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  • 1.  hMPXV- anyone seeing it?

    Posted 07-07-2022 13:43
    Is anyone else seeing human monkeypox hMPXV in their HIV patients? I identified 2 cases last week here in Eugene, OR in my clinic which is a mix of HIV, PrEP, sexual health, Hep C and also serves homeless/syringe exchange participants in the attached harm reduction site.

    The first case had some prominent GI symptoms (diarrhea, abdominal bloating) 3 days after starting DAA therapy for HCV with GLE/PIB, he initially attributed his sx to that but when I spoke to him by phone he had developed a penile rash by Day 4. On exam he had multiple small (5mm or less) indurated ulcers with firm rolled edges similar to chancres, completely painless, there were a few with central umbilication similar to molluscum but when I unroofed one to sample it, could not express any purulent or casseous material. He did have painful inguinal adenopathy. The other case was his sexual partner who developed buttock rash and anorectal pain but did not have inguinal LAD, though I suspect had painful internal nodes.

    The local health department started my patients on tecovirimat under the treatment IND from the CDC even though both are on ART and have stable CD4 above 500. I am assuming due to anogenital location of rash.

    Just curious what other folks are seeing and if you have chosen to try to treat with tecovirimat and/or vaccinate to reduce disease severity. Has anyone seen people with severe illness from hMPXV?

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    Rachel Picone DNP, FNP-C, AAHIVS
    EUGENE OR
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  • 2.  RE: hMPXV- anyone seeing it?

    Posted 22 days ago
    Yes we are seeing a lot of Monkeypox here in Dallas TX.  Tpoxx is difficult to obtain from our local health department, and just wondering if others have found it to be actually useful in mild cases, or just reserving it for those with painful anal/ genital lesions?


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    Marc Tribble
    Uptown Physicians Group
    Dallas TX
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  • 3.  RE: hMPXV- anyone seeing it?

    Posted 21 days ago
    We are seeing it here in Seattle, varying and atypical presentations. Our clinic will finally be getting a supply of vaccine next week. Tecovirimat is available via a treatment IND and we are signing up for that. I'm not sure what the criteria are for tecovirimat but we have one patient with very painful genital/anal lesions being treated with it via the Health Dept clinic since we are not set up for it yet.


    Peter Shalit, MD, PhD, FACP, AAHIVS 
    Cabrini Tower, 901 Boren Ave Suite 850, Seattle, WA 98104 
    P 206-624-0688 F 206-624-2432  





  • 4.  RE: hMPXV- anyone seeing it?

    Posted 21 days ago
    Our clinic had one this week in a newly diagnosed HIV+ person, on ART for a month. He had 2 lesions, one looked like a small bite and another was about 4mm, raised with pus. I submitted 4 swabs for testing, all were completely dry and I was convinced I did it wrong. Luckily the samples had a good amount of DNA per the lab and both tested positive for monkeypox. Our health department gave the patient TPOXX and as far as I know he isn't having severe disease. New Mexico has had 6 confirmed cases now so far.

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    Carly Floyd
    Albuquerque NM
    cfloyd@southwestcare.org
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  • 5.  RE: hMPXV- anyone seeing it?

    Posted 21 days ago
    Update 07-22-22: After submitting the 6 page case report form, and sending my office visit note, and photos supplied by the patient, the local county health department here quickly approved the patient and we were able to get him the medication in less than 24 hours. 

    Each clinical office/ site does have to complete a 1572 form for the initial patient, but after that, just the other documents are enough. 

    So in the end, it was easier that I had first thought.  Will wait and see how much it helps the patient's painful lesions.



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    Marc Tribble
    Uptown Physicians Group
    Dallas TX
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  • 6.  RE: hMPXV- anyone seeing it?

    Posted 20 days ago
    We have had several, one unfortunately was told by the emergency room that he did not have monkey pox and showed up in the office with lesions in various stages. The patient with multiple penile lesions had a wicked secondary cellulitis!--
    V. Cafaro Sent from Gmail Mobile





  • 7.  RE: hMPXV- anyone seeing it?

    Posted 12 days ago
    I’ve seen 2 cases of human monkey pox virus infection this past week in my office. We are working closely with the SNHD(Southern Nevada Health District) pharmacy to prescribe the smallpox antiviral, TPOXX, for active cases and the smallpox vaccine, Jynneos , for PrEP and PEP(if exposure was 4 days or less ).
    Of note, the patients must be advised that the existing smallpox treatment and vaccines are not (yet) approved for human monkey pox virus in the U.S and must sign an “informed consent form” obtained on the CDC website. We are able to electronically send the Rx to the SNHD pharmacy, but must fax the signed form to them before it can be dispensed.
    There is increasing data that the smallpox antiviral and vaccine are very effective against hMPX.

    I would encourage everyone to consult with their local health district to create your own protocol to coordinate delivery of these vaccines and treatments for our patients at risk.


    Sent from my iPhone




  • 8.  RE: hMPXV- anyone seeing it?

    Posted 11 days ago
    Hi Dino,

    Jynneos (vaccine) is actually indicated by the FDA for prevention of both smallpox and monkeypox disease! 

    TPOXX is still under Expanded Access Investigational New Drug Protocol (EA-IND) for treatment of non-variola orthopoxviruses (including monkeypox) during an outbreak.

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    Carly Floyd
    Albuquerque NM
    cfloyd@southwestcare.org
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  • 9.  RE: hMPXV- anyone seeing it?

    Posted 6 days ago
    Hi Carly!
    Thanks for the correct info!
    😁

    Sent from my iPhone




  • 10.  RE: hMPXV- anyone seeing it?

    Posted 3 days ago
    Lots of MPX here in Philadelphia. very limited vaccine supply, unfortunately. We have a "warmline" for patients to call to express interest in the vaccine if they self identify as fitting our health departments criteria. Demand is def higher than supply. 

    One big thing we are seeing is MPX is typically not the only infectious agent the patient has. we have identified folks with co-occuring GC, Chlamydia, syphilis, and COVID. so I guess my take away is if they are coming in for MPX suspicion, check for everything else too.

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    Angela Kapalko
    Physician Assistant Chairperson for AAHIVM
    Philadelphia FIGHT CommunityHealth Centers
    Philadelphia PA
    akapalko@fight.org
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