サル痘の臨床所見 （197名）

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

The BMJ, 2022 

英国：

5月6日に西アフリカに渡航歴のある方にサル痘の警告→1週間でリンクのない方が6名診断。7月12日までに、1735名が英国で診断（96％が男性同士の同性愛者であり、79％がロンドンで発生）。

今回、south London HCID centreの症例についてretrospectiveに解析

期間：5/13-7/1

陽性：197名（全例男性、年齢：中央値38歳 IQR 32-42） 

全例で皮膚所見あり。

性器皮膚所見が最も多く（56.4%）、次に肛門、肛門周囲（56.4%）であり、どちらかを認める症例は88.3%であった。皮膚所見数の中央値は5個で、8名で100か所以上の所見あり。22名（11.2％）で単一所見のみであった。

全身症状（86.3％）：発熱（61.9%）, リンパ節腫脹（57.9%）,倦怠感（31.5%）。全身症状は61.5%で皮膚所見前に呈していた。36％で直腸痛もしくは排便時痛を訴えていた。16.8％で咽頭痛、15.7％で陰茎浮腫があった。1名で経過中、局所的直腸穿孔を認めた。

35.5%でHIV 陽性。21.1％で淋菌陽性、11.2%でクラミジア陽性、3.7%で梅毒陽性。

検査陰性例での他の診断は梅毒(14.3%, N=14), 単純ヘルペス（13.5%, N=13）, 帯状疱疹（7.1%, N=7）, クラミジア（6.1%, N=6）, 皮膚細菌感染（3.1%, N=3）等　

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.

Doxycycline versus azithromycin for the treatment of anorectal Chlamydia trachomatis infection in women concurrent with vaginal infection (CHLAZIDOXY study): a multicentre, open-label, randomised, controlled, superiority trial, Lancet infectious diseases 2022