Monday, September 26, 2022

Vicente Descalzo, Doctor: “There are patients diagnosed with tonsillitis and they have monkeypox in their throats”


  • Vicente Descalzo is a specialist in the infectious disease service at Vall d’Hebron, a hospital who participated in a study published in ‘The Lancet’ on smallpox.

  • Study reinforces hypothesis that direct skin-to-skin contact is the main route of transmission of monkeypox

  • “We must act decisively with vaccination, first vaccinating men who have sex with men, but also heterosexual men who have had a lot of sex”

To date, there have been approximately 30,640 cases reported worldwide, of which 5,162 have been found in Spain, the country with the highest number of cases per population on the entire planet. Here 3% of the infected have had to be hospitalized and two have died. Most transmission has occurred in groups of men who have sex with other men (98% of cases in the world and over 80% in Spain).

According to the Spanish report, Four out of 10 patients need medical treatment for complications of monkeypox. Complications such as pimples, glands and swelling of the rectum or tonsils in the genital and anal region.

NIUS interviewed Vicente Descalzo, a specialist in the Infectious Diseases Service at the Drassens-Val d’Hebron STD/HIV Unit, a hospital that participated in this study together with 12 d’Octubre Hospital, the German Trias University Hospital and the Fundación. Lucha controls infections.

ask. Did you know about monkeypox when cases started to appear?

answer. The Val d’Hebron has participated with 15 patients for this study, but we have seen hundreds of them since May. At first they came in droppers but gradually the number increased. I hadn’t even studied (human) smallpox in college, because it was a disease that had already been eradicated. We knew that monkeypox was present in Africa, with a mortality rate of 10% in those contexts, in rural areas that would not normally go there. Something that is not our case, where only two people have died out of thousands of infected in Spain.

Q. Is the disease easy to diagnose?

R. It’s not easy. Only if you have seen multiple injuries is this easy. Patients have come to me saying they were told they were condyloma or molluscum, because the lesions are very similar at first, with those umbilical papules, because they are the size of the navel. It is easy to see if these lesions appear in the genital area, but there are other monkeypox syndromes as well, for example, proctitis. There are people who come in with intense rectal pain, in which you search and you don’t even see the sores because they are in the rectum. Or it is even more difficult to diagnose pictures, for example, with tonsillitis, with sore throat and plaques. I have had patients who have been diagnosed with tonsillitis and given antibiotics because they had plaques and monkeypox in their throats. That is, the wounds that we see in the pubis or body, they are in the throat. And in this study up to 10% had tonsillitis.

Q. No more pimples on the rest of the body?

R. Infection occurs more by direct contact with wounds than by air. Lesions tend to develop in the area where the virus inoculation took place. And it can happen in areas where sexual contact has occurred. Depending on both sexes, such as in the pubis, in the anus or in the rectum, or in the mouth or in the throat. And in the case of women, at the vaginal level. Those first injuries are caused by the initial inoculum, where the virus comes from. And what we see is that after the inoculum, or with the appearance of these lesions, the patient has a slight discomfort and fever for a few days, probably because the virus is spreading throughout the body. In the second stage when the lesions start appearing in other parts: on the hands, on the face… they are sores that occur in different stages. This does not happen in all patients. And, moreover, unlike what happened in Africa, where he had many injuries, there are not many injuries.

Q. Is air transmission of monkeypox ruled out?

R. The interesting thing about this study is that we have looked for viruses at different places. Not only in injuries. When our patients come to the unit, we usually take throat, rectum and urine samples to check for STIs, for gonorrhea and chlamydia, and we also look for monkeypox. And what we’ve seen is that a lot of patients with sores have monkeypox virus in these places, but when you look at the concentration of the virus, we see that it’s lower in the throat than the concentration in the sores , which is very high. high. And this difference is statistically significant.

P. And does this mean that by having less concentration in the throat while speaking, you will expel less droplets of saliva which are contagious?

R. We estimate, we cannot establish 100% that if you have a low concentration of virus at the oropharyngeal level, transmission through that area is less effective. An exception to this are patients with tonsillitis, with a very bad sore throat. They have high concentrations of virus at the oropharyngeal level.

Q. Is this a highly contagious disease?

P. This is a virus for which we had no immunity. The people who have been most exposed were not vaccinated against this virus, because the virus was never here. That’s why it’s been a powder keg. The virus has reached a group that has a large number of sexual partners and has no immunity, the virus has spread very quickly. Or at least that’s what I see from the cases we’re seeing. I hope that as more people get the disease and have more access to vaccinations, there will be a slight reduction in transmission.

