부산대학교 도서관

Summary Background The scale of the 2022 global mpox (formerly known as monkeypox) outbreak has been unprecedented. In less than 6 months, non-endemic countries have reported more than 67 000 cases of a disease that had previously been rare outside of Africa. Mortality has been reported as rare but hospital admission has been relatively common. We aimed to describe the clinical and laboratory characteristics and outcomes of individuals admitted to hospital with mpox and associated complications, including tecovirimat recipients. Methods In this cohort study, we undertook retrospective review of electronic clinical records and pathology data for all individuals admitted between May 6, and Aug 3, 2022, to 16 hospitals from the Specialist and High Consequence Infectious Diseases Network for Monkeypox. The hospitals were located in ten cities in England and Northern Ireland. Inclusion criteria were clinical signs consistent with mpox and MPXV DNA detected from at least one clinical sample by PCR testing. Patients admitted solely for isolation purposes were excluded from the study. Key outcomes included admission indication, complications (including pain, secondary infection, and mortality) and use of antibiotic and anti-viral treatments. Routine biochemistry, haematology, microbiology, and virology data were also collected. Outcomes were assessed in all patients with available data. Findings 156 individuals were admitted to hospital with complicated mpox during the study period. 153 (98%) were male and three (2%) were female, with a median age of 35 years (IQR 30--44). Gender data were collected from electronic patient records, which encompassed full formal review of clincian notes. The prespecified options for data collection for gender were male, female, trans, non-binary, or unknown. 105 (71%) of 148 participants with available ethnicity data were of White ethnicity and 47 (30%) of 155 were living with HIV with a median CD4 count of 510 cells per mm.sup.3 (IQR 349--828). Rectal or perianal pain (including proctitis) was the most common indication for hospital admission (44 [28%] of 156). Severe pain was reported in 89 (57%) of 156, and secondary bacterial infection in 82 (58%) of 142 individuals with available data. Median admission duration was 5 days (IQR 2--9). Ten individuals required surgery and two cases of encephalitis were reported. 38 (24%) of the 156 individuals received tecovirimat with early cessation in four cases (two owing to hepatic transaminitis, one to rapid treatment response, and one to patient choice). No deaths occurred during the study period. Interpretation Although life-threatening mpox appears rare in hospitalised populations during the current outbreak, severe mpox and associated complications can occur in immunocompetent individuals. Analgesia and management of superimposed bacterial infection are priorities for patients admitted to hospital. Funding None. Author Affiliation: (a) Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK (b) Division of Infection and Immunity, University College London, London, UK (c) Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Wiltshire, UK (d) Department of Infectious Diseases, Belfast Health and Social Care Trust, Belfast, UK (e) Department of Infectious Diseases, Cambridge University