Yasmine S. Ali，醫學博士 / October 02, 2024 / 藥物與疾病 / Medscape / 快速回顧測驗
1970 年首次在人類中發現的正痘病毒稱為 mpox（當時稱為猴痘），最初僅限於非洲。如今，世界各地都可以觀察到mpox，世界衛生組織最近宣布該疾病為全球公共衛生緊急事件。美國疾病管制與預防中心 (CDC) 發布了前往受影響地區的旅遊通知，並在剛果共和國發現了該病毒的第二種特定亞型，該亞型可能更致命。歐洲疾病預防與控制中心也意識到，旅行和社交模式（例如參加節慶和其他人群眾多的活動）會使患者面臨感染MPOX的風險。然而，它與其他幾種疾病相似，對許多從業者來說可能不熟悉。
您準備好發現並治療患者的 MPOX 了嗎？透過這個快速測驗來測試一下自己。
與成人相比，兒童 MPOX 的表現有何不同？
他們幾乎總是無症狀
他們可能有症狀，但不太可能需要住院
他們更有可能出現嚴重症狀
兒童和成人之間沒有發現差異
與成人相比，兒童 MPOX 的表現有何不同？
您的同行選擇了：
他們幾乎總是無症狀 ————————————12%
他們可能有症狀，但不太可能需要住院 ———-41%
他們更有可能出現嚴重症狀 —————————29%
兒童和成人之間沒有發現差異 ————————18%
對全球監測數據的分析顯示，全世界報告的 MPOX 病例中只有 1.3% 是兒童。這些研究人員發現，儘管他們可能有症狀，但他們的疾病嚴重程度較低，並且在全球範圍內沒有觀察到死亡，只有 1 人入院。
其他研究也支持這項發現，顯示兒童可能在學校環境中出現症狀，但似乎沒有人出現需要成年後住院治療的嚴重問題。根據美國兒科學會的數據，兒童最容易出現寒顫、發燒、頭痛、不適、喉嚨痛和新發淋巴結腫大，其次是獨特的M痘皮疹。這種皮疹被描述為斑疹，發展為丘疹、水皰，然後是界限清楚的深層、堅硬或堅硬的膿皰，並可能發展為結痂。
這些關於兒童較少出現嚴重 MPOX 症狀的發現與對 50 歲以上成年人的研究形成鮮明對比，後者比 18-49 歲成年人更有可能經歷嚴重疾病、住院治療和死亡。
作為 2022 年疫情的一部分，患者報告了哪些 MPOX 胃腸道表現？
膽石性胰臟炎
胃灼熱/胃食道逆流症
肝損傷
直腸炎
最近的一項系統性回顧旨在描述mpox對胃腸道的影響，特別是自2022年爆發以來。研究人員發現，據報導，直腸炎是MPOX患者的主要胃腸道表現。他們還報告說，其他胃腸道表現包括腹痛、腹瀉、噁心、直腸出血和疼痛、裡急後重和嘔吐。
其他稍早進行的研究發現，胃腸道症狀最有可能影響兒童患者，這些患者更有可能表現出腹痛、厭食、噁心、嘔吐和腹瀉。然而，團隊也發現，表現為肛門/直腸疼痛和直腸出血的直腸炎等症狀在以前與MPOX感染無關，是2022年爆發所特有的。這項結果在其他研究中得到了呼應。
對於疑似MPOX和口腔/口周假膜斑塊的患者，應考慮下列哪一個鑑別診斷/合併感染？
單純皰疹
傳染性軟疣
口腔念珠菌病
梅毒
對於疑似MPOX和口腔/口周假膜斑塊的患者，應考慮下列哪一個鑑別診斷/合併感染？
您的同行選擇了：
單純皰疹 ————————36%
傳染性軟疣 ———————18%
口腔念珠菌病 ——————29%
梅毒 ——————————-17%
mpox 皮膚病學表現的發現顯示，口腔/口周病變很常見，但很容易與幾種鑑別診斷混淆。假膜斑與口腔念珠菌病和非念珠菌真菌感染有關。
此外，特別是在免疫功能低下的患者中，很可能發生合併感染。可能需要不只一種形式的診斷測試和來自病變的多個樣本來評估具有廣泛皮膚表現的免疫功能低下患者。
相較之下，痘病毒的皮膚鏡檢查歞顯示，與口腔念珠菌病表現為口腔/口周假膜斑塊不同，傳染性軟疣表現為多種中心呈凹狀的有光澤的蠟狀結節或丘疹。
同樣，口腔/口周潰瘍可能與單純皰疹感染混淆，而該區域的下疳樣丘疹可能是梅毒的徵兆。軟性下疳通常與生殖器潰瘍有關，而不是口腔/口周病變，在美國也極為罕見。
在流行地區，哪些預防策略對 MPOX 最有效？
無症狀檢測
接觸者追蹤
西多福韋和布西多福韋 (cidofovir and brincidofovir) 等抗病毒藥物的預防性處方
配備分子診斷工具的哨點監測點
在流行地區，哪些預防策略對 MPOX 最有效？
您的同行選擇了：
無症狀檢測 —————————————————————————————————-6%
接觸者追蹤 —————————————————————————————————-53%
西多福韋和布西多福韋 (cidofovir and brincidofovir) 等抗病毒藥物的預防性處方 —–16%
配備分子診斷工具的哨點監測點 ———————————————————————–25%
一項綜述旨在探討與改善mpox護理相關的關鍵方面，包括公共衛生和醫療保健層面的預防和控制措施，例如監測和報告、隔離、接觸者追蹤和疫苗接種。研究人員發現，配備分子診斷工具的哨點監測點對於早期發現MPOX疫情和及時做出公共衛生反應至關重要。他們的結論是，此類地點應策略性地分佈在流行地區，以便能夠快速識別可能患有mpox的患者並促進發燒疾病監測。
