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新生兒猴痘病毒感染

新生兒猴痘病毒感染

資料來源:n engl j med 387;17 nejm.org 2022 年 10 月 27 日 / 財團法人台灣紅絲帶基金會編譯

致編輯:持續的猴痘爆發最近被世界衛生組織宣佈為國際關注的突發公共衛生事件。幼兒有患嚴重疾病的風險;因此,早期識別和及時治療很重要。

  我們報告了一例 10 日齡嬰兒周產期獲得性猴痘病毒感染和腺病毒合併感染的病例。嬰兒於 2022 年 4 月下旬順利出生後,在出生的第 9 天出現皮疹。皮疹最初呈水泡狀,從手掌和足底開始,隨後擴散到面部和軀幹,逐漸變成膿皰(圖 1)。嬰兒出生前 9 天,嬰兒的父親患有發熱性疾病,隨後出現大面積皮疹;皮疹在嬰兒出生前消退。嬰兒分娩四天后,母親身上出現了類似的皮疹。這家人住在英國,沒有去非洲旅行的歷史,也沒有與任何旅行者接觸的歷史。

圖1:新生嬰兒皮膚上之猴痘損傷(圖片顯示的是新生兒手腳上的猴痘皮膚損傷;可見病變範圍從水皰到膿皰,還顯示了開始結痂的病變。照片是在皮疹發作後第 5 天獲得的)。

 

由於出現低氧性呼吸衰竭,該嬰兒在出生後第 15 天被轉移到地區兒科重症監護病房。考慮了許多診斷(新生兒水痘、單純皰疹病毒感染、克薩奇病毒或腸道病毒感染、葡萄球菌皮膚感染、疥瘡、梅毒和淋病)。腋窩淋巴結病的存在、皮膚病變的性質以及家族內感染的非典型時間線引起了人們對人類猴痘的關注。從嬰兒和母親獲得的血液、尿液、水泡液和咽喉拭子樣本的聚合酶鏈反應測試得到猴痘病毒感染(進化枝 IIb)的診斷。在嬰兒的呼吸道分泌物和血液中也發現了腺病毒。嬰兒的病情惡化,開始侵入式通氣。開始了為期 2 週的腸內 tecovirimat(劑量為 50 mg,每天兩次)與靜脈西多福韋 (cidofovir) 聯合用藥。經過 4 週的重症監護,包括 14 天的侵入式通氣,嬰兒康復並出院回家。

  新生兒猴痘病毒感染的報告很少見。這是一例家庭聚集性周產期傳播後新生兒猴痘病毒感染病例;不能排除經胎盤傳播。因為這是一個單一的病例,所以不可能將臨床疾病直接歸因於單一病原體(猴痘病毒或腺病毒),也不可能將嬰兒臨床狀況的改善歸因於使用替考韋馬 (tecovirimat) 或西多福韋 (cidofovir)。新生兒水皰疹的鑑別診斷時應考慮猴痘病毒感染。

 

Padmanabhan Ramnarayan,醫學博士,英國倫敦,倫敦帝國理工學院 

p.ramnarayan@imperial.ac.uk

Rebecca Mitting, M.B., B.S. 英國倫敦,帝國理工學院醫療保健 NHS 信託基金 

Elizabeth Whittaker, Ph.D. 英國倫敦帝國理工學院

Maria Marcolin, M.R.C.P.C.H. Ciara O’Regan, M.R.C.P.C.H. Ruchi Sinha, M.R.C.P.C.H. Aisleen Bennett, Ph.D. Moustafa Moustafa, M.R.C.P.C.H. Neil Tickner, M.Pharm. Mark Gilchrist, M.Sc. 英國倫敦,帝國理工學院醫療保健 NHS 信託基金 

Anthony Kershaw, M.R.C.P.C.H. 英國倫敦,西北大學醫療保健 NHS 信託基金 

Tommy Rampling, D.Phil. 英國倫敦,英國衛生安全局 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Neonatal Monkeypox Virus Infection

n engl j med 387;17 nejm.org October 27, 2022

 

To the Editor: The ongoing monkeypox outbreak was recently declared to be a Public Health Emergency of International Concern by the World Health Organization. Young children are at risk for severe disease; therefore, early recognition and prompt treatment are important.

  We report a case of perinatally acquired monkeypox virus infection and adenovirus coinfection in a 10-day-old infant. After the infant’s uneventful birth in late April 2022, a rash developed on day 9 of life. The rash was initially vesicular, starting on the palms and soles and subsequently spreading to the face and trunk, and gradually became pustular (Fig. 1). Nine days before the birth, the infant’s father had had a febrile illness, followed by a widespread rash; the rash resolved before the infant’s birth. Four days after the infant’s delivery, a similar rash developed in the mother. The family lived in the United Kingdom, and there was no history of travel to Africa or of contact with any travelers.

  The infant was transferred to the regional pediatric intensive care unit on day 15 of life owing to evolving hypoxemic respiratory failure. A number of diagnoses (neonatal varicella, herpes simplex virus infection, coxsackievirus or enterovirus infection, staphylococcal skin infection, scabies, syphilis, and gonorrhea) were considered. The presence of axillary lymphadenopathy, the nature of the skin lesions, and the atypical timeline of intrafamilial infection aroused concern regarding human monkeypox. Polymerase-chain-reaction testing of blood, urine, vesicular-fluid, and throatswab samples obtained from the infant and mother led to a diagnosis of monkeypox virus infection (clade IIb). Adenovirus was also identified in the infant’s respiratory secretions and blood. The infant’s condition worsened, and invasive ventilation was initiated. A 2-week course of enteral tecovirimat (at a dose of 50 mg twice a day) was commenced in combination with intravenous cidofovir. After 4 weeks in intensive care, including 14 days of invasive ventilation, the infant recovered and was discharged home. 

  Reports of neonatal monkeypox virus infection are rare. This was a case of neonatal monkeypox virus infection after peripartum transmission within a family cluster; transplacental transmission could not be ruled out. Because this was a single case, it is not possible to attribute the clinical illness to either pathogen (monkeypox virus or adenovirus) directly, nor is it possible to attribute the improvement in the infant’s clinical condition to the use of tecovirimat or cidofovir. Monkeypox virus infection should be considered in the differential diagnosis of a neonatal vesicular rash. 

 

 

圖1:新生嬰兒皮膚上之猴痘損傷(圖片顯示的是新生兒手腳上的猴痘皮膚損傷;可見病變範圍從水皰到膿皰,還顯示了開始結痂的病變。照片是在皮疹發作後第 5 天獲得的)。

 

Padmanabhan Ramnarayan, M.D. Imperial College London London, United Kingdom p.ramnarayan@imperial.ac.uk

Rebecca Mitting, M.B., B.S. Imperial College Healthcare NHS Trust London, United Kingdom 

Elizabeth Whittaker, Ph.D. Imperial College London London, United Kingdom 

Maria Marcolin, M.R.C.P.C.H. Ciara O’Regan, M.R.C.P.C.H. Ruchi Sinha, M.R.C.P.C.H. Aisleen Bennett, Ph.D. Moustafa Moustafa, M.R.C.P.C.H. Neil Tickner, M.Pharm. Mark Gilchrist, M.Sc. Imperial College Healthcare NHS Trust London, United Kingdom 

Anthony Kershaw, M.R.C.P.C.H. London Northwest University Healthcare NHS Trust London, United Kingdom 

Tommy Rampling, D.Phil. U.K. Health Security Agency London, United Kingdom

 

 

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