New challenges in human monkeypox outside Africa: A review and case report from Italy

Abstract

Background: Human monkeypox (MPX) is a neglected zoonotic disease caused by the MPX virus a double-stranded DNA virus which belongs to the Poxviridae family genus Orthopoxvirus. It is endemic in the rural rainforests of Central and Western Africa where it is responsible of human sporadic cases and outbreaks since 1970. Outside Africa MPXV caused an outbreak in 2003 in the United States linked to importation of infected rodents from Ghana and a few travel-related cases in the USA, United Kingdom, Israel and Singapore. Actually, a worldwide outbreak with more than 1200 confirmed cases mainly concentrated among men who have sex with men is ongoing.

Case report: We present the case of an Italian man living in Portugal that was diagnosed with MPX at our clinic in Milan, Italy. Monkeypox virus infection was confirmed by a specific homemade Real-Time PCR. Samples obtained from different sites (pharynx, skin lesions, anal ulcer, seminal fluid) turned all positive with different viral load.

Conclusions: Our report illustrates the challenge of a disease that seems to present in a different way from classic description with possible human-to-human transmission through sexual contact.

Keywords: Diagnosis; HIV; Italy; Monkeypox; Outbreak.

Fig. 1

A–E. Skin lesions with different appearance obtained at time of diagnosis of MPX. A, buttock. B, perianal ulcerated lesion. C, trunk. D, one of the trunk lesions at major magnification. E, two vesicula/pustular lesion of the arm. F, one foot lesion. Arrows indicate two lesions of the trunk.

Fig. 2

Clinical and virological timeline of the patient affected by monkeypox. Real-Time PCR cycle threshold value indicates the number of PCR cycle required to a positive result. The value is inversely proportional to the viral DNA. Ct value of 40 cycle is the PCR negative cut-off.

Fig. 3

Isolation of Monkeypox virus in Vero E6 cells from skin lesions and oropharyngeal swab. a: mock-infected Vero E6 cells; b: Vero E6 cells at 3 days post-infection; c: Vero E6 cells at 6 days post-infection.