The National Institute for Infectious Diseases ‘Lazzaro Spallanzani’ Irccs of Rome and the Ircss San Raffaele Hospital Università Vita – Salute San Raffaele of Milan coordinated the multicenter study ‘Clinical and laboratory predictors of mpox severity and duration: an Italianmulticentrecohortstudy (mpox-Icona)’, just published in the journal eBioMedicine of the Lancet Group. This is the most important case study on Mpox ever published in Italy, as well as one of the largest in the world, having observed 541 patients out of a total of 1,056 cases reported to date in Italy.
The work – reports a note – conducted in 15 Italian infectious disease centers belonging to the Icona Network, includes cases of Mpox due to Clade IIb of 2022-2023 and was aimed at studying the factors associated with greater severity and a longer duration of the disease.
As explained by one of the two first authors of the study, Valentina Mazzotta, of the UOC Viral Immunodeficiencies of Spallanzani, “the main result is that a higher viral load of the Mpox virus in the pharyngeal swab was associated with a more severe course. Other factors associated with greater severity are Caucasian ethnicity, an onset with fever, the presence of involvement of the oral cavity, lesions around the anus and lymphadenopathy. Mpox has a longer duration in case of ano-rectal, oro-pharyngeal localization, in case of extensive skin rash and in people with HIV with severe immunodeficiency”.
“The association between high viral load and greater severity of disease – says Andrea Antinori, director of the Clinical Department of the Inmi Spallanzani and one of the two senior authors of the work – is the first documented in the literature and demonstrates that a highly replicating virus significantly impacts the morbidity of Mpox. These results, although demonstrated on the viral Clade IIb and not on the Clade Ib that is causing the current epidemic in Central Africa, can also be transferred to the context of the new emerging variant of the Mpox virus and suggest that the control of viral replication, as occurs in the vaccinated person in which a powerful anti-viral immune response is stimulated, can, in addition to having a protective value from infection, also protect from severe disease”.
The publication “of these data is a concrete testimony to the presence of centers of excellence in Italy that were able to manage the 2022 epidemic outbreak in an effective and culturally productive way within the solid network of the Icona foundation – underlines Antonella Castagna, head of Infectious Diseases at San Raffaele and director of the specialization school in Infectious and Tropical Diseases at the Vita-Salute San Raffaele University.
The study – the note concludes – also involved the Department of Medicine of the University of Udine; Asst Fatebenefratelli Sacco, Luigi Sacco Hospital of Milan; Asst Grande Ospedale Metropolitano Niguarda of Milan; Aorn Ospedali dei Colli of Naples; Asst Santi Paolo e Carlo, University of Milan; Irccs San Gerardo dei Tintori Foundation, University of Milan-Bicocca of Monza; Irccs Policlinico San Martino, University of Genoa; University Hospital Trust Policlinico Paolo Giaccone of Palermo; Gemelli Irccs University Hospital Foundation, Catholic University of the Sacred Heart of Rome; Icona Foundation of Milan.
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