Pathology and Monkeypox virus Localization in Tissues From Immunocompromised Patients With Severe or Fatal Mpox
Published by Oxford University Press on behalf of Infectious Diseases Society of America 2024..
BACKGROUND: Pathology and Monkeypox virus (MPXV) tissue tropism in severe and fatal human mpox is not thoroughly described but can help elucidate the disease pathogenesis and the role of coinfections in immunocompromised patients.
METHODS: We analyzed biopsy and autopsy tissues from 22 patients with severe or fatal outcomes to characterize pathology and viral antigen and DNA distribution in tissues by immunohistochemistry and in situ hybridization. Tissue-based testing for coinfections was also performed.
RESULTS: Mucocutaneous lesions showed necrotizing and proliferative epithelial changes. Deceased patients with autopsy tissues evaluated had digestive tract lesions, and half had systemic tissue necrosis with thrombotic vasculopathy in lymphoid tissues, lung, or other solid organs. Half also had bronchopneumonia, and one-third had acute lung injury. All cases had MPXV antigen and DNA detected in tissues. Coinfections were identified in 5 of 16 (31%) biopsy and 4 of 6 (67%) autopsy cases.
CONCLUSIONS: Severe mpox in immunocompromised patients is characterized by extensive viral infection of tissues and viremic dissemination that can progress despite available therapeutics. Digestive tract and lung involvement are common and associated with prominent histopathological and clinical manifestations. Coinfections may complicate mpox diagnosis and treatment. Significant viral DNA (likely correlating to infectious virus) in tissues necessitates enhanced biosafety measures in healthcare and autopsy settings.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:229 |
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| Enthalten in: |
The Journal of infectious diseases - 229(2024), Supplement_2 vom: 26. März, Seite S219-S228 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ritter, Jana M [VerfasserIn] |
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| Links: |
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| Themen: |
Antigens, Viral |
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| Anmerkungen: |
Date Completed 28.03.2024 Date Revised 28.03.2024 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/infdis/jiad574 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM367340976 |
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| 100 | 1 | |a Ritter, Jana M |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Pathology and Monkeypox virus Localization in Tissues From Immunocompromised Patients With Severe or Fatal Mpox |
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| 500 | |a Date Completed 28.03.2024 | ||
| 500 | |a Date Revised 28.03.2024 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Published by Oxford University Press on behalf of Infectious Diseases Society of America 2024. | ||
| 520 | |a BACKGROUND: Pathology and Monkeypox virus (MPXV) tissue tropism in severe and fatal human mpox is not thoroughly described but can help elucidate the disease pathogenesis and the role of coinfections in immunocompromised patients | ||
| 520 | |a METHODS: We analyzed biopsy and autopsy tissues from 22 patients with severe or fatal outcomes to characterize pathology and viral antigen and DNA distribution in tissues by immunohistochemistry and in situ hybridization. Tissue-based testing for coinfections was also performed | ||
| 520 | |a RESULTS: Mucocutaneous lesions showed necrotizing and proliferative epithelial changes. Deceased patients with autopsy tissues evaluated had digestive tract lesions, and half had systemic tissue necrosis with thrombotic vasculopathy in lymphoid tissues, lung, or other solid organs. Half also had bronchopneumonia, and one-third had acute lung injury. All cases had MPXV antigen and DNA detected in tissues. Coinfections were identified in 5 of 16 (31%) biopsy and 4 of 6 (67%) autopsy cases | ||
| 520 | |a CONCLUSIONS: Severe mpox in immunocompromised patients is characterized by extensive viral infection of tissues and viremic dissemination that can progress despite available therapeutics. Digestive tract and lung involvement are common and associated with prominent histopathological and clinical manifestations. Coinfections may complicate mpox diagnosis and treatment. Significant viral DNA (likely correlating to infectious virus) in tissues necessitates enhanced biosafety measures in healthcare and autopsy settings | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Monkeypox virus | |
| 650 | 4 | |a HIV | |
| 650 | 4 | |a immunocompromise | |
| 650 | 4 | |a mpox | |
| 650 | 4 | |a pathology | |
| 650 | 7 | |a Antigens, Viral |2 NLM | |
| 650 | 7 | |a DNA, Viral |2 NLM | |
| 700 | 1 | |a Martines, Roosecelis B |e verfasserin |4 aut | |
| 700 | 1 | |a Bhatnagar, Julu |e verfasserin |4 aut | |
| 700 | 1 | |a Rao, Agam K |e verfasserin |4 aut | |
| 700 | 1 | |a Villalba, Julian A |e verfasserin |4 aut | |
| 700 | 1 | |a Silva-Flannery, Luciana |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Elizabeth |e verfasserin |4 aut | |
| 700 | 1 | |a Bullock, Hannah A |e verfasserin |4 aut | |
| 700 | 1 | |a Hutson, Christina L |e verfasserin |4 aut | |
| 700 | 1 | |a Cederroth, Terra |e verfasserin |4 aut | |
| 700 | 1 | |a Harris, Cynthia K |e verfasserin |4 aut | |
| 700 | 1 | |a Hord, Kristin |e verfasserin |4 aut | |
| 700 | 1 | |a Xu, Ya |e verfasserin |4 aut | |
| 700 | 1 | |a Brown, Cameron A |e verfasserin |4 aut | |
| 700 | 1 | |a Guccione, Jack P |e verfasserin |4 aut | |
| 700 | 1 | |a Miller, Matthew |e verfasserin |4 aut | |
| 700 | 1 | |a Paddock, Christopher D |e verfasserin |4 aut | |
| 700 | 1 | |a Reagan-Steiner, Sarah |e verfasserin |4 aut | |
| 700 | 0 | |a Mpox Pathology Working Group |e verfasserin |4 aut | |
| 700 | 1 | |a Carter, Jasmine |e investigator |4 oth | |
| 700 | 1 | |a Seixas, Josilene N |e investigator |4 oth | |
| 700 | 1 | |a Lee, James |e investigator |4 oth | |
| 700 | 1 | |a Cash-Goldwasser, Shama |e investigator |4 oth | |
| 700 | 1 | |a Bower, William A |e investigator |4 oth | |
| 700 | 1 | |a Schrodt, Caroline A |e investigator |4 oth | |
| 700 | 1 | |a Bamrah Morris, Sapna |e investigator |4 oth | |
| 700 | 1 | |a Alarcón, Jemma |e investigator |4 oth | |
| 700 | 1 | |a Evans, Mark G |e investigator |4 oth | |
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