Is there a way to predict the severity of the disease in people who become infected with the Mpox virus? An Italian study has looked for associated factors that can allow understanding in time if the patient will develop a serious form and that can guide doctors in case management decisions, especially in the initial phases. And one of the points on which the authors shine the spotlight is the viral load. “High values in the upper respiratory tract in the first week of infection,” they suggest, are “a possible predictor of serious infection by Mpox,” the infection known as monkeypox before the name was changed in an anti-stigma key.
The study by the Mpox-Icona group – which involves experts from various centers and universities in Italy, from the Lazzaro Spallanzani Institute in Rome to the Sacco hospital in Milan, from the San Martino Polyclinic in Genoa to the Paolo Giaccone Polyclinic in Palermo, from San Raffaele to Niguarda in Milan, and also Aorn Ospedali dei Colli in Naples, San Gerardo in Monza, Gemelli University Polyclinic in Rome and the Icona Foundation in Milan – evaluated the predictors of the duration of Mpox, analyzed the kinetics of inflammatory markers and described the detection of Mpxv virus DNA in body fluids after clinical recovery. The work published in ‘eBioMedicine’, as infectious disease specialist Matteo Bassetti also explains in X, “demonstrates that the higher the quantity of virus in the body, the greater the probability of having severe forms”.
Other aspects observed are that “Caucasian race and presentation with fever, sore throat, lymphadenopathy and perianal lesions could” also “predict the severe evolution of the disease”. But in particular, precisely “elevated Ct values of the upper respiratory tract in the first week of infection”. These results could help to develop a laboratory strategy with measurable parameters of unfavorable clinical evolution in the very early stages of the infection, even in patients who do not present skin lesions.
The authors started from the fact that in the 2022-2023 epidemic, severe and prolonged courses of Mpox were described. The multicenter historical cohort study therefore considered adults with a laboratory-confirmed diagnosis between May 2022 and September 2023 in 15 Italian centers. The cases were followed from the day of diagnosis until clinical recovery. A total of 541 patients were enrolled, including 4 women. Average age: 38 years. The severe form was reported in 215 patients (39.7%). None died.
Investigating the “significant difference” observed between the viral load of patients who had a mild infection and those who developed severe disease, the experts found that the risk of developing severe disease decreased “by approximately 5% for each increase in Ct,” the higher the value, the more indicative of a low viral load. In other words, decreasing the viral load detected in the upper respiratory tract also decreased the risk of severe disease. The experts also noted that “the mpox virus did not show any tendency to cause specific organ damage. Furthermore, the study showed viral dissemination to several anatomical sites after clinical recovery, although definitive interpretations of infectivity could not be drawn.”
The direct association between upper respiratory tract Ct values and Mpox severity, the authors conclude, “suggests its potential use as a laboratory tool, together with known clinical predictors, for early case management and to identify individuals at risk of severe disease. This could facilitate timely initiation of antiviral treatment or referral for hospitalization, particularly among the most vulnerable individuals, such as those with advanced HIV infection. Finally, research efforts and continued international surveillance are critical to improve current containment strategies and future outbreak responses among members of key populations.”
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