Hospitals, Cambridge, UK (f) Department of HIV/GUM, Chelsea and Westminster Hospital, London, UK (g) Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK (h) Department of Infectious Diseases, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK (i) Department of Sexual Health and HIV, King's College Hospital NHS Foundation Trust, London, UK (j) Department of Infectious Diseases, Leeds Teaching Hospitals NHS Trust, Leeds, UK (k) Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK (l) Department of Infectious Diseases, London North West University Healthcare NHS Trust, UK (m) Department of Infectious Diseases, North Manchester General Hospital, Manchester, UK (n) Department of Infection and Tropical Medicine, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK (o) Department of Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (p) Department of Infectious Diseases, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (q) Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK (r) Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK (s) Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation Trust, London UK (t) Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK * Correspondence to: Dr Douglas Fink, Department of Infection and Immunity, University College London, London NW3 2PP, UK (footnote)[Dagger] Members are listed in the Byline: Douglas L Fink, PhD [douglas.fink@nhs.net] (a,b), Helen Callaby, MRCP (c), Akish Luintel, MRCP (a), William Beynon, MRCP (d), Helena Bond, MRCP (d), Eleanor Y Lim, PhD (e), Effrossyni Gkrania-Klotsas, PhD (e), Jospeh Heskin, MBChB (f), Margherita Bracchi, MD (f), Balram Rathish, MRCP (g), Iain Milligan, FRCPath (g), Geraldine O'Hara, DPhil (g), Stephanie Rimmer, MRCP (h), Joanna R Peters, MRCP (h), Lara Payne, MRCP (i), Nisha Mody, MBBS (i), Bethany Hodgson, MRCP (j), Penny Lewthwaite, FRCP (j), Rebecca Lester, PhD (k), Stephen D Woolley, MD (k), Ann Sturdy, MRCP (l), Ashley Whittington, MRCP (l), Leann Johnson, MBChB (m), Nathan Jacobs, BMBS (m), John Quartey, MBChB (n), Brendan AI Payne, FRCP (n), Stewart Crowe, MRCP (o), Ivo AM Elliott, DPhil (o), Thomas Harrison, MBChB (p), Joby Cole, PhD (p), Katie Beard, MBBS (q), Tomas-Paul Cusack, MRCP (q), Imogen Jones, MRCP (r), Rishi Banerjee, MRCP (r), Tommy Rampling, DPhil (c,s), Jake Dunning, Douglas L Fink, Iain D Milligan, Akish Luintel, Alison J Rodger, Sanjay R Bhagani, Lucy E Lamb, Rachel C Moores, Simon F K Lee, Colin S Brown, Susan Hopkins, Stephen Mepham, Simon Warren, Aoife Molloy, Ian Cropley, Alex Kew, Natasha Karunaharan, Antonia Scobie, Jennifer Hart, Dianne Irish, Tanzina Haque, Hamid Jalal, Robin Smith, Damien Mack, Tristan Barber, Fiona Burns, Robert Miller, Eleanor Hamlyn, Pedro Simoes, Breda Athan, Jennifer Abrahamsen, Jessica Joyce, Caroline Taylor, Sally Reddecliffe, Chloe Miller, Brooke Reeve, Hugh Kingston, Tim Crocker-Buque, Nicolas Massie, Ankush Dhariwal, Angelina Jayakumar, Robert Hammond, Alexandra Bramley, Tanmay Kanitkar, Laura Maynard-Smith, Eliza Gil, Cavan O'Connor, Derek Cocker, Wendy Spicer, Marisa Lanzman, Meera Thacker, Zoe O Anorson, Dharmesh Patel, Alan Williams, Catherine F Houlihan, Dominic Wakerley, Claire N Gordon, Helen Callaby, Daniel J Bailey, Jenna Furneaux, Abbie M Bown, Elizabeth J Truelove, Marian J Killip, David Jackson, Tracy L B