Dr. Ted Rosen discusses the infectious diseases that made headlines in 2022, including Mpox, STDs, and more.
Ted Rosen, MD, FAAD, Professor of Dermatology, Baylor College of Medicine, Houston, Texas
“I’m here to talk about infectious diseases. What a happy subject it is. It has been a good year for infectious diseases,” said The Dermatology Digest Editor-in-Chief Ted Rosen, MD, FAAD, who presented “What’s New and Hot in Infectious Disease” at the 2022 Fall Clinical Conference® in Las Vegas.
Of course, there was and is COVID-19, he said.
“But from a dermatology standpoint, the interesting thing is now that we’ve progressed from the original issue COVID, through all the various forms up to Delta and Omicron, the number of patients presenting with skin signs has actually decreased rather dramatically.”
The last study on Omicron suggested skin signs occurred in about 11% of COVID-19 patients—down from more than 30%. And so-called COVID toes have just about disappeared, said Dr. Rosen.1
Mpox
The other viral headliner, monkeypox, is now called Mpox, said Dr. Rosen.
“Unlike with COVID, we already had a medication to use. Tecovirimat was approved for smallpox, but Mpox is like smallpox. It’s an orthopoxvirus. And in fact, tecovirimat seems to work pretty well. It’s dosed by weight.”2
“We also had a vaccine, unlike with COVID, with modified vaccinia Ankara vaccine (JYNNEOS, Bavarian Nordic), which pretty much replaced the basic smallpox vaccine. It’s much safer.”
Mpox probably was “mistreated” initially, according to Dr. Rosen.
“It was talked about as being from close, personal contact because of a desire not to stigmatize any group. In reality, 95% to 99% of these cases are seen in gay or bisexual men who have sex with men. Until we concentrated on the people at high risk, it was kind of diluting the whole message.”
The problem was there wasn’t enough medicine or vaccines, initially, said Dr. Rosen.
With the accumulations of vaccines and medicine for Mpox, the virus seems to have quieted down, he said.
“The CDC says that it probably won’t go away and will be maintained among those at high risk but at a very low level, as people have changed their sexual habits and more people have been able to secure treatment and preventative vaccination.”
“Just keep in mind, if you see pustules (umbilicated pustules or crusted pustules), they don’t have to be disseminated. They can be in a small area—like right around the mouth or right around the genitalia. With these signs, think about Mpox.”
Mpox is not cultured, but rather sampled and subjected to PCR. Positive results come back as nonspecific “non-variola orthopoxvirus,” which is Mpox because that’s the orthopoxvirus circulating at the moment, according to Dr. Rosen.
“Mpox is a little different than smallpox in that pain, lesional pain, is very important. In fact, that’s the most common thing that people are being hospitalized for.”
STDs Increasing Dramatically
Sexually transmitted diseases (STDs) have enjoyed a major resurgence, particularly congenital syphilis, which has doubled in the number of cases since 2017, said Dr. Rosen.
“Syphilis of all stages and highly infectious primary and secondary syphilis are also way, way, way up. So be sure to watch out for that.”
While there are a variety of STDs to think about, Dr. Rosen focused on human immunodeficiency virus (HIV).
“The good news this year is the lifetime risk of acquiring HIV has gone down dramatically in men and women. Therapeutics have become much simpler in that we have injections that can be done every other month both as therapy for maintenance, as well as for pre-exposure prophylaxis. You don’t have to take handfuls of pills at any time for treatment and don’t have to remember to take pills as prevention.”
There’s more in the pipeline, including a Moderna mRNA HIV vaccine in phase 3 clinical trials, according to Dr. Rosen.
Oddball Viruses
“There are a variety of other oddball viruses that are just waiting to cause problems.”
The Lloviu virus (LLOV), found in bats, is a relative of Ebola and has been found in Spain, Hungary, and Romania, said Dr. Rosen.
“It’s killing the bats by hemorrhagic disease, so it’s acting like Ebola. That’s not good.”
There’s another virus carried by pet rats in a number of states, said Dr. Rosen.
“It causes a high fever and some other symptoms. If someone comes in complaining of flushