Skin lesion specimens as first choice to detect monkeypox virus | CPT PPP Coverage
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Skin lesion specimens as first choice to detect monkeypox virus appeared on www.thelancet.com by The Lancet.
- Müller M
- Ingold-Heppner B
- Stocker H
- Heppner FL
- Dittmayer C
- Laue M
for evaluating images of mpox (formerly known as monkeypox). However, I have several concerns about the case presented in the Clinical Picture.
- Tarín-Vicente EJ
- Alemany A
- Agud-Dios M
- et al.
Unlike oropharyngeal swabs and blood samples, viral DNA loads in lesion swab samples remain high despite evolving morphology of pustulae.
Therefore, skin lesion specimens should be the first choice to detect monkeypox virus. However, the PCR tests for monkeypox virus in this patient were conducted in anorectal and oropharyngeal swabs instead of skin swabs.
- Tarín-Vicente EJ
- Alemany A
- Agud-Dios M
- et al.
But lymphadenopathy was not mentioned in this patient. In fact, lymphadenopathy is the most important sign differentiating mpox from smallpox and chickenpox.
- Tarín-Vicente EJ
- Alemany A
- Agud-Dios M
- et al.
But only the herpes simplex virus, Chlamydia trachomatis, and Neisseria gonorrhoea were tested for in tissue samples. Given the condomless penetrative and receptive anal intercourse by this patient, at least serological tests for syphilis and HIV should be conducted.
Finally, the positive PCR results for monkeypox virus in anorectal and oropharyngeal swabs were sufficient to make a diagnosis of mpox in this case. I consider that it is not necessary to conduct histopathological examination for this patient. Although histopathological examination can also determine the disease, it is traumatic and time consuming.
I declare no competing interests.
References
- 1.
Electron microscopy images of monkeypox virus infection in 24-year-old man.
Lancet. 2022; 4001618
- 2.
Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study.
Lancet. 2022; 400: 661-669
- 3.
Clinical characteristics and comparison of longitudinal qPCR results from different specimen types in a cohort of ambulatory and hospitalized patients infected with monkeypox virus.
J Clin Virol. 2022; 155105254
- 4.
Human monkeypox: clinical features of 282 patients.
J Infect Dis. 1987; 156: 293-298
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