Mpox: Characterization and clinical outcomes of patients in Colombian healthcare institutions

Abstract

Introduction

In 2022, the world experienced a monkeypox outbreak caused by the Clade IIb strain of the virus. While this outbreak had widespread effects, more information is needed on mpox's specific impact in Colombia, particularly regarding how it is managed, its burden, and its epidemiology. This research seeks to examine the medical context, clinical presentation, and health outcomes of individuals diagnosed with mpox infection, with a particular focus on those with HIV in Colombia.

Methods

This retrospective study was conducted in fourteen Health institutions in Colombia based on computerized clinical records from Jan 2022 to Dec 2023. Clinical and epidemiological characteristics were collected from diagnosis until discharge (or death). Participants in the study were diagnosed through molecular methods (PCR) and their clinical evolution was tracked through hospital and/or outpatient medical records. Registered variables were based on the mpox 2023 Case Report Form (2023 - CRF) proposed by the World Health Organization.

Results

One thousand four hundred thirteen (1413, 97.2 % male) individuals, including 2.6 % identified as healthcare workers, were included in this study. The majority (54 %, 764/1413 individuals) were persons living with HIV (PWH) and almost one-third of them (30.1 %, n = 284) of participants had concomitant sexually transmitted diseases and HIV, with syphilis being the most prevalent (20.4 %), followed by Neisseria gonorrhoeae (16.4 %). Complications were infrequent, with cellulitis being the most common, and no individuals received mpox-specific treatment or vaccination. Although all individuals had skin lesions distributed across various body regions, differences were noted in lesion distribution among women. Those living with HIV showed higher emergency department attendance and reported having known mpox contacts. While complications were rare, with cellulitis being the most common, women living with HIV showed a higher rate of emergency room visits and known mpox contacts. Although not statistically significant, gastrointestinal, musculoskeletal, psychological, respiratory, and STI symptoms, including syphilis and urethritis, were more common in the virologically non-suppressed HIV group. At the same time, proctitis was more prevalent in the suppressed group. No significant differences were found based on CD4 count, using 200 cells/mm³ in PWH.

Conclusion

Over half of the participants were people living with HIV (PWH), with a significant presence of STIs like syphilis. While skin lesions and complications varied, no significant differences were linked to CD4 count or viral load suppression. Mpox symptomatology was not significantly associated with unsuppressed viral loads or low CD4 levels, highlighting the need for further research.