Ambulatory and hospitalized patients with suspected and confirmed mpox: an observational cohort study from Brazil.
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Silva Mayara Secco Torres, Coutinho Carolina, Torres Thiago Silva, Peixoto Eduardo, Ismério Ronaldo, Lessa Flavia, Nunes Estevão Portela, Hoagland Brenda, Echeverria Guevara Amanda Dolores, Bastos Matheus Oliveira, Ferreira Tavares Isabel Cristina, Diniz Ribeiro Maria Pia, Meneguetti Seravalli Ramos Maria Roberta, Andrade Hugo Boechat, Lovetro Santana Ana Paula, Santini-Oliveira Marilia, Santos Netto Juliana Barbosa, Reges Paula, Magalhães Monica Avelar, Silva Rosadas Leonardo Azevedo, Nazer Sandro, Velasque Luciane, Cardoso Sandra Wagner, da Silva Edson Elias, Veloso Valdilea Gonçalves, Wakimoto Mayumi Duarte, Grinsztejn Beatriz, INI-Fiocruz Mpox Study Group
Аннотация
METHODS: This was a single-center, prospective, observational cohort study that enrolled all patients with suspected mpox between June 12 and August 19, 2022. Mpox was confirmed by a PCR test. We compared characteristics of confirmed and non-confirmed cases, and among confirmed cases according to HIV status using distribution tests. Kernel estimation was used for exploratory spatial analysis.
FINDINGS: Of 342 individuals with suspected mpox, 208 (60.8%) were confirmed cases. Compared to non-confirmed cases, confirmed cases were more frequent among individuals aged 30-39 years, cisgender men (96.2% vs. 66.4%; p < 0.0001), reporting recent sexual intercourse (95.0% vs. 69.4%; p < 0.0001) and using PrEP (31.6% vs. 10.1%; p < 0.0001). HIV (53.2% vs. 20.2%; p < 0.0001), HCV (9.8% vs. 1.1%; p = 0.0046), syphilis (21.2% vs. 16.3%; p = 0.43) and other STIs (33.0% vs. 21.6%; p = 0.042) were more frequent among confirmed mpox cases. Confirmed cases presented more genital (77.3% vs. 39.8%; p < 0.0001) and anal lesions (33.1% vs. 11.5%; p < 0.0001), proctitis (37.1% vs. 13.3%; p < 0.0001) and systemic signs and symptoms (83.2% vs. 64.5%; p = 0.0003) than non-confirmed cases. Compared to confirmed mpox HIV-negative, HIV-positive individuals were older, had more HCV coinfection (15.2% vs. 3.7%; p = 0.011), anal lesions (45.7% vs. 20.5%; p < 0.001) and clinical features of proctitis (45.2% vs. 29.3%; p = 0.058).
INTERPRETATION: Mpox transmission in Rio de Janeiro, Brazil, rapidly evolved into a local epidemic, with sexual contact playing a crucial role in its dynamics and high rates of coinfections with other STI. Preventive measures must address stigma and social vulnerabilities.
FUNDING: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz).