MONKEYPOX HUMAN, RODENT - CENTRAL AFRICAN REPUBLIC
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Date: Sat 8 Oct 2011
Source: The Lancet, Volume 378, Issue 9799, Page 1354 [abbreviated,
edited]
http://www.thelancet.com/journals/lance ... cle_upsell
Maculopapular lesions in the Central African Republic
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In June 2010, 2 boys aged 14 years and 15 years were found to have
diffuse maculopapular lesions associated with pustules and crusts.
They had been living in a settlement in the deep forest area of the
southern Central African Republic (CAR). The cases were reported to
the Institut Pasteur at Bangui. The lesions developed after the boys
had hunted and eaten a wild rodent (bemba). They both presented to a
health centre one week after eruption of the extensive lesions, which
covered the face, torso, and limbs. Both boys were systemically well,
with no fever or notable lymphadenopathy.
Laboratory investigations were done on serum and scabs and on a biopsy
sample from the brain of a young mouse that had been inoculated 5 days
earlier with scab material from the lesions. Monkeypox virus was
detected by quantitative PCR based on partial haemagglutinin gene and
identified by sequencing. The phylogenetic tree showed that the strain
was identical to the Democratic Republic of the Congo (DRC, formerly
Zaire) strain circulating in central Africa. This reported strain was
identical to one associated with an outbreak of monkeypox in 2001 in a
Bantu family living on the border between the CAR and the DRC, 480 km
[about 300 miles] from the cases reported here.
Our patients were admitted to the local health centre and kept in
isolation until they were no longer infectious. When last seen a week
after discharge, in June 2010, both were well and neither showed any
sequelae.
Monkeypox virus has a wide range of hosts, so it can maintain a
reservoir in wild animals while sporadically causing human disease,
generally in remote villages in the rainforest areas of central and
west Africa. Large outbreaks, with transmission between people, occur
only in the DRC. The case-fatality rate in Africa is between 1 percent
and 10 percent. There is no specific treatment or vaccine although
smallpox vaccination is 85 percent effective in preventing monkeypox.
In 2003, the 1st human monkeypox outbreak in the western hemisphere
was reported in the USA after importation of rodents from Ghana.
We have describe the occurrence of 2 typical cases of monkeypox,
caused by the same viral genotype, 10 years after the previous
infections with this strain. Although monkeypox is rare, its
differentiation from other similar presenting illnesses is important.
--
Communicated by:
Dr Mirdad Kazanji
Directeur
Institut Pasteur de Bangui
BP 923, Bangui, RCA
[Interested readers should consult the full text of this report:
Maculopapular lesions in the Central African Republic. By Nicolas
Berthet, Emmanuel Nakoun, Eline Whist, Benjamin Selekon, Ana-Maria
Burguire, Jean-Claude Manuguerra, Antoine Gessain, Mirdad Kazanji. The
Lancet, Volume 378, Issue 9799, Page 1354
http://www.thelancet.com/journals/lance ... cle_upsell
(paid registration required). The Lancet report includes an excellent
illustration of the maculopapular lesions observed.
ProMED-mail thanks Dr Kazanji for drawing attention to this report.
Although monkeypox virus was 1st isolated from captive monkeys in
Copenhagen in 1958, its natural hosts are mainly rodents and squirrels
in central and west Africa. However monkeypox can infect humans and
cause lesions clinically similar to those caused by smallpox virus.
Unlike smallpox virus it does not transmit efficiently from human to
human. Sequencing of the monkeypox genome has established that in fact
it is not closely related to variola virus (smallpox virus).
The Central African Republic is a landlocked country in Central
Africa. It borders Chad in the north, Sudan in the north east, South
Sudan in the east, the Democratic Republic of the Congo and the
Republic of the Congo in the south, and Cameroon in the west. The
HealthMap interactive map of the Central Africa Republic can be
accessed at:
http://healthmap.org/r/1jPk. - Mod.CP]