Pharyngeal Co-Infections with Monkeypox Virus and Group A Streptococcus, United States, 2022

Abstract

We report 2 cases of pharyngeal monkeypox virus and group A Streptococcus co-infection in the United States. No rash was observed when pharyngitis symptoms began. One patient required intubation before mpox was diagnosed. Healthcare providers should be aware of oropharyngeal mpox manifestations and possible co-infections; early treatment might prevent serious complications.

Keywords: Group A Streptococcus; Streptococcus pyogenes; bacteria; co-infection; monkeypox; monkeypox virus; mpox; pharyngeal disease; pharynx; streptococci; viruses; zoonoses.

Figure 1

Computed tomography scans of patient’s neck in study of pharyngeal co-infections with monkeypox virus and group A Streptococcus, United States, 2022. A) Sagittal view of neck of patient A (39-year-old man) showing massive cervical lymphadenopathy (red circle and arrow). B) Axial view of hypopharynx of patient A after intubation with endotracheal tube. Asterisks show enlarged cervical lymph nodes. Patient was dependent on endotracheal tube because of soft tissue edema along the airway. ET, endotracheal tube; OGT, orogastric tube.

Figure 2

Video laryngoscopy images of patient larynx and pharynx in study of pharyngeal co-infections with monkeypox virus and group A Streptococcus, United States, 2022. A) View of oropharynx, hypopharynx, and laryngeal inlet of patient A (39-year-old man). Arrows indicate mpox lesions. B) Detailed view of mpox lesions. Arrows indicate several lesions. EP, epiglottis; ET, endotracheal tube; OP, oropharynx (lateral wall); T, tongue.