Due to the current SARS-CoV-2 pandemic and the daily increase in monkeypox cases, experts recommend that health systems be vigilant for this eventuality.
Source: RT in Spanish
Italian doctors and researchers confirmed the diagnosis of the only documented case to date of simultaneous infection with monkeypox virus and SARS-CoV-2 (coronavirus that causes covid-19) in a 36-year-old Italian recently infected with HIV . The find was published last Friday in the Journal of Infection.
The history of the diseases
In their publication, the team of Italian doctors describes that the patient spent five days in Spain in June 2022. Nine days after his return, he presented a high fever accompanied by a sore throat, fatigue, headache and swollen glands. groin. In early July he tested positive for SARS-CoV-2 and began to develop a rash on his left arm.
In the following days, small painful vesicles appeared on the torso, lower limbs, face and buttocks, which continued to progress slowly to pustules. For this reason he went to the emergency room and was later immediately transferred to an infectious disease unit.
The patient reported being vaccinated against SARS-CoV-2 with two doses of Pfizer’s BNT162b2 vaccine (the last one in December 2021) and that he had already contracted covid-19 in January 2022. He also reported having had sexual intercourse without condom with men during his stay in Spain and that in a test carried out in September last year he was negative for HIV infection.
Given the high suspicion of monkeypox supported by suggestive skin lesions and his recent trip to Spain, pustule exudate swabs and nasopharyngeal secretions were sent to Italian diagnostic laboratories for monkeypox orthopoxvirus detection and sequencing. of SARS-CoV-2. Both viruses were confirmed in the analyzes of these samples.
Serologic tests for sexually transmitted infections viral hepatitis, herpes simplex, gonorrhea, chlamydia, and lymphogranuloma venereum were negative. However, the one for HIV-1 was positive. Since her viral load was not very high and her CD4 cell count remained within normal ranges, doctors assume that her HIV infection was relatively recent.
Although symptoms had resolved by day 6 of the first symptoms, and the patient was discharged to home isolation, the monkeypox oropharyngeal smear was still positive after 20 days, suggesting that these individuals may still be contagious. for several days after clinical remission.
recommendations
Study lead author Santi Nolasco, a doctoral student at the Department of Clinical and Experimental Medicine at the University of Catania, and colleagues wrote that due to the ongoing SARS-CoV-2 pandemic and the daily increase in smallpox cases of the ape, health systems must be attentive to this eventuality. In this sense, they should promote adequate diagnostic tests in high-risk subjects, which are essential for containment since there is no widely available treatment or prevention.
They noted that this particular case emphasizes that sexual intercourse may be the predominant route of transmission, thus recommending full screening for sexually transmitted infections after a diagnosis of monkeypox.
In their publication they also highlight how the monkeypox disease and the symptoms of covid-19 can overlap, and corroborate how, in the case of co-infection, the anamnestic collection (the clinical examination that is carried out through questioning) and sexual habits are crucial for making the correct diagnosis. This possibility of coinfection is particularly high in subjects with a recent history of travel to areas where there have been outbreaks of monkeypox.
