Diagnosis of Imported Monkeypox, Israel, 2018

Abstract

We report a case of monkeypox in a man who returned from Nigeria to Israel in 2018. Virus was detected in pustule swabs by transmission electron microscopy and PCR and confirmed by immunofluorescence assay, tissue culture, and ELISA. The West Africa monkeypox outbreak calls for increased awareness by public health authorities worldwide.

Keywords: Israel; Monkeypox; West Africa; disease outbreaks; monkeypox virus; orthopoxvirus; outbreak; transmission electron microscopy; viruses; zoonoses.

Figure 1

Dermal manifestations of monkeypox on patient in Israel, 2018. Maculopapular rash was apparent on the face (A) and body on the day of hospital admission. A lesion on the left proximal extremity (B) was suspected to be a rickettsial eschar. After 3 days, the rash changed into vesicles and pustules on the face (C) and body (D). Skin resolution was apparent 13 days after admission; pustules and vesicles crusted and were shed (E, F). G) Timeline of disease progression.

Figure 2

Transmission electron microscopy and cell culture–based diagnosis of monkeypox in patient in Israel, 2018. Virus particles were detected in lesion samples as either virion aggregates (arrows) (A) or individual virions (B) with a typical brick shape. Infected Vero cells depicted typical cytopathic effect, exhibiting cell detachment and rounding. Scale bar in A indicates 0.2 μm; scale bar in B indicates 100 nm. C) Infected Vero cells depicting typical cytopathic effect: cell detachment and rounding. Original magnification ×10. D) Immunofluorescent staining of infected Vero cells: DNA (DAPI [4′,6-diamidino-2-phenylindole] stain) and monkeypox virus; viral factories are evident (arrows). Original magnification ×25.