Mpox (Monkeypox) Proctitis

Monkeypox: Considerations as a New Pandemic Looms

Poxviruses are large (200-450 nm) and enveloped viruses carrying double-stranded DNA genome with an epidermal cell-specific adaptation. The genus Orthopoxvirus within Poxviridae family constitutes several medically and veterinary important viruses including variola (smallpox), vaccinia, monkeypox virus (MPXV), and cowpox. The monkeypox disease (mpox) has recently emerged as a public health emergency caused by MPXV. An increasing number of human cases of MPXV have been documented in non-endemic nations without any known history of contact with animals brought in from endemic and enzootic regions, nor have they involved travel to an area where the virus was typically prevalent. Here, we review the MPXV replication, virus pathobiology, mechanism of viral infection transmission, virus evasion the host innate immunity and antiviral therapies against Mpox. Moreover, preventive measures including vaccination were discussed and concluded that cross-protection against MPXV may be possible using antibodies that are directed against an Orthopoxvirus. Despite the lack of a specialised antiviral medication, several compounds such as Cidofovir and Ribavirin warrant consideration against mpox.

Several infections have emerged in humans, domestic animals, wildlife, and plant populations, causing a severe problem for humanity. Since the discovery of the Monkeypox virus (Mpox) in 1958 in Copenhagen, Denmark, it has resurfaced several times, producing severe infections in humans and resulting in a significant fatality rate. Mpox is an Orthopoxvirus of the Poxviridae family. This family contains various medically important viruses. The natural reservoir of Mpox is unknown yet. Mpox might be carried by African rodents and nonhuman primates (such as monkeys). The role of monkeys has been confirmed by its various outbreaks. The infection may be transferred from unidentified wild animals to monkeys, who can then spread it to humans by crossing species barriers. In close contact, human-to-human transmission is also possible. Mpox outbreaks have been documented regularly in Central and Western Africa, but recently in 2022, it has spread to over one hundred-six countries. There is no specific treatment for it, although the smallpox vaccine, antivirals, and vaccinia immune globulin help in the effective management of Mpox. In conclusion: Monkeypox poses a severe threat to public health due to the lack of specific vaccinations and effective antivirals. Surveillance studies in affected regions can assist in the early diagnosis of disease and help to control significant outbreaks. The present review provides information on epidemiology, clinical symptoms, risk factors, diagnosis, and preventive measures of Mpox.

Background: Monkeypox disease (MPOX) recently re-emerged in May 2022, causing international outbreaks in multiple non-endemic countries. This study demonstrates a novel comparison between the knowledge and perceptions of Saudi healthcare workers (HCWs) and the general public regarding MPOX. Methods: An online survey, conducted from 27 May to 5 June 2022, assessing participants’ MPOX and monkeypox virus (MPV) knowledge in terms of transmission, vaccination, isolation precautions, and their attitudes toward seeking more information. Results: A total of 1546 members of the public and 1130 HCWs completed the survey. Briefly, 61.3% of the public and 74.2% of HCWs showed interest in seeking more information about MPOX. Both groups had average overall mean MPOX knowledge scores. Members of the public holding university degrees and those showing high levels of worry regarding MPOX had significantly higher knowledge scores. However, HCWs showed a poor vaccination knowledge score, while only 57% recognized that MPOX can present similarly to COVID-19 in the early stages. Female HCWs and those with high self-rated MPOX awareness had significantly high knowledge scores. HCWs in secondary and tertiary centers had significantly higher knowledge scores. Conclusion: Both groups showed a decent attitude in terms of seeking more MPOX knowledge, which correlated positively with their worry about and awareness of the disease. These observations are mostly as a consequence of the ongoing COVID-19 pandemic, which encouraged the public and HCW to acquire more information about any novel emerging disease. Policymakers should make the most of this attitude in their awareness campaigns to prevent the spread of the disease and encourage vaccination in cases where it is needed. The knowledge gaps among HCWs were most evident in terms of clinical presentation and vaccinations; this problem needs addressing if we are to avoid further emerging MPOX cases.

The monkeypox virus (MPXV) that causes the monkeypox disease, was first discovered in 1958 This double-stranded DNA virus shares the Orthopox genus of the Poxviridae family with Smallpoxvirus This article is protected by copyright. All rights reserved.