Q. Is it possible to get infected through casual contact with an infected person? For example, using a towel or sheet previously used by an infected person?

R. Infection occurs when there is intimate contact, skin-to-skin. Casual contact I don’t think is as effective for transmission.

Q. What is meant by intimate contact?

R. It’s not just sexual. It could be a contact where there is a hug…

Q. At this point, can it be said that monkeypox is a sexually transmitted disease?

R. This is a complex question. Sexual transmission is still a very important route for transmission of the virus. It is almost adopting this role, but it is up to the authorities to qualify it.

Q. Has it been proved that it can also be transmitted through sexual fluids?

R. Infection occurs through contact with wounds. If you have sores in your mouth, with a few kisses you can spread it; But, if you don’t have those, to date, there is no evidence that you can. What happens is that sexual contact leads to contact injuries. If I have sores on the pubis and penis, when having sexual contact with other areas, contagion may occur, but not because of the fluid itself. It is similar to syphilis, where the infection is also transmitted through contact with wounds.

Q. Does the fact that 40% of monkeypox patients have complications that require medical treatment mean that we are dealing with a much more serious disease than we initially thought?

R. Complications they need treatment for does not mean they are serious complications. Most of these complications required pain control, which in some cases was quite disabling, especially when it affected the anorectal or oropharynx, in which we had to give a lot of pain treatment, which increased the analgesic regimen. Other patients have suffered a bacterial superinfection and require antibiotics. It is important to keep the wounds clean as there is a high risk of superinfection.

Q. Does the fact that the viral load in the respiratory tract is low mean that home isolation can be shortened?

R. More studies will be needed to support whether home isolation is necessary. Today, with the advent of a brand new virus that we don’t really know how it works, I think it’s good to be vigilant. When we know more things, maybe we can narrow down some of the measures. Someone can get hurt in fingers, hands and arms and if you take the subway, for example, and grab the bar, it cannot be ruled out that someone later grabs that bar and No transmission takes place.

Q. Can transmission occur only when healthy skin touches one of the pustules?

R. There is no evidence, but I have seen monkeypox lesions on healthy skin. In principle, there is no need for prior trauma. Sure, past trauma helps with the transition, but I don’t think it’s necessary.

Q. Is the post-exposure vaccine effective for contact with an infected person, taking into account that incubation lasts about a week, compared to the between 15 and 22 days described in the Democratic Republic of the Congo?

R. The incubation time is very difficult to determine. Very few patients had a clear idea of ​​when they might have been exposed to the virus. The study has seven days of data, but few patients have been analyzed. In any case, pre-exposure vaccination would logically be much more effective than post-exposure. The problem is the limited availability of vaccines right now, and that is why they have preferred to administer it in post-exposure cases. But if the incubation is not that long, it will not be as effective. What is needed is a political decision that really puts pressure on the industry to have more vaccines for all risk groups.

Q. Why is Spain the country with the highest number of infections in terms of population?

R. Perhaps we are ahead of other countries in terms of time. Perhaps there was a chain of events that favored broadcasting… Also in other cities like Berlin or London there is a lot of exchange on a sexual level. I don’t think there is such a big difference in the behavior of Spain compared to other regions of Europe.

> There have been other outbreaks outside Africa before, but none quite as big as this one. What happened this time?

R. The virus has found a more efficient transmission route (skin-to-skin). We had a virus that had not yet experienced this route of transmission. Now it has jumped on this transmission route that has expanded rapidly in this context and especially in vulnerable groups, because of its greater risk. Previous outbreaks were through pets but not sexually.

> Is there any reason to be worried?

R. Today the virus affects a group of men who have sex with other men and all measures are aimed at reducing the risk in this population, basically through vaccination. It is important to inform the group, to recommend that they reduce exposure to the virus, but it is not easy to completely change their practices and maintain them over time. That’s why vaccination is most important. The risk to the rest of the population is low. It’s true that we see heterosexual women and men, but the risk is lower for them.

Fifth note of musical scale. Can this virus jump to a group of children?

R. I don’t think that is going to happen. For me this is not a concern. There have been cases of children who have been found to have symptoms, but have been immediately isolated and the story has been cut short. You have to act carefully. And, I emphasize, we must act decisively with vaccination, first of all in the most at-risk groups, men who have sex with men, but also heterosexual men who have a lot of sex. Spain has had two deaths, far fewer than the more than 5,000 people infected. I prefer not to be worried and act responsibly and with common sense.

Nation World News Desk
Nation World News Desk
Nation World News is the fastest emerging news website covering all the latest news, world’s top stories, science news entertainment sports cricket’s latest discoveries, new technology gadgets, politics news, and more.

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