Clinical characteristics and predictors of human mpox outcome during the 2022 outbreak in Nigeria: a cohort study.

Autor:	Ogoina D; Infectious Diseases Unit, Department of Internal Medicine, Niger Delta University Teaching Hospital, Niger Delta University, Yenagoa, Bayelsa, Nigeria. Electronic address: dimieogoina@gmail.com., Dalhat MM; Infectious Diseases Control Centre, Kaduna, Kaduna, Nigeria., Denue BA; Department of Medicine, University of Maiduguri, Borno, Nigeria., Okowa M; Department of Public Health, Ministry of Health, Asaba, Delta, Nigeria., Chika-Igwenyi NM; Infectious Diseases Unit, Internal Medicine Department, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi , Nigeria., Yusuff HA; Department of Public Health, Ministry of Health, Abeokuta, Ogun, Nigeria., Christian UC; Infectious Diseases and Tropical Medicine Unit, Department of Internal Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria., Adekanmbi O; Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria., Ojimba AO; Centre for Communicable Disease Control and Research, Federal Medical Centre, Asaba, Delta, Nigeria., Aremu JT; Infectious Diseases Unit, Federal Teaching Hospital Gombe, Gombe, Nigeria., Habila KL; Kaduna State Emergency Medical Services and Ambulance System, Kaduna, Kaduna, Nigeria., Oiwoh SO; Department of Internal Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo, Nigeria., Tobin EA; Institute of Viral Haemorrhagic Fever and Emerging Pathogens, Irrua Specialist Teaching Hospital, Irrua, Edo, Nigeria., Johnson SM; Department of Internal Medicine, Federal University Teaching Hospital, Owerri, Imo, Nigeria., Olaitan A; Department of Internal Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun, Nigeria., Onyeaghala C; Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria., Gomerep SS; Infectious Diseases Unit, Jos University Teaching Hospital, and Medicine Department, University of Jos, Plateau, Nigeria., Alasia D; Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria., Onukak AE; Department of Internal Medicine, University of Uyo, Uyo, Nigeria., Mmerem J; Infectious Disease and Tropical Medicine Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria., Unigwe U; Infectious Disease and Tropical Medicine Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria., Falodun O; Department of Internal Medicine, National Hospital Abuja, Federal Capital Territory, Nigeria., Kwaghe V; Department of Internal Medicine, University of Abuja Teaching Hospital, Gwagalada, Abuja, Federal Capital Territory, Nigeria., Awang SK; Infectious Diseases Unit, Department of Internal Medicine, Modibo Adama University Teaching Hospital, Yola, Adamawa, Nigeria., Sunday M; Department of Public Health, Federal Medical Centre, Ebute Metta, Lagos, Nigeria., Maduka CJ; Department of Internal Medicine, Federal Medical Centre, Umahia, Abia, Nigeria., Na'uzo AM; Department of Paediatrics, Federal Medical Centre, Birnin Kebbi, Kebbi, Nigeria., Owhin SO; Department of Medicine, Clinical Haematology Unit, Federal Medical Center, Owo, Ondo, Nigeria., Mohammed AA; Infectious Diseases and Tropical Medicine Unit, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Kaduna, Nigeria., Adeiza MA; Infectious Diseases and Tropical Medicine Unit, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Kaduna, Nigeria.
Jazyk:	angličtina
Zdroj:	The Lancet. Infectious diseases [Lancet Infect Dis] 2023 Dec; Vol. 23 (12), pp. 1418-1428. Date of Electronic Publication: 2023 Aug 22.
DOI:	10.1016/S1473-3099(23)00427-9
Abstrakt:	Background: Research from sub-Saharan Africa that contributes to our understanding of the 2022 mpox (formerly known as monkeypox) global outbreak is insufficient. Here, we describe the clinical presentation and predictors of severe disease among patients with mpox diagnosed between Feb 1, 2022, and Jan 30, 2023 in Nigeria. Methods: We did a cohort study among laboratory-confirmed and probable mpox cases seen in 22 mpox-treatment centres and outpatient clinics across Nigeria. All individuals with confirmed and probable mpox were eligible for inclusion. Exclusion criteria were individuals who could not be examined for clinical characterisation and those who had unknown mortality outcomes. Skin lesion swabs or crust samples were collected from each patient for mpox diagnosis by PCR. A structured questionnaire was used to document sociodemographic and clinical data, including HIV status, complications, and treatment outcomes from the time of diagnosis to discharge or death. Severe disease was defined as mpox associated with death or with a life-threatening complication. Two logistic regression models were used to identify clinical characteristics associated with severe disease and potential risk factors for severe disease. The primary outcome was the clinical characteristics of mpox and disease severity. Findings: We enrolled 160 people with mpox from 22 states in Nigeria, including 134 (84%) adults, 114 (71%) males, 46 (29%) females, and 25 (16%) people with HIV. Of the 160 patients, distinct febrile prodrome (n=94, 59%), rash count greater than 250 (90, 56%), concomitant varicella zoster virus infection (n=48, 30%), and hospital admission (n=70, 48%) were observed. Nine (6%) of the 160 patients died, including seven (78%) deaths attributable to sepsis. The clinical features independently associated with severe disease were a rash count greater than 10 000 (adjusted odds ratio 26·1, 95% CI 5·2-135·0, p<0·0001) and confluent or semi-confluent rash (6·7, 95% CI 1·9-23·9). Independent risk factors for severe disease were concomitant varicella zoster virus infection (3·6, 95% CI 1·1-11·5) and advanced HIV disease (35·9, 95% CI 4·1-252·9). Interpretation: During the 2022 global outbreak, mpox in Nigeria was more severe among those with advanced HIV disease and concomitant varicella zoster virus infection. Proactive screening, management of co-infections, the integration and strengthening of mpox and HIV surveillance, and preventive and treatment services should be prioritised in Nigeria and across Africa. Funding: None. Competing Interests: Declaration of interests We declare no competing interests. (Copyright © 2023 Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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