Scientific Letter
Monkeypox, also in pediatric age
Viruela del mono, también en la edad pediátrica
Marc Roguera Sopena
, Laura Naqui Xicota, Águeda Hernández Rodríguez, María Jesús Méndez Hernández, Carlos Rodrigo Gonzalo de Liria
Corresponding author
Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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María Jesús Méndez Hernández, Carlos Rodrigo Gonzalo de Liria" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Marc" "apellidos" => "Roguera Sopena" "email" => array:1 [ 0 => "mroguera.germanstrias@gencat.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Laura" "apellidos" => "Naqui Xicota" ] 2 => array:2 [ "nombre" => "Águeda" "apellidos" => "Hernández Rodríguez" ] 3 => array:2 [ "nombre" => "María Jesús" "apellidos" => "Méndez Hernández" ] 4 => array:2 [ "nombre" => "Carlos" "apellidos" => "Rodrigo Gonzalo de Liria" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Viruela del mono, también en la edad pediátrica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 455 "Ancho" => 905 "Tamanyo" => 39738 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cutaneous lesions in the left buttock.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a girl aged 3 years brought in for observation of cutaneous lesions in the absence of fever, pruritus or other symptoms. The salient feature in the physical examination was the presence polymorphous cutaneous lesions localised to the buttocks, with umbilicated pustular, vesicular and papular elements and a maximum diameter of 3 mm (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). There was no evidence of oral, perianal or genital lesions. There was also no significant lymph node or visceral organ enlargement, and the rest of the examination was normal. A few hours earlier, monkeypox virus (MPXV) infection had been confirmed in the father. The patient had no history of travel or contact with animals. Testing by of a vesicular fluid swab specimen turned out positive for MPXV (real-time polymerase chain reaction). Instructions were given to have the patient isolate at home with use of contact, airborne and droplet precautions until the full resolution of the cutaneous lesions (at 10 days from onset). At the 2-month follow-up, there were no complications and new lesions had not developed. Additional cases had not been detected in any contacts in the school.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">This is the first paediatric case of MPXV infection reported in Spain (June 17, 2022).</p><p id="par0015" class="elsevierStylePara elsevierViewall">Monkeypox is a viral zoonosis produced by MPXV, which has become the most important <span class="elsevierStyleItalic">Orthopoxvirus</span> species worldwide.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> At present, numerous outbreaks have been identified in different countries, with more than 2000 cases reported in Spain as of July 2022. The severity of the infection depends on the presence of comorbidities and age, with a reported overall mortality of 15% and a higher risk in young children in endemic areas in sub-Saharan Africa.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It produces symptoms similar to those observed in patients with smallpox, although less severe. The main mechanism of transmission in humans is through contact with mammals, chiefly rodents or primates, in endemic regions. Transmission from one person to another is also possible through air droplets, direct contact with cutaneous lesions, bodily fluids or objects used by infected individuals.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The most frequent mechanism of transmission in the current outbreak has been sexual contact.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Infection by MPXV tends to cause mild and self-limiting disease lasting 2–4 weeks that only requires symptomatic treatment. However, in some cases it may cause severe disease. Complications can include bacterial superinfection of the cutaneous lesions, bronchopneumonia, sepsis, encephalitis and keratitis. Isolation measures are indicated, with contact, airborne and droplet precaution, until the full resolution of the cutaneous lesions. Antiviral drugs, such as brincidofovir and tecovirimat, have been tried in humans, but there is not enough evidence yet to support the indication.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Post-exposure prophylaxis with intravenous immunoglobulin or smallpox vaccine is not approved in the paediatric age group, and should be reserved for compassionate use.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Whenever a case is confirmed, close contacts should be followed up, especially any sexual contacts, for 3 weeks.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 455 "Ancho" => 905 "Tamanyo" => 39738 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cutaneous lesions in the left buttock.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1605 "Ancho" => 805 "Tamanyo" => 84349 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Detail of cutaneous lesions in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministerio de Sanidad. Alerta de viruela del mono en España y a nivel mundial. Protocolo para la detección precoz y manejo de casos ante la alerta de viruela de los monos (Monkeypox) en España. Madrid: Ministerio de Sanidad; 2022 [Accessed 16 June 2022]. Available from: <a target="_blank" href="https://www.sanidad.gob.es/profesionales/saludPublica/ccayes/alertasActual/alertaMonkeypox">https://www.sanidad.gob.es/profesionales/saludPublica/ccayes/alertasActual/alertaMonkeypox</a>." ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case report of Monkeypox in a 4-year-old boy from the DR Congo: challenges of diagnosis and management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.K. Eltvedt" 1 => "M. Christiansen" 2 => "A. Poulsen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2020/8572596" "Revista" => array:5 [ "tituloSerie" => "Case Rep Pediatr" "fecha" => "2020" "volumen" => "2020" "paginaInicial" => "8572596" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32328334" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical features and management of human monkeypox: a retrospective observational study in the UK" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Adler" 1 => "S. Gould" 2 => "P. Hine" 3 => "L.B. Snell" 4 => "W. Wong" 5 => "C.F. Houlihan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1473-3099(22)00228-6" "Revista" => array:6 [ "tituloSerie" => "Lancet Infect Dis" "fecha" => "2022" "volumen" => "22" "paginaInicial" => "1153" "paginaFinal" => "1162" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35623380" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inmunoglobulina anti-<span class="elsevierStyleItalic">Vaccinia</span> y profilaxis postexposición mediante vacuna basada en <span class="elsevierStyleItalic">Vaccinia</span> para el control del brote de viruela símica (<span class="elsevierStyleItalic">Monkeypox</span>)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Rodríguez-Cuadrado" 1 => "E. Pinto-Pulido" 2 => "M. Fernández-Parrado" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2022.08.017" "Revista" => array:2 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2022" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000009700000006/v2_202212090838/S2341287922002149/v2_202212090838/en/main.assets" "Apartado" => array:4 [ "identificador" => "38181" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000009700000006/v2_202212090838/S2341287922002149/v2_202212090838/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287922002149?idApp=UINPBA00005H" ]
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