英国盖伊和圣托马斯NHS基金会信托基金Aatish Patel团队研究了2022年疫情期间伦敦中心人猴痘的临床特征和新表现。2022年7月28日，《英国医学杂志》发表了这一成果。

为了探讨人猴痘感染的临床特点，2022年5月至7月，研究组在伦敦南部建立了一个区域性高重要性的传染病中心，提供相关的初级和二级护理转诊，以及附属性健康中心，共招募了197例经聚合酶链反应确诊的猴痘感染患者，进行描述性案例系列分析。

受试者的中位年龄为38岁。所有197名参与者均为男性，其中196人被认定为同性恋、双性恋或其他与男性发生性关系的男性。所有患者均表现为皮肤粘膜病变，最常见于生殖器（111例，56.3%）或肛周（82例，41.6%）。

170名（86.3%）参与者报告了系统性疾病。最常见的全身症状是发热（122例，61.9%）、淋巴结病（114例，57.9%）和肌痛（62例，31.5%）。166人中有102人（61.5%）在出现皮肤粘膜症状之前出现全身特征，64人（38.5%）在出现皮肤粘膜症状之后出现全身特征（4人未知）。27例（13.7%）仅表现为粘膜皮肤症状，无全身特征。

直肠疼痛71例（36.0%），喉咙痛33例（16.8%），阴茎水肿31例（15.7%）。口腔病变27例（13.7%），扁桃体征9例（4.6%）。195名参与者中有70名（35.9%）同时感染艾滋病。性传播感染筛查者中有56人（31.5%）伴有性传播感染。总体来说，20名（10.2%）参与者因症状（最常见的是直肠疼痛和阴茎肿胀）入院治疗。

这些发现证实了猴痘病毒在英国和许多其他非流行国家的同性恋、双性恋和其他男男性行为者中正在进行前所未有的社区传播。在皮肤粘膜和全身特征之间观察到一种可变的时间相关性，这表明该疾病有一个新的临床过程。该研究确定了猴痘感染的新临床表现，包括直肠疼痛和阴茎水肿。这些介绍应包括在公共卫生信息中，以帮助早期诊断和减少进一步传播。

附：英文原文

Title: Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series

Author: Aatish Patel, Julia Bilinska, Jerry C H Tam, Dayana Da Silva Fontoura, Claire Y Mason, Anna Daunt, Luke B Snell, Jamie Murphy, Jack Potter, Cecilia Tuudah, Rohan Sundramoorthi, Movin Abeywickrema, Caitlin Pley, Vasanth Naidu, Gaia Nebbia, Emma Aarons, Alina Botgros, Sam T Douthwaite, Claire van Nispen tot Pannerden, Helen Winslow, Aisling Brown, Daniella Chilton, Achyuta Nori

Issue&Volume: 2022/07/28

Abstract:

Objective To characterise the clinical features of monkeypox infection in humans.

Design Descriptive case series.

Setting A regional high consequences infectious disease centre with associated primary and secondary care referrals, and affiliated sexual health centres in south London between May and July 2022.

Participants 197 patients with polymerase chain reaction confirmed monkeypox infection.

Results The median age of participants was 38 years. All 197 participants were men, and 196 identified as gay, bisexual, or other men who have sex with men. All presented with mucocutaneous lesions, most commonly on the genitals (n=111 participants, 56.3%) or in the perianal area (n=82, 41.6%). 170 (86.3%) participants reported systemic illness. The most common systemic symptoms were fever (n=122, 61.9%), lymphadenopathy (114, 57.9%), and myalgia (n=62, 31.5%). 102/166 (61.5%) developed systemic features before the onset of mucocutaneous manifestations and 64 (38.5%) after (n=4 unknown). 27 (13.7%) presented exclusively with mucocutaneous manifestations without systemic features. 71 (36.0%) reported rectal pain, 33 (16.8%) sore throat, and 31 (15.7%) penile oedema. 27 (13.7%) had oral lesions and 9 (4.6%) had tonsillar signs. 70/195 (35.9%) participants had concomitant HIV infection. 56 (31.5%) of those screened for sexually transmitted infections had a concomitant sexually transmitted infection. Overall, 20 (10.2%) participants were admitted to hospital for the management of symptoms, most commonly rectal pain and penile swelling.

Conclusions These findings confirm the ongoing unprecedented community transmission of monkeypox virus among gay, bisexual, and other men who have sex with men seen in the UK and many other non-endemic countries. A variable temporal association was observed between mucocutaneous and systemic features, suggesting a new clinical course to the disease. New clinical presentations of monkeypox infection were identified, including rectal pain and penile oedema. These presentations should be included in public health messaging to aid early diagnosis and reduce onward transmission.

DOI: 10.1136/bmj-2022-072410

Source: https://www.bmj.com/content/378/bmj-2022-072410