New Delhi: A study conducted by Indian Council of Medical Research (ICMR) and National Institute of Virology (NIV-Pune) has revealed that people with no active skin lesions can also be victim of monkeypox. The study was conducted following the death of one 22-year-old person in Kerala due to monkeypox.
The was the first and only fatal case of monkeypox reported from India to date. "This case highlights the importance of maintaining a high index of suspicion to diagnose MPVX (monkeypox) in those presenting with atypical manifestations, exanthematous fever with epidemiological linkage from MPVX endemic or outbreak countries.
The OPS/NPS specimen as well as possible urine specimen should be considered as the critical specimens for MPVX diagnosis in cases with no active skin lesions," the findings of the study pointed out.
While describing the case study of the deceased from Kerala (only casualty in India), the study said that on July 27, the 22-year old apparantly with no significant past medical history was admitted in an unconscious state to a private hospital in Kerala following single episode of acute onset generalised tonic-clonic seizures.
"The patient had developed fever, headache on July 15 while in UAE followed by development of painful right inguinal lymphadenopathy with pus discharge for which he had sought medical care on July 19. He was partially relieved of his symptoms and returned from UAE to Kerala on July 21," the study said.
He played football on July 23, which led to worsening of pain in right inguinal areas for which he consulted a surgeon on July 25 in Kerala. On July 26, he had a fever spike followed by generalised tonic clonic seizure.
"On evaluation of emergency department of hospital, his vital were stable with with no signs of meningeal irritation. The right inguinal lymphadenopathy with abscess formation and a single healed scrotal lesion were observed. Apart from that there were no exanthemas," the study highlighted.
The study further said that on July 28, the patient developed features of worsening cerebral edema and was intubated and mechanically ventilated. "Despite anti cerebral edema measures, he progressed to brainstem dysfunction and succumbed on July 30," it said. The clinical specimens, oropharyngeal swab (OPS) and nasopharyngeal swab (NPS), plasma and serum collected on July 30 was referred to ICMR-NIV for MPVX diagnosis.
"Only OPS/NPS of the case was found to be positive for MPVX. The next generation sequencing on OPS/NPS specimen could retrieve 92.76 percent of the MPVX genome and belonged to A.2 lineage of clade IIb as observed in other confirmed monkeypox cases in India," the findings said adding "in this case apart from a doubtful healed scrotal lesion and lymph node abscess, no other skin lesions were present."
Although a total of 15 fatalities have been reported globally, India witnessed one fatality. To date, India had recorded 11 cases of monkeypox infection with five in Kerala and six in New Delhi.
The current outbreak of monkeypox had been largely limited to the community of men who have sex with men primarily with multiple bisexual or homosexual partners.
