An Italian who was in Spain, the first case of coinfection with monkeypox, SARS-CoV-2 and HIV

An investigation, the results of which have been published in the

has described the characteristics and diagnosis of the first case of coinfection with monkeypox, SARS-CoV-2 and HIV.

This is

As described in the article by researchers from the University of Catania (Italy), the 36-year-old patient "nine days after being in Spain [between June 16 and 20] presented fever (up to 39°C), accompanied by sore throat, fatigue, headache, and right inguinal adenomegaly.

That same afternoon, he began to develop a rash on his left arm

and the next day "small painful vesicles surrounded by an erythematous halo appeared on the torso, lower limbs, face and buttocks."

On July 5,

so the man went to the emergency room of the G. Rodolico San Marco Polyclinic of the University Hospital of Catania, to later be transferred to the center's Infectious Diseases Unit.

Upon admission, "the patient said he had been treated for syphilis in 2019. In September 2021, an HIV test was performed with a negative result

," the researchers describe, adding that, in addition, "he suffered from bipolar disorder, for which he regularly took carbamazepine 200 mg daily.

The patient had been vaccinated against SARS-CoV-2 with two doses, the last in December 2021, and contracted Covid-19 in January 2022. As reported on his admission to the unit,

"On physical examination, her body was dotted, including the palm of her right hand and the perianal region, with skin lesions in various stages of progression, ranging from small vesicles, to reddened pustules with halos and umbilicated plaques," the report said. Article.

Extraction of samples

Given the high suspicion of being infected with monkeypox, samples of the exudate from the pustules were extracted, as well as secretions from the nasopharynx

.

"

for monkeypox virus and SARS-CoV-2," the researchers note.

In the case of monkeypox, the doctors confirmed that it was the West African variant (the one registered in Spain and in most of the countries affected by the global outbreak), while in the case of Covid, the lineage it was BA.5.1.

As for other serological tests for viral hepatitis, herpes simplex, gonorrhea, chlamydia, and lymphogranuloma venereum, they were negative.

"However,

with a viral load of 234,000 copies/mL. The CD4 lymphocyte count remained unchanged at 812 cells/L (normal values ​​between 410-1590 cells/L)," the research points out.

On the third day of admission, "almost all of the skin lesions began to scab over. Sotrovimab 500 mg was infused intravenously."

By day five (July 9, 2022), "almost all symptoms resolved and laboratory test values ​​normalized," the researchers report.

Since the symptoms had resolved,

"On July 19, 2022, he returned to our institute for a new oropharyngeal swab for monkeypox virus, which was still positive. The scabs had almost completely healed, leaving a small scar. A triple combination of dolutegravir was started , abacavir and lamivudine for the treatment of HIV," the publication states.

transmission route

The researchers point out that "

, and corroborates how in the case of co-infection, collecting anamnesis and knowing sexual habits are crucial to making the correct diagnosis".

Regarding Covid, they recall that the BA.4 and BA.5 subvariants of SARS-CoV-2 are currently responsible for more than one million cases of Covid-19 per day worldwide.

"Therefore,

, especially in subjects with a recent history of travel to countries with a smallpox outbreak. of the monkey", they warn.

"This case highlights that

Therefore,

," the researchers advise, adding. : "In fact, our patient tested positive for HIV, and given his preserved CD4 count, we can assume that the infection was relatively recent."

In addition, they warn that, by verifying that the patient was still positive for monkeypox 20 days after symptoms, "

.

They end the article by stating that "given that this is the only recorded case of co-infection with monkeypox virus, SARS-CoV-2 and HIV, there is still not enough evidence to support that this combination can aggravate the state of the However, given the current SARS-CoV-2 pandemic and the daily increase in cases of monkeypox,

, which are essential for containment, as there is no widely available treatment or prophylaxis."

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