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Pathology and Monkeypox virus Localization in Tissues From Immunocompromised Patients With Severe or Fatal Mpox
Jana M Ritter1, Roosecelis B Martines1, Julu Bhatnagar1
1Infectious Diseases Pathology Branch.
The Journal of Infectious Diseases
|January 20, 2024
Summary
Severe mpox (monkeypox virus) in immunocompromised patients involves widespread tissue infection and dissemination. Digestive tract and lung involvement are common, and coinfections can complicate diagnosis and treatment.
Area of Science:
- Virology
- Pathology
- Immunocompromised Host Research
Background:
- Limited understanding of Monkeypox virus (MPXV) pathology and tissue tropism in severe/fatal human mpox.
- Need to elucidate disease pathogenesis and coinfection role in immunocompromised individuals.
Purpose of the Study:
- Characterize pathology and MPXV distribution in tissues from severe/fatal mpox cases.
- Investigate coinfections in affected patients.
Main Methods:
- Analysis of biopsy and autopsy tissues from 22 patients.
- Immunohistochemistry and in situ hybridization for viral antigen/DNA.
- Tissue-based testing for coinfections.
Main Results:
- Necrotizing epithelial changes in mucocutaneous lesions.
- Digestive tract lesions and systemic necrosis with thrombotic vasculopathy in half of autopsy cases.
- Bronchopneumonia and acute lung injury common; MPXV detected in all tissues; coinfections present in 31-67% of cases.
Conclusions:
- Severe mpox involves extensive tissue infection and viremic dissemination, potentially progressing despite treatment.
- Digestive tract and lung involvement are frequent, with significant histopathological findings.
- Coinfections complicate mpox management; high viral DNA in tissues warrants enhanced biosafety.
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