‘Given the current SARS-CoV-2 pandemic and the daily increase of monkeypox cases, healthcare systems must be aware of this eventuality’
The 36-year-old suffered symptoms including fatigue, fever, and a sore throat nine days after returning from a trip to Spain, where he engaged in unprotected sex.
He first tested positive for Covid on 2 July, and the following day small, painful vesicles surrounded a rash appeared on the man’s torso, lower limbs, face and glutes.
By 5 July, the man had gone to hospital in Palermo as the vesicles had further spread and evolved into pustules - small bumps on the skin .
According to a case study report published in the Journal of Infection, he was tested for monkeypox and subsequently returned a positive result.
The patient was also screened for multiple STIs and also tested positive for HIV-1.
Researchers established that the infection was relatively recent.
After recovering from Covid-19 and monkeypox, the patient was discharged from hospital on 11 July to home isolate. By this stage, his skin lesions had healed, after crusting over, leaving a small scar.
“This case highlights how monkeypox and Covid-19 symptoms may overlap, and corroborates how in case of co-infection, anamnestic collection and sexual habits are crucial to perform the correct diagnosis,” the researchers, from the University of Catania, said in their case report.
“To note, the monkeypox oropharyngeal swab was still positive after 20 days, suggesting that these individuals may still be contagious for several days after clinical remission,” the report said. “Consequently, physicians should encourage appropriate precautions.”
They added: “As this is the only reported case of monkeypox virus, SARS-CoV-2 and HIV co-infection, there is still not enough evidence supporting that this combination may aggravate patient’s condition.
“Given the current SARS-CoV-2 pandemic and the daily increase of monkeypox cases, healthcare systems must be aware of this eventuality.”
While most monkeypox cases in the current outbreak have been linked to sexual activity, research published by the US Centers for Disease Control and Prevention offers new insight into other ways it may be spreading.
They refer to the case of one man who noticed his first lesion and subsequently developed a rash about two weeks after attending a "large, crowded outdoor event at which he had close contact with others, including close dancing, for a few hours”.
According to researchers from Stanford University School of Medicine, he tested positive for monkeypox after seeking care at an emergency department about a week later.
The patient's "primary risk factor was close, nonsexual contact with numerous unknown persons at a crowded outdoor event," the researchers wrote, and the case "highlights the potential for spread at such gatherings, which may have implications for epidemic control."
The event he attended in the UK was not a rave and was not attended specifically or mostly by persons identifying as gay or bisexual, according to the researchers. While many attendees wore tank tops and shorts, he wore pants and a short-sleeve top. He did not notice anyone with skin lesions or who seemed ill, and he attended a few other similar events over the next four days.
According to CDC guidance, "monkeypox can spread to anyone" through close contact, which is often skin-to-skin, as well as intimate contact that includes sex, hugging, massage and kissing.
The patient -- a man in his 20s who recently returned to the US after travel to the UK -- did not report any sexual contact and did not have evidence of genital lesions. Samples of both saliva and nasal swabs tested positive for the virus, even though the patient did not report any related signs of illness such as fever, chills or cough.