Beetar-King, Ulrike M V Arnold, Rhea M Strachan, Jones Matthew, Hannah J Matthew, Jane C Osborne, Tommy Rampling, Richard Vipond, Barry Gibney, Jodie Owen, Helena Bond, Will Beynon, Michael Hunter, Louise McCorry, Carol Emerson, Say Quah, Suzanne Todd, Emma McCarty, Eoin Walker, Susan Feeney, Tanya Curran, Kathy Li, JD Mullan, Kate Jackson, Peter Nelson, Kevin Lewis, Mark McNicol, Marcus Pratt, Anna Smith, Erin Vos, Fahad Alsalemee, Daniel O Leary, John Canny, Katherine McGinnity, Carly Culbert, Conor McDowell, Cathy McQuillan, Eunjin Jeong, Lynsey Glass, Jessica Dyche, Paula McClean, Rebecca Stewart, Harold Ursolino, Melissa Perry, Hannah McCormick, Eleanor Y Lim, Effrossyni Gkrania-Klotsas, Margherita Bracchi, Joseph Heskin, Nicklas Brown, Thomas Juniper, Borja Mora-Peris, Alessia Dalla-Pria, Nicola Mackie, Lucy Garvey, Alan Winston, Graham Cooke, Mark Nelson, Emer Kilbride, Ala Elbishi, William Kerrigan, Joshua Silva, Jesal Gohil, Sasha Payagala, Yasmin Walters, Joanna Smith, Jonathan Goodfellow, Kitty Lyons, Hsiu Tung, Kinjal Patel, Merle Henderson, Michael Butler, Edu Peres, Taiana Silva Carvalho, Antoine Joly, Molly Dickinson, Luke S P Moore, Nabeela Mughal, Stephen Hughes, Shrada Chitlangia, Priyanka Viramgana, Ruth Byrne, Paul Randell, Luigi Strangis, Nicola Poveda, Deborah Bovey, Poppy Richardson, Vivian Heaslip, Christopher Higgs, Marta Boffito, Nicolo Girometti, Gary Whitlock, Victoria Tittle, Rachel Jones, Michael Rayment, Christopher Scott, David Asboe, Marcus Pond, David Muir, Balram Rathish, Geraldine O'Hara, Movin Abeywickrema, Sarah-Lou Bailey, Sara E Boyd, Dayana Da Silva Fontoura, Anna Daunt, Claire Y Mason, Jamie Murphy, Vasanth V Naidu, Aatish Patel, Caitlin Pley, Ethan Redmore, Katherine Sharrocks, Luke B Snell, Rohan Sundramoorthi, Jerry C H Tam, Aisling Brown, Sam Douthwaite, Anna Goodman, Gaia Nebbia, William Newsholme, Nicholas Price, Emily Shaw, Alex Salam, Claire van Nispen tot Pannerden, Helen Winslow, Julia Bilinska, Sarah Keegan, Harry Coleman, Jessica Doctor, Nasreen Moini, Daniella Chilton, Golaleh Haidari, Rebecca Simons, Rajababu Kulasegaram, Nick Larbalestier, Achyuta Nori, Jack R Potter, Cecilia Tuudah, Paul Wade, Alexandra Travers, Sarah Dunford, Joshua Greenwood, Georgina Oledimmah, Lesley Gyampo, Pedro SA Pinto, AbdulKadir Muse, Zoe Parker, Charlotte Alexander, Alexander Khan, Medinat Ajayi, Abigail Baltazar, Davis Sharella, Nasra Hersi, Thuy Nguyen, Rugiatu Timbo, Ismail Jalloh, Susan Bryan, Patricia Clarke, Marcia Kerr, Fidelis Amedu, Maria BohoBonaba, Sarah Haque, Michelle Howson, Norbai Tambilawan, Soledad Yupanqui Estay, Hawanatu Bangura, Tseday Gideon, Damilola Jerome-oboh, Linda Tetteh, Chioma Nwagu, Viwoalo Agbaglah, Nona Narag, Mahima Zaveri, Maedhbh Ni Luanaigh, Peggy Keane, Joanna R Peters, Stephanie Rimmer, Aula Abbara, Borja Mora-Peris, Olamide Dosekun, Lucy Garvey, Mhairi Bolland, Adam Stafford, Dina Saleh, Rhianna Sheridan, Ella Davies, Kristi Sun, Mark Gilchrist, Priti Kukadia, Muhammed Embrahimsa, Christopher Chiu, Michael Butler, Kinjal Patel, Lauren Taylor, Charlotte Short, Jasmini Alagratnam, Iresh Jayaweera, Kavitha Gundugola, Lara V S Payne, Nisha Mody, Killian Quinn, Caoimhe Nic Fhogartaigh, Nivenjit Kaur, Salmaan Bholah, Kajann Kantha, Jonathan Youngs, Temi Lampejo, Nicholas Pitto, David S Lawrence, Holly