審查和定性分析發現，幾乎沒有證據支持在不進行疫苗接種追蹤的情況下使用無症狀檢測或接觸者追蹤。
一項審查發現，儘管西多福韋和布西多福韋等抗病毒藥物已在一些實驗室應用中證明可以對抗MPOX病毒，但它們在臨床經驗中僅顯示出有限的證據。此外，儘管西多福韋已被超適應症用於治療嚴重的MPOX病例（特別是併發症高風險患者，例如免疫功能低下的患者），並且布西多福韋在臨床前階段已顯示出希望，但兩者都沒有顯示出作為預防藥物的價值。一般來說，當益處大於潛在風險時，抗病毒治療僅適用於複雜或嚴重的mpox病例。
建議哪些人接種mpox 疫苗？
前往發生MPOX傳播的地理區域的人
那些跨性別者
與男性發生非一夫一妻制性行為的男性
實行一夫一妻制或與雙性戀男性伴侶有親密接觸的女性
建議哪些人接種mpox 疫苗？
您的同行選擇了：
前往發生MPOX傳播的地理區域的人 ————————————–58%
那些跨性別者 ————————————————————————0%
與男性發生非單一伴侶制性行為的男性 ————————————38%
實行單一伴侶制或與雙性戀男性伴侶有親密接觸的女性 ————–4%
免疫實踐諮詢委員會建議，工作中可能接觸到 MPOX 的人員應接種疫苗，以在接觸到 MPOX 後提供保護。即使在 2022 年疫情爆發期間，也不建議廣泛接種疫苗。
然而，疾病預防控制中心建議曾接觸過mpox的人和可能更容易被感染的人接種疫苗，包括：
• 公共衛生官員確定為mpox感染者接觸者的人
• 在過去 2 週內有一位或多位性伴侶被診斷出患有 MPOX 的人
• 過去 2 週內在已知患有 MPOX 的地區有多個性伴侶的人
僅僅與發生 MPOX 的地理區域內的其他人接觸是不夠的；密切或親密接觸是關鍵的風險因素。跨性別或性別多樣化可能是風險因素，但僅與其他高風險行為一起出現，例如多個性伴侶或匿名性行為。同性戀、雙性戀或性別不合格的身份本身並不是一個風險因素，與這樣的人建立單一伴侶制的關係也不被認為是高風險。
CDC 建議在接觸後 4 天內接種疫苗，以預防 MPOX 的發作。如果在接觸後 4-14 天接種疫苗，疫苗可能會減輕症狀，但不太可能預防疾病。
本快速審查測驗摘自並改編自Medscape 文章：猴痘(Mpox)、不斷增長的Mpox 爆發提示CDC 諮詢、ECDC 重新發出關於Mpox 病例可能增加的警告、剛果共和國宣布Mpox 為流行病、CDC 發布Mpox 病毒亞型健康警報在剛果，急性直腸炎、口腔非念珠菌真菌感染、黏膜念珠菌病以及天花（痘苗）和猴痘，活疫苗，非複製型 (Rx)。
引用此文獻：Yasmine S. Ali。Mpox 崛起：快速回顧測驗- Medscape – 2024 年 10 月 2 日。
Rapid Review Quiz: Mpox Rising
Yasmine S. Ali, MD / October 02, 2024 / Drugs & Diseases / Medscape / Rapid Review Quiz
First identified in humans in 1970, the orthopoxvirus called mpox — then referred to as monkeypox — was originally limited to Africa. Today, mpox can be observed around the world, and the World Health Organization recently declared the disease a global public health emergency. The US Centers for Disease Control and Prevention (CDC) issued travel notices for affected regions and identified a second specific subtype of the virus in the Republic of Congo that is potentially more deadly. The European Centre for Disease Prevention and Control also recognized that travel and patterns of socialization, such as attending festivals and other events with large crowds, place patients at risk for mpox. However, it resembles several other illnesses and might be unfamiliar to many practitioners.
Are you prepared to spot and treat mpox in your patients? Test yourself with this quick quiz.
表單的頂端
How does mpox present differently in children compared with adults?
They are almost always asymptomatic
They might have symptoms, but they are less likely to require hospital admission
They are more likely to have severe symptoms
No difference is found between children and adults
How does mpox present differently in children compared with adults?
Your Peers Chose:
They are almost always asymptomatic ————————————————————-12%
They might have symptoms, but they are less likely to require hospital admission —–41%
They are more likely to have severe symptoms —————————————————29%
No difference is found between children and adults ———————————————18%
Analysis of global surveillance data indicates that only 1.3% of reported cases of mpox worldwide were in children. These researchers found that although they might have symptoms, they had lower disease severity, and they observed no deaths and only one hospital admission worldwide.
Other research supports this finding, indicating that children might have symptoms in school settings but none appear to have serious issues that require hospitalization as adults. According to the American Academy of Pediatrics, children are most likely to present with chills, fever, headache, malaise, sore throat, and new lymphadenopathy, followed by the distinctive mpox rash. This rash is described as macules that progress to papules, vesicles, and then deep-seated, hard, or firm pustules that are well circumscribed and might progress to scabs.
These findings of fewer severe mpox symptoms in children stand in contrast with research on adults older than age 50 years, who are even more likely to experience severe disease, hospitalization, and mortality than adults aged 18-49 years.
表單的頂端
Which of these gastrointestinal manifestations of mpox was reported by patients as part of the 2022 outbreak?
Gallstone pancreatitis
Heartburn/gastroesophageal reflux disease
Liver injury
Proctitis
A recent systematic review aimed to characterize the gastrointestinal effects of mpox, particularly since the 2022 outbreak. The researchers found that proctitis was reported as a predominant gastrointestinal manifestation in mpox patients. They also reported that other gastrointestinal manifestations include abdominal pain, diarrhea, nausea, rectal bleeding and pain, tenesmus, and vomiting.
Other research conducted slightly earlier found that gastrointestinal symptoms are most likely to affect pediatric patients, and that these patients were more likely to exhibit abdominal pain, anorexia, nausea, vomiting, and diarrhea. However, this team also found that symptoms such as proctitis presenting as anal/rectal pain and rectal bleeding were not previously associated with mpox infection and are unique to the 2022 outbreak. This result is echoed in other research.
表單的頂端
Which of these differential diagnoses/co-infections should be considered in patients that present with suspected mpox and oral/perioral pseudomembranous plaques?
Herpes simplex
Molluscum contagiosum
Oral candidiasis
Syphilis
Which of these differential diagnoses/co-infections should be considered in patients that present with suspected mpox and oral/perioral pseudomembranous plaques?
Your Peers Chose:
Herpes simplex ————————————36%
Molluscum contagiosum ————————18%
Oral candidiasis ————————————29%
Syphilis ———————————————–17%
Findings on dermatologic manifestations of mpox indicate that oral/perioral lesions are commonly observed but can easily be confounded with several differential diagnoses. Pseudomembranous plaques are associated with both oral candidiasis and noncandidal fungal infections.
Moreover, especially in immunocompromised patients, co-infection is likely. More than one form of diagnostic testing and multiple samples from lesions might be required to evaluate immunocompromised patients that present with widespread skin manifestations.
In contrast, a dermoscopic review of poxviruses shows that unlike oral candidiasis which presents with oral/perioral pseudomembranous plaques, molluscum contagiosum presents with multiple shiny, waxy nodules or papules with a concave center.
Similarly, oral/perioral ulcers might be confused with herpes simplex infection, whereas chancriform papules in this region might be a sign of syphilis. Chancroid is usually associated with genital ulcers, not oral/perioral lesions, and it is also exceptionally rare in the United States.
表單的頂端
Which of these prevention strategies is most effective against mpox in endemic areas?
Asymptomatic testing
Contact tracing
Prophylactic prescription of antivirals such as cidofovir and brincidofovir
Sentinel surveillance sites equipped with molecular diagnostic tools
Which of these prevention strategies is most effective against mpox in endemic areas?
Your Peers Chose:
Asymptomatic testing —————————————————————————-6%
Contact tracing ————————————————————————————-53%
Prophylactic prescription of antivirals such as cidofovir and brincidofovir ———-16%
Sentinel surveillance sites equipped with molecular diagnostic tools —————-25%
A review aimed to explore key aspects related to improving nursing care for mpox, including prevention and control measures at both the public health and healthcare levels, such as surveillance and reporting, isolation, contact tracing, and vaccination. The researchers found that sentinel surveillance sites equipped with molecular diagnostic tools were critical to the early detection of mpox outbreaks and timely public health responses. They concluded that sites like these should be strategically positioned across endemic regions to enable rapid identification of possible patients with mpox and facilitate febrile illness monitoring.
A review and qualitative analysis found little evidence to support the use of asymptomatic testing or contact tracing without vaccination follow-up.
A review found that although antiviral medications such as cidofovir and brincidofovir have demonstrated some laboratory applications against the mpox virus, they have shown only limited evidence in clinical experience. Moreover, although cidofovir has been used off-label to treat severe cases of mpox (particularly in patients at high risk for complications, such as those who are immunocompromised) and brincidofovir has shown promise at the preclinical stage, neither has demonstrated value as a prophylactic agent. Generally, antiviral therapy is reserved for complicated or severe cases of mpox when the benefits outweigh potential risks.
表單的頂端
For whom is mpox vaccination recommended?
Those traveling to a geographic area where mpox transmission is occurring
Those who are transgender
Men who have nonmonogamous sex with men
Women who have monogamous sex or intimate contact with bisexual male partners
For whom is mpox vaccination recommended?
Your Peers Chose:
Those traveling to a geographic area where mpox transmission is occurring ———————–58%
Those who are transgender ————————————————————————————–0%
Men who have nonmonogamous sex with men ————————————————————38%
Women who have monogamous sex or intimate contact with bisexual male partners ———–4%
The Advisory Committee on Immunization Practices recommends that people whose jobs might expose them to mpox get vaccinated to protect them if they are exposed. Widespread vaccination is not recommended, even during the 2022 outbreak.
However, the CDC recommends vaccination for individuals who have been exposed to mpox and those who might be more likely to become infected, including:
- People identified by public health officials as contacts of those infected with mpox
- People who had one or more sexual partners diagnosed with mpox in the past 2 weeks
- People who have had multiple sexual partners in the past 2 weeks in an area with known mpox
Mere contact with others in a geographic area where mpox is occurring is not enough; close or intimate contact is a critical risk factor. Being transgender or gender-diverse might be a risk factor, but only along with other high-risk behavior, such as multiple sexual partners or anonymous sex. Mere identity as gay, bisexual, or gender nonconforming is not itself a risk factor, and a monogamous relationship with such a person is not considered high risk.
The CDC recommends that the vaccine be administered within 4 days of exposure to prevent the onset of mpox. If administered 4-14 days after exposure, the vaccination might reduce symptoms but is not as likely to prevent the disease.
Learn more about the vaccine.
This Rapid Review quiz was excerpted and adapted from the Medscape articles Monkeypox (Mpox), Growing Mpox Outbreak Prompts CDC Advisory, ECDC Renews Warning About Possible Increases in Mpox Cases, Congo Republic Declares Mpox an Epidemic, CDC Issues Health Alert for Subtype of Mpox Virus in Congo, Acute Proctitis, Noncandidal Fungal Infections of the Mouth, Mucosal Candidiasis, and smallpox (vaccinia) and monkeypox vaccine, live, nonreplicating (Rx).
Cite this: Yasmine S. Ali. Rapid Review Quiz: Mpox Rising – Medscape – Oct 02, 2024.