Infection with the monkeypox virus is more prevalent among genus Funisciurus squirrels, less prevalent among genus Heliosurus squirrels, and rare among forest monkeys. These squirrels inhabit secondary woods close to human settlements in rural Zaire, particularly where oil palm is cultivated. In Prime Rain Forest, they are in short supply. The monkeypox virus often affects children between the ages of 5 and 9, particularly in rural settings where children hunt and consume squirrels and other small animals. Animal husbandry will minimize the danger and occurrence of human monkeypox, even in areas where the virus has spread to squirrels, as the human population grows and relies primarily on animals for animal protein. Population expansion and economic development in West and Central Africa may lessen the danger of monkeypox infection in people, but visitors who interact with animals should be vaccinated against smallpox. The spread of monkeypox can be stopped by measures such as post-exposure vaccination, contact tracing, case identification, and isolation of infectious patients. The recent monkeypox incidence is of further concern in light of the current COVID-19 pandemic.

The reemergence of monkeypoxvirus (MPXV) in 2017 after about 39 years of no reported cases in Nigeria, and the recent incidence in countries such as the United States of America, United Kingdom, Singapore, and Israel which have been reportedly linked with travelers from Africa, have heightened concern that MPXV may have emerged to occupy the vacant ecological and immunological niche created by the extinct smallpox virus. This study was carried out to identify environmental conditions and areas that are environmentally suitable (risky areas) for MPXV in southern Nigeria. One hundred and sixteen (116) spatially unique MPXV occurrence data from 2017–2021 and corresponding environmental variables were spatially modeled by a maximum entropy algorithm to evaluate the contribution of the variables to the distribution of the viral disease. A variance inflation analysis was adopted to limit the number of environmental variables and minimize multicollinearity. The five variables that contributed to the suitability model for MPXV disease are precipitation of driest quarter (47%), elevation (26%), human population density (17%), minimum temperature in December (7%), and maximum temperature in March (3%). For validation, our model had a high AUC value of 0.92 and standard deviation of 0.009 indicating that it had excellent ability to predict the suitable areas for monkeypox disease. Categorized risk classes across southern states was also identified. A total of eight states were predicted to be at high risk of monkeypox outbreak occurrence. These findings can guide policymakers in resources allocation and distribution to effectively implement targeted control measures for MPXV outbreaks in southern Nigeria.

In 2022–23, the human monkeypox virus (MPXV) caused a global outbreak in several non-endemic countries. Here, we evaluated the diagnostic performance of four real-time qualitative PCR assays for the laboratory diagnosis of mpox (monkeypox) monkeypox disease. From July to August 2022, 27 positive and 10 negative specimens (lesion, crust and exudate swabs) were tested in the laboratory of the Hygiene Unit of the San Martino Hospital (Genoa, Italy) by using home-made real-time PCR to detect MPXV generic G2R_G DNA. According to the manufacturer’s instructions, we also retrospectively analyzed these specimens using RealCycler MONK-UX/-GX (Progenie Molecular), STANDARD M10 MPX/OPX (SD Biosensor), Novaplex MPXV (Seegene Inc.) and RealStar Orthopoxvirus PCR Kit 1.0 (Altona Diagnostics) assays, recognized as research-use-only tests. The diagnostic accuracy and sensitivity of these assays ranged from 97.3% (95% CI: 86.2–99.5%) to 100% (95% CI: 90.6–100%) and 96.3% (95% CI: 81.72–99.34%) to 100% (95% CI: 72.2–100%), respectively. The RealCycler MONK-UX and STANDARD M10 MPX/OPX did not detect one positive sample with a cycle threshold of 36. The overall specificity was 100% (95% CI: 72.2–100%), and Cohen’s Kappa values ranged from 1 (95% CI: 0.67–1) to 0.93 (95% CI: 0.61–1). As they are highly accurate, reliable and user-friendly, these tests should be recommended for the routine or rapid laboratory discrimination of mpox from other rash illnesses.

APOBEC3, an enzyme subfamily that plays a role in virus restriction by generating mutations at particular DNA motifs or mutational “hotspots,” can drive viral mutagenesis with host-specific preferential hotspot mutations contributing to pathogen variation. While previous analysis of viral genomes from the 2022 Mpox (formerly Monkeypox) disease outbreak has shown a high frequency of C>T mutations at TC motifs, suggesting recent mutations are human APOBEC3-mediated, how emerging monkeypox virus (MPXV) strains will evolve as a consequence of APOBEC3-mediated mutations remains unknown. By measuring hotspot under-representation, depletion at synonymous sites, and a combination of the two, we analyzed APOBEC3-driven evolution in human poxvirus genomes, finding varying hotspot under-representation patterns. While the native poxvirus molluscum contagiosum exhibits a signature consistent with extensive coevolution with human APOBEC3, including depletion of TC hotspots, variola virus shows an intermediate effect consistent with ongoing evolution at the time of eradication. MPXV, likely the result of recent zoonosis, showed many genes with more TC hotspots than expected by chance (over-representation) and fewer GC hotspots than expected (under-representation). These results suggest the MPXV genome: 1) may have evolved in a host with a particular APOBEC GC hotspot preference, 2) has inverted terminal repeat (ITR) regions–which may be exposed to APOBEC3 for longer during viral replication– and longer genes likely to evolve faster, and therefore 3) has a heightened potential for future human APOBEC3-meditated evolution as the virus spreads in the human population. Our predictions of MPXV mutational potential can both help guide future vaccine development and identification of putative drug targets and add urgency to the task of containing human Mpox disease transmission and uncovering the ecology of the virus in its reservoir host.