Middleditch, Lourdes Dominguez-Dominguez, Ayoma Ratnappuli, Sara Al-Hashimi, Amelia Oliveira, Zoe Ottaway, Larissa Mulka, Bethany Hodgson, Penny Lewthwaite, Anne M Neary, Michael R Downey, Danielle C Lucy, Craig I McCallum, Michael Beadsworth, Libuse Ratcliffe, Tom E Fletcher, Gerry Davies, Nicholas Wong, Stephen Aston, Thomas E Wingfield, Thomas Blanchard, Paul Hine, Rebecca Lester, Stephen D Woolley, Susie Gould, Christopher Smith, Michael Abouyannis, Abolaji Atomode, James Cruise, Merna Samual, Nicola Scott, Vino Srirathan, Joseph Lewis, Lauren Richards, Mary-Ann Cummings, Emily Gillan, Rebecca Peers, Amy Tickle, Grace Keating, Tendi Chinyanda, Mav Sanchez, Daniel Harrison, Hoyle, Ben Metcalfe, Jennifer Taylor, Nicky Johnson, Neil Kelle, Kirsty McDowell, Ian Richardson, Monette Saguidan, Nicky Farmer, Angella Gillespie, Shay Willoughby, Samantha Parker, Shamseena Avulan, Shazia Arif, Suzanne Marshall, David Carlisle, Mohsen Rezaei, Angela Booth, Joanne Watts, Lauren Tremarco, Priyanga Jeyanayagam, Odinaka Ubochi, Daniel Vagianos, Mark Richardson, Anthony Jarvis, Kyra Gow, Jade Walmsley, Adam O'keefe, Anna Smielewska, Mark Hopkins, Fatima Balane, Sarah Bradley, Tumena Corrah, Venus Daquiz, Christopher Dugan, Joshua Elliot, Fiona Foley, Dawn Friday, May Gamit, David Garner, Karishma Gokani, Laurence John, Deepa Joseph, Nuzhath Khan, Cherifer Mamuyac, Alastair McGregor, John McSorley, Victoria Parris, Luciana Rubinstein, Julian Rycroft, Kelcy Salinas, Jason Salinas, Jency Sebatian, Melanie Smith, Marina Tejero Garcia, Uchenna Ume, Margarete Vicentine, Gabriel Wallis, Ann Sturdy, Ashley Whittington, Nathan Jacobs, Leann Johnson, Alec Bonington, Alison Uriel, Andrew Ustianowski, Balazs Dancso, Celia Hogan, Clare van Halsema, F Javier Vilar, Karen Devine, Katherine Ajdukiewicz, Rajesh Rajendran, Samit Ghosh, Michael Riste, Nicholas Machin, Chitra Babu, Shazaad Ahmad, Dorcas Obeng, Farnaz Dave, Gavin Conolley, Joseph Thompson, Maya Tickell-Painter, Prasun Chakravorty, Rachel Pringle, Mohammad R Zafar, Sarah Lawrence, Amada Sanchez-Gonzalez, Cristina Fernandez, Lynsey Goodwin, David Carey, Molly Howarth-Maddison, Samuel Moody, Rebecca Upton, Christina Apthorp, Charlotte Murray, Kirstie Salthouse, Sabah Nadeem, Grant Ridley, Francesca White, Andrew Brown, Michael Lawless, Mohamed Mohamed, Robert Mulligan, Amy Belfield, Jacob Brolly, Maria Calderon, James Cheveau, Milo Cullinan, Sophie Garrad, Will Griffiths, Aidan Ireland, Peter Ireland, Charlotte Milne, Paul Nwajiugo, John Quartey, Bijan Ghavami-Kia, Chris Duncan, Adam Evans, Ewan Hunter, Ashley Price, Matthias Schmid, Uli Schwab, Yusri Taha, Brendan Payne, Ivo A M Elliott, Stewart Crowe, Charles J Woodrow, Drosos E Karageorgopoulos, Peter J Davis, Emily Lord, Oliver J Bannister, Andrew B Dagens, Thomas Harrison, Joby Cole, Anne Tunbridge, Saher Choudry, Adam Telfer, Ihsan Jhibril, Syed N Atta, Ben Stone, Cariad Evans, Mike Ankcorn, Suha Akili, Mehmet Yavuz, Vicky Goodall, Sam Farrow, Georgina Mountford, Tomas-Paul Cusack, Kate Beard, Julian Sutton, Tristan Clark, Annette Mason, Mike Vickers, Derek Macallan, Tihana Bicanic, Angela Houston, Cassie Pope, NgeeKeong Tan, Christopher Ward, Imogen Jones, Rishi Banerjee, Jonathan Cohen, Marieke Emonts-le Clercq, David Porter, Andrew Riordan, Ruchi Sinha, Elizabeth Whittaker