本期文章：《新英格兰医学杂志》：Online/在线发表

英国伦敦玛丽女王大学Chloe M. Orkin团队研究了2022年4月至6月16个国家的人类猴痘病毒感染情况。该研究于2022年7月21日发表在《新英格兰医学杂志》上。

2022年4月之前，在猴痘病毒流行的非洲地区以外，很少有人感染猴痘病毒的报告。目前，世界各地都有病例发生。感染的传播、风险因素、临床表现和结局定义尚不明确。

研究组成立了一个由临床医生组成的国际合作小组，他们参与了一个国际病例系列，以描述聚合酶链反应确诊的猴痘病毒感染的表现、临床过程和结果。他们报道了2022年4月27日至6月24日在16个国家的43个地点诊断出的528例感染。

总体来说，98%的感染者是同性恋或双性恋男性，75%是白人，41%是人类免疫缺陷病毒感染者；中位年龄为38岁。95%的感染者疑似通过性行为传播。在本病例系列中，95%的患者出现皮疹（64%的患者皮疹<10处），73%的患者有肛门生殖器皮损，41%的患者有粘膜皮损（54例患者有单一生殖器皮损）。

皮疹前常见的全身特征包括发热（62%）、嗜睡（41%）、肌痛（31%）和头痛（27%）；淋巴结病也很常见（56%）。377名受试者中有109名（29%）报告了伴随性传播感染。在有明确接触史的23人中，潜伏期中位数为7天。

在32名接受精液分析的感染者中，有29人检测到猴痘病毒DNA。5%的患者接受了抗病毒治疗，70人（13%）住院；住院原因是疼痛管理，主要是严重的肛门直肠疼痛（21人）；软组织重叠感染（18人）；咽炎限制口腔进食（5人）；眼部病变（2人）；急性肾损伤（2人）；心肌炎（2人）；以及感染控制目的（13人）。没有死亡报告。

研究结果表明，在本病例系列中，猴痘表现为多种皮肤病学和系统性临床表现。在传统上猴痘流行的地区以外同时发现病例，突出了快速识别和诊断病例的必要性，以遏制进一步的社区传播。

附：英文原文

Title: Monkeypox Virus Infection in Humans across 16 Countries — April–June 2022

Author: John P. Thornhill, M.D., Ph.D.,, Sapha Barkati, M.D.,, Sharon Walmsley, M.D.,, Juergen Rockstroh, M.D.,, Andrea Antinori, M.D.,, Luke B. Harrison, M.D., Ph.D.,, Romain Palich, M.D., Ph.D.,, Achyuta Nori, M.D.,, Iain Reeves, M.D.,, Maximillian S. Habibi, M.D., Ph.D.,, Vanessa Apea, M.D., M.P.H.,, Christoph Boesecke, M.D.,, Linos Vandekerckhove, M.D., Ph.D.,, Michal Yakubovsky, M.D.,, Elena Sendagorta, M.D., Ph.D.,, Jose L. Blanco, M.D., Ph.D.,, Eric Florence, M.D., Ph.D.,, Davide Moschese, M.D.,, Fernando M. Maltez, M.D., Ph.D.,, Abraham Goorhuis, M.D., Ph.D.,, Valerie Pourcher, M.D., Ph.D.,, Pascal Migaud, M.D.,, Sebastian Noe, M.D.,, Claire Pintado, M.D.,, Fabrizio Maggi, M.D., Ph.D.,, Ann-Brit E. Hansen, M.D., Ph.D.,, Christian Hoffmann, M.D., Ph.D.,, Jezer I. Lezama, M.D., Ph.D.,, Cristina Mussini, M.D.,, AnnaMaria Cattelan, M.D.,, Keletso Makofane, M.P.H., Ph.D.,, Darrell Tan, M.D., Ph.D.,, Silvia Nozza, M.D., Ph.D.,, Johannes Nemeth, M.D.,, Marina B. Klein, M.D.,, and Chloe M. Orkin, M.D.

Issue&Volume: 2022-07-21

Abstract:

BACKGROUND

Before April 2022, monkeypox virus infection in humans was seldom reported outside African regions where it is endemic. Currently, cases are occurring worldwide. Transmission, risk factors, clinical presentation, and outcomes of infection are poorly defined.

METHODS

We formed an international collaborative group of clinicians who contributed to an international case series to describe the presentation, clinical course, and outcomes of polymerase-chain-reaction–confirmed monkeypox virus infections.

RESULTS

We report 528 infections diagnosed between April 27 and June 24, 2022, at 43 sites in 16 countries. Overall, 98% of the persons with infection were gay or bisexual men, 75% were White, and 41% had human immunodeficiency virus infection; the median age was 38 years. Transmission was suspected to have occurred through sexual activity in 95% of the persons with infection. In this case series, 95% of the persons presented with a rash (with 64% having <10 lesions), 73% had anogenital lesions, and 41% had mucosal lesions (with 54 having a single genital lesion). Common systemic features preceding the rash included fever (62%), lethargy (41%), myalgia (31%), and headache (27%); lymphadenopathy was also common (reported in 56%). Concomitant sexually transmitted infections were reported in 109 of 377 persons (29%) who were tested. Among the 23 persons with a clear exposure history, the median incubation period was 7 days (range, 3 to 20). Monkeypox virus DNA was detected in 29 of the 32 persons in whom seminal fluid was analyzed. Antiviral treatment was given to 5% of the persons overall, and 70 (13%) were hospitalized; the reasons for hospitalization were pain management, mostly for severe anorectal pain (21 persons); soft-tissue superinfection (18); pharyngitis limiting oral intake (5); eye lesions (2); acute kidney injury (2); myocarditis (2); and infection-control purposes (13). No deaths were reported.

CONCLUSIONS

In this case series, monkeypox manifested with a variety of dermatologic and systemic clinical findings. The simultaneous identification of cases outside areas where monkeypox has traditionally been endemic highlights the need for rapid identification and diagnosis of cases to contain further community spread.

DOI: 10.1056/NEJMoa2207323