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 Journal of Infection and Public Health 15 (2022) 1287–1289

Contents lists available at ScienceDirect

Journal of Infection and Public Health

journal homepage: www.elsevier.com/locate/jiph

Short communication

First case report of human monkeypox in Latin America: The beginning

of a new outbreak. ]]
]]]]]]
]]

⁎,2
Edgar Pérez-Barragán a,1, Samantha Pérez-Cavazos b,
a
Infectious Diseases Department, Hospital de Infectología, Centro Médico Nacional La Raza, Mexico City, Mexico
b
Department of Hospital Epidemiology and Infection Prevention, Hospital Christus-Muguerza Betania, Puebla, Puebla, CP 72501, Mexico

a r t i cl e i nfo a bstr ac t

Article history: On 13 May 2022, a familial cluster of two cases of monkeypox was reported in the United Kingdom (UK) by
Received 5 June 2022 the UK Health Security Agency (UKHSA). These cases had no relation to a case imported from Nigeria that
Received in revised form 6 September 2022 was previously reported on 7 May 2022 in the UK. In the following days, several other European Union (EU)
Accepted 9 October 2022
the Member States and other countries have reported cases of monkeypox not linked to travel to endemic
countries. The report by the World Health Organization (WHO) until May 26, 2022, is of a total of 257
Keywords:
confirmed cases and 120 suspected cases, without any report of death. This outbreak involves 23 countries
Monkeypox
Human monkeypox that are not endemic to the monkeypox virus. Latin America had no reported cases. We describe a case of
re-emerging disease imported monkeypox in Mexico City, Mexico.
© 2022 Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is
an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Case Laboratory tests were remarkable for not classifiable hypergly­

cemia (105 mg/dL), hyperuricemia (7.9 mg/dL) and elevated acute
A 50-year-old male patient, a resident of New York, currently phase reactants (C-reactive protein: 24.0 mg/dL, erythrocyte sedi­
receiving pre-exposure prophylaxis (PrEP) with a history of anal mentation rate 15 mm/hr) The rest were reported with no relevant
fistula, syphilis, human papillomavirus, gonorrhea, chlamydia, gen­ findings: white blood cells: 4.8 k/µL, neutrophils: 2.56 k/µL, lym­
ital herpes; presented for medical consultation on May 26, 2022, due phocytes: 1.73 k/µL, hemoglobin: 15.8 g/ dL, and platelets: 165,000/
to symptoms of lower back pain, headache, abdominal pain, myalgia, mm3, transaminases were reported in normal values and VDRL and
and papular lesions in the anal region for the previous six days. HIV-serology were reported as non-reactive.
Forty-eight hours later, he presented a new apparition of papular The corresponding state and national institutions were im­
lesions on his face, trunk, and arms and inguinal lymphadenopathy, mediately notified and swab samples from lesions were collected for
fever, and hyporexia. He reported having made a trip to Amsterdam polymerase chain reaction (PCR) at the Instituto Nacional de
five days prior to the onset of symptoms. Diagnóstico y Referencia Epidemiológica "Dr. Manuel Martínez
Physical examination revealed normal vital signs, with the pre­ Báez", located in Mexico City, being reported as detected after 24 h.
sence of 1.5 cm lymph nodes in both inguinal regions and the pre­ During the three first days of hospitalization, more erythematous
sence of papular lesions in the left zygomatic region, in the anterior macular lesions were added to the scalp, face, arm, and left shoulder
and posterior trunk, and right arm of 1 cm. He also presented an 8- with no signs of superimposed bacterial infection. After these, no
mm maculopapular lesion with a pustular border. In the anal region, more lesions, fever, or other symptoms were documented. The pa­
two papular lesions with a pustular border of 5–10 mm were tient was discharged after six days of stay with a good clinical re­
documented. sponse.
1
ORCID ID: 0000-0002-3839-1567.
2
ORCID ID: 0000-0002-1222-1930.

Abbreviations: CDC, Centers for Disease Control and Prevention; EEA, European Economic Area; EU, European Union; MP, Monkeypox; PCR, Polymerase Chain Reaction; PrEP,
pre-exposure prophylaxis; UK, United Kingdom; UKHSA, UK Health Security Agency; WHO, World Health Organization
⁎
Correspondence to: Department of Hospital Epidemiology and Infection Prevention; Hospital Christus-Muguerza Betania, Avenida 11 Ote 1826, Col. Azcárate, Puebla, Puebla,
CP 72501, Mexico.
E-mail addresses: [email protected] (E. Pérez-Barragán), [email protected] (S. Pérez-Cavazos).

https://doi.org/10.1016/j.jiph.2022.10.001
1876-0341/© 2022 Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
E. Pérez-Barragán and S. Pérez-Cavazos Journal of Infection and Public Health 15 (2022) 1287–1289

Fig. 1. Erythematous papulopustular lesions on the upper and lower extremities.

function. It has been described that a greater number of lesions

occurs in children and in immunosuppressed patients. [7].
The rash has a centrifugal and cephalocaudal distribution, with
the face being the first affected site. It usually affects the palms and
soles in up to 75 % of cases, and mucous membranes such as the
genitals, conjunctiva, and oral mucosa may also be involved. The
fatality rate has been reported in the literature as around 1–10 %,
however, in the pediatric population, this rate is higher, up to 15 %.
[3] Therefore, immunocompromised hosts and children should be
considered at risk and should be identified and treated immediately.
Treatment is mainly symptomatic and supportive. Smallpox
vaccine can be considered for postexposure prophylaxis of close
contacts at increased risk for severe disease, however, careful ben­
efit/risk assessment should be performed for the exposed individual.
In addition, antivirals are potential treatment options, two oral
Fig. 2. Pustular erythematous lesions in the abdominal region and right upper ex­ drugs, brincidofovir, and tecovirimat, have been approved for the
tremity. treatment of smallpox and have demonstrated efficacy against
monkeypox in animals and have been used as off-label antivirals in
some people. [8,9].
Conclusions Today, monkeypox must be considered among the differential
diagnoses in patients with a rash of undetermined etiology (espe­
Monkeypox (MP) is a zoonotic disease known since 1970, first cially those with vesicular or pustular lesions) who have had recent
described in the Democratic Republic of the Congo in a 9-year-old travel to endemic areas. Some cases have been identified in com­
pediatric patient. It stands out as the most important Orthopoxvirus munities of gay, bisexual and other men who have sex with men, and
since the eradication of smallpox in 1980. [1] This genus includes based on European Centers of Disease Control epidemiological as­
monkeypox, camelpox, cowpox, vaccinia, and variola viruses. [2] sessment, the likelihood of monkeypox spreading in persons having
Two clades have been identified, Congo-Basin and West African, the multiple sexual partners in the European Economic Area ( EEA) is
latter being considered less virulent and associated with a lower considered high. [10] It is important to note that the risk of mon­
mortality rate. [3]. keypox is not limited to men who have sex with men.
The number of human monkeypox cases has been on the rise Infection of sexual partners, both female and male, has been
since the 1970 s, with the most dramatic increases occurring in the previously reported for vaccinia virus, another virus of the
Democratic Republic of Congo. The median age at presentation has Orthopoxvirus genus, post smallpox vaccination. [11] Anyone who
increased from 4 (the 1970 s) to 21 years (2010–2019). There was an has close contact with someone who is infectious is at risk.
overall case fatality rate of 8.7 %, with a significant difference be­ The Monkeypox outbreak shows that we will continue to face
tween clades—Central African 10.6 % (95 % CI: 8.4–13.3%) vs. West emerging diseases, and that international coordination and soli­
African 3.6 % (95 % CI: 1.7–6.8 %). [4] Since 2003, importand travel- darity are essential for public health.(Figs. 1,2).
related spread outside of Africa has occasionally resulted in out­
breaks. Interactions/activities with infected animals or individuals
CRediT authorship contribution statement
are risk behaviors associated with acquiring monkeypox. [1,5] In
2018, only seven international cases were reported outside Africa -
SPC & EPB coordination, writing, conception, and design.
in the United Kingdom, Israel and Singapore. [1,5,6] The incubation
period for this agent has been described as between 5 and 21 days,
and the most important routes of transmission for its acquisition are Elsevier Waivers team
through close contact, secretions, or fomites. [3] The infection is
characterized by having a total duration between 14 and 21 days and Through this letter, I confirm that the team of authors listed in
having two stages: a first invasive phase, which lasts 1–3 days, the case report “Human monkeypox in Mexico: First case report” do
where headache, low back pain, asthenia, lymphadenopathy, fever, not receive any specific grant from funding agencies in the public,
and myalgia occur; and a second stage, the eruptive one, in which commercial, or not-for-profit sectors, also that they are not receiving
the characteristic rash begins with lesions in different primary any financial aid or funding through our institution for research or to
stages: macule, papule, vesicle, pustule, and scab. The total number publish articles in this moment. And thus, we kindly request to
of lesions varies according to the type of host and its immunological consider our petition for a fee waiver.

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E. Pérez-Barragán and S. Pérez-Cavazos Journal of Infection and Public Health 15 (2022) 1287–1289

Consent for publication References

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[3] Sklenovská N, Van, Ranst M. Emergence of monkeypox as the most important
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Conflict of Interest [11] Vaccinia Virus Infection After Sexual Contact with a Military Smallpox Vaccinee
— Washington, 2010 [Internet]. [cited 2022 May 29]. Available from: 〈https://
All authors report no conflicts of interest with this article. www.cdc.gov/mmwr/preview/mmwrhtml/mm5925a2.htm〉.

Acknowledgements

Not applicable.

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