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Presentación clínica de Mpox, enfoques de diagnóstico y estrategias de tratamiento: una revisión
Boghuma K Titanji1, Aniruddha Hazra2,3, Jason Zucker4
1Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia.
JAMA
|October 14, 2024
Resumen
Mpox es una enfermedad viral transmitida por contacto con la piel. Aunque generalmente es leve, puede ser grave en individuos inmunocomprometidos. La vacunación y la atención de apoyo son fundamentales para controlar los brotes de mpox.
Área de la Ciencia:
- Epidemiología
- Enfermedades infecciosas
- Salud pública
Sus antecedentes:
- El brote mundial de mpox (virus de la viruela de los monos - MPXV) del clado IIb, declarado una emergencia de salud pública de preocupación internacional (PHEIC), afectó a más de 99.000 personas en todo el mundo.
- Los recientes aumentos en las infecciones por MPXV de clade I en África Central llevaron a una segunda declaración PHEIC en agosto de 2024.
- La transmisión de Mpox es principalmente a través del contacto directo piel a piel, con infecciones de clado IIb a menudo vinculadas a la actividad sexual entre hombres que tienen relaciones sexuales con hombres.
Objetivo del estudio:
- Resumir la epidemiología, la presentación clínica, el diagnóstico y el tratamiento de la mpox.
- Para resaltar la importancia de la atención de apoyo, la terapia y la vacunación en el control de la mpox.
- Informar a los proveedores de atención sanitaria y a los funcionarios de salud pública sobre las tendencias y recomendaciones actuales de mpox.
Principales métodos:
- Revisión de los datos mundiales y estadounidenses sobre brotes de mpox, incluidas las tasas de infección y mortalidad.
- Descripción de las manifestaciones clínicas de mpox, incluidos los síntomas prodrómicos y la progresión de la lesión.
- Resumen de los métodos de diagnóstico (prueba PCR) y estrategias de tratamiento (atención de apoyo, terapéutica, vacunación).
Principales resultados:
- Clade IIb MPXV causó un brote global significativo, con más de 33,000 casos y 60 muertes en los Estados Unidos.
- Las infecciones actuales de mpox en los Estados Unidos promedian 200 por mes, con una reciente declaración de PHEIC debido a un aumento del clado I.
- Mpox se presenta típicamente con fiebre, linfadenopatía y lesiones cutáneas características, que progresan durante 2-4 semanas. Los resultados graves son más comunes en individuos inmunocomprometidos.
Conclusiones:
- Mpox es una enfermedad autolimitada para la mayoría, pero plantea riesgos para las poblaciones inmunocomprometidas, particularmente aquellas con VIH avanzado.
- La atención de apoyo es el tratamiento principal, con terapias avanzadas disponibles para casos graves.
- La vacunación con Modified Vaccinia Ankara- Bavarian Nordic es eficaz (66-86%) y se recomienda para los grupos de alto riesgo.
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