health authorities in Utah found monkeypox virus on many frequently used household surfaces, blankets, furniture, and other objects in a home where residents had been isolating for weeks. Although monkeypox is mainly spread through skin-to-skin contact in the current outbreak, the authors noted that “transmission via contaminated objects or surfaces is also possible.”