Human monkeypox virus: Epidemiologic review and research progress in diagnosis and treatment

HomeRadioGraphicsVol. 43, No. 6 PreviousNext Cases from the Cooky JarFree AccessUterine InversionKaitlin M. Zaki-Metias , Melina Hosseiny, Fardad Behzadi, Patricia BalthazarKaitlin M. Zaki-Metias , Melina Hosseiny, Fardad Behzadi, Patricia BalthazarAuthor AffiliationsFrom the Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, 44405 Woodward Ave, Medical Education, Pontiac, MI 48341 (K.M.Z.M.); Department of Radiology, University of California San Diego, San Diego, Calif (M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (F.B.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (P.B.).Address correspondence to K.M.Z.M. (email: [email protected]).Kaitlin M. Zaki-Metias Melina HosseinyFardad BehzadiPatricia BalthazarPublished Online:May 18 2023https://doi.org/10.1148/rg.230004MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Uterine inversion, or uterine intussusception, is a rare, potentially life-threatening entity characterized by inversion of the fundus into the uterine cavity, which often manifests as an acute complication of childbirth (1,2). Less commonly, uterine inversion is nonpuerperal, occurring as a result of an endometrial or myometrial mass (2,3). Patients typically present with symptoms that include vaginal bleeding and pelvic pain.At MRI, uterine inversion appears as a U-shaped uterus with loss of the normal convex fundal contour on sagittal images (Fig 1A, 1B) (2). A target configuration may be visualized on axial images, representing the concentric serosa, myometrium, and endometrium (Fig 1C, 1D) (2). MRI is also useful in assessing the cause in patients with nonpuerperal uterine inversion, including submucosal leiomyomas, uterine leiomyosarcomas, and endometrial malignancies. There are four grades of uterine inversion, which are characterized by the degree of inferior bowing of the fundus relative to the cervix and/or vaginal introitus (Fig 2).Figure 1. Uterine inversion in a previously healthy premenopausal female patient with acute onset of pelvic pain and vaginal bleeding. A bleeding vaginal or cervical mass was suspected on physical examination, and pelvic MRI was performed for further evaluation. Sagittal T2-weighted (A) and contrast-enhanced fat-suppressed T1-weighted (B) MR images of the pelvis demonstrate a U-shaped uterus (U) with loss of the normal fundal contour, with protrusion of the fundus into the distended vaginal canal (V), consistent with grade III uterine inversion. The cervix (C) is located superior to the inverted fundus. At the fundus, there is an ill-defined rounded lesion (arrow in A and B) with heterogeneous T1 signal intensity and enhancement with irregular margins, with adjacent heterogeneous T2 signal intensity and increased T1 signal intensity. The findings are most consistent with a hemorrhagic submucosal uterine leiomyoma. Axial T2-weighted (C) and contrast-enhanced fat-suppressed T1-weighted (D) MR images of the pelvis show concentric rings of signal intensity indicating the serosa, myometrium, endometrium, and vagina.Figure 1.Download as PowerPointOpen in Image Viewer Figure 2. Illustration depicts the normal anatomic position of the uterus (A) and the various grades of inversion. Grade I uterine inversion (B) is characterized by inferior bowing of the fundus up to but not beyond the cervix. In grade II uterine inversion (C), the inverted fundus protrudes through the cervix and into the vagina. The uterus is fully inverted and protrudes out of the vagina in grade III uterine inversion (D).Figure 2.Download as PowerPointOpen in Image Viewer Disclosures of conflicts of interest.—K.M.Z.M. Meeting attendance and travel reimbursement from Trinity Health Oakland Hospital. P.B. Editorial board member of RadioGraphics, Association of University Radiologists GE Radiology Research Academic Fellowship, meeting travel reimbursement from the American College of Radiology.K.M.Z.M and P.B. have provided disclosures (see end of article); all other authors have disclosed no relevant relationships.

The burden of monkeypox virus amidst the Covid-19 pandemic in Africa: A double battle for Africa

H erein, we report two cases of 2019 novel coronavirus (2019-nCoV).Both patients are believed to have exposure related to Wuhan, China (1-4).We demonstrated change in the course of disease over time on CT scans (5,6).Case 1 A 45-year-old woman living in Wuhan, China, was admitted to the hospital for 2 days due to cough and fever.On admission, her body temperature was elevated (38.2°C [100.76°F]) and there were coarse breath sounds of both lungs at auscultation.Her laboratory studies showed an

Anatomic and biomechanical knowledge of the supporting structures that provide stability to the medial and lateral elbow is essential to correctly interpret pathologic findings.

HomeRadioGraphicsVol. 41, No. 7 PreviousNext Cases from the Cooky JarFree AccessOvarian Serous Surface Papillary Borderline Tumor: Sea Anemone SignC. Austin Wheeler , Ciléin Kearns, Valery L. Turner, Tushar R. GargC. Austin Wheeler , Ciléin Kearns, Valery L. Turner, Tushar R. GargAuthor AffiliationsFrom the Department of Radiology, University of Alabama at Birmingham School of Medicine, 619 19th Street S, JT N338, Birmingham, AL 35249 (C.A.W.); Medical Research Institute of New Zealand, Wellington, New Zealand, and Artibiotics, Wellington, New Zealand (C.K.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (V.L.T.); and Department of Radiology, Seth GS Medical College and KEM Hospital, Parel Mumbai, Maharashtra, India (T.R.G.).Address correspondence to C.A.W. (e-mail: [email protected]).C. Austin Wheeler Ciléin KearnsValery L. TurnerTushar R. GargPublished Online:Nov 1 2021https://doi.org/10.1148/rg.2021210201MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In On the pathway from benign cystadenoma to malignant cystadenocarcinoma, borderline tumors represent a crucial entity within the spectrum of ovarian epithelial carcinogenesis. Of this class, serous borderline neoplasms represent the common subclass (65%) (1).One distinct sub-subclass is named serous surface papillary borderline tumor (SSPBT) for its unique (although not wholly exclusive) imaging features (2) (Figs 1–3). Macroscopically, its surface stroma frequently branches into exophytic papillary stalks; hence the name. When these cystic lesions form frondlike excrescences, they mimic the likeness of a sea anemone at MRI (1,2). Histopathologic analysis even recapitulates this architectural pattern with micropapillary tumor cell proliferation.Figure 1. Classically described sea anemone appearance of a borderline serous surface papillary tumor in a 52-year-old woman. (A) Axial postcontrast T1-weighted MR image of the pelvis demonstrates heterogeneous soft-tissue enhancement with multiple enhancing fronds (arrow). (B, C) Axial (B) and sagittal (C) T2-weighted MR images of the pelvis demonstrate a complex T2-hyperintense adnexal tumor with multiple papillary excrescences (arrow).Figure 1.Download as PowerPointOpen in Image Viewer Figure 2. (A, B) Gray-scale (A) and color Doppler (B) transvaginal US images in a 52-year-old woman (same patient as in Fig 1) show that this mass has internal echogenic content with a branching appearance (arrow in A) and internal vascularity (arrowhead in B). (C) Low-power photomicrograph (hematoxylin-eosin stain) used for histologic correlation shows that epithelial ovarian tumor cells grow as papillary structures (P) in a hierarchical fashion (large, medium, and small papillae). Tumor cells composing papillae are of serous type with eosinophilic cytoplasm and mild to moderate nuclear atypia. No mitotic activity is seen in this case. (Fig 2C courtesy of Longwen Chen, MD, PhD.)Figure 2.Download as PowerPointOpen in Image Viewer Figure 3. Medical illustration shows the sea anemone sign, which features papillary fingerlike projections with internal branching. Associated findings may include coarse calcifications, ascites, para-aortic lymphadenopathy, and spread to the peritoneum. (Reprinted, with permission, from Ciléin Kearns, Artibiotics, Copyright © 2021.)Figure 3.Download as PowerPointOpen in Image Viewer Preoperative detection at diagnostic imaging can be informative because less aggressive borderline tumors tend to carry a more favorable prognosis, potentially altering management. Early identification and treatment are vital, as these tumors commonly manifest in younger women of childbearing age who may benefit from fertility-sparing surgery (1).All authors have disclosed no relevant relationships.