A man tests positive for smallpox, COVID and HIV after vacationing in Spain

Large spots on the body of a man who was found to be suffering from monkeypox. Pic: Journal of Infection

Health authorities have been warned to be on the lookout for monkeypox occurring in patients at the same time as COVID-19 after a case was identified in Italy.

It comes after a 36-year-old man sought treatment when he developed symptoms following a trip to Madrid from his home in Sicily.

He had suffered from a fever, headache, fatigue and sore throat to begin with, but he also had a series of large spots, which began to swell.

A research paper published in the Journal of Infection said tests on the man found he wasn’t just suffering coronavirusbut he also had monkey pox.

Further tests diagnosed him as HIV positive as well, he added – the first case of infection with all three viruses.

The study’s authors said that because monkeypox and COVID share “the symptoms of fever, lymphadenopathy, headache, sore throat, and fatigue,” it can be “difficult for doctors to make the correct diagnosis, having also keep in mind that not all monkeypox patients develop.” skin lesions and that COVID-19 can rarely present with rashes and vesicles (spots).”

They said that while it is too early to say whether the combination of the viruses may lead to a worse outcome, doctors should be aware that it could happen, as there is no widely available treatment in case they occur together. .

The authors of the paper said: “As this is the only reported case of coinfection by monkeypox virus, SARS-CoV-2 and HIV, there is still insufficient evidence to support that this combination can aggravate the patient’s condition.

“Given the current SARS-CoV-2 pandemic and the daily increase in cases of monkeypox, healthcare systems must be aware of this eventuality, promoting appropriate diagnostic tests in high-risk subjects, which are essential for containment as there is no widely available treatment or treatment. prophylaxis.”

The scars left after the spots on the body of a man with monkey pox began to heal. Image: Diary of the infection

“Outstanding” cases need to examine the patient’s history

The man, who was twice vaccinated against COVID, spent five days in Spain from June 16 to 20, 2022 and nine days later came down with a temperature of 39 degrees, accompanied by a sore throat, fatigue, headache and groin pain.

On July 2, he tested positive for COVID and later that day a rash began to develop on his left arm that turned into small, painful spots surrounded by a red ring on his torso, lower extremities, face, and lower part

The spots continued to swell and three days later he went to the emergency department of the Hospital Universitari Policlinico “G. Rodolico – San Marco” in Catania, Italy, where he was transferred to the infectious diseases unit.

He told doctors that he had been treated for syphilis in 2019 and had tested negative for HIV in 2021.

Because of his symptoms, they decided to run a series of tests and found that he was positive for all three viruses, identifying monkeypox as being of the West African clade, the variant responsible for the Spanish outbreak, and the variants of COVID being BA. 5.1, one of the two main variants causing infections worldwide.

By the third day in the hospital, almost all of the skin lesions began to crust over and eventually became scars. He was treated for HIV and then discharged.

Doctors say her case highlights the need to examine patients’ histories in their efforts to reach a diagnosis, since a failure to make the correct diagnosis could put others at risk.

The authors, led by Santi Nolasco, said the man had reported having unprotected sex with men during his stay in Spain.

They said: “This case highlights how the symptoms of monkeypox and COVID-19 can overlap and corroborates that in case of co-infection, [patient history] collection and sexual habits are crucial to make the correct diagnosis.

“Our case underscores that sexual intercourse could be the predominant route of transmission. Therefore, a comprehensive STI examination is recommended after a diagnosis of monkeypox.

“In fact, our patient tested positive for HIV-1, and given his preserved CD4 count, we could assume that the infection was relatively recent.

“Of note, the oropharyngeal swab of monkeypox was still positive after 20 days, suggesting that these individuals may still be contagious for several days after clinical remission. Consequently, clinicians should encourage appropriate precautions.”

The document says that since January 2022, more than 16,000 people in more than 74 countries have been affected by monkeypox, and the COVID subvariants BA.4 and BA.5 are currently responsible for more than one million cases in day all over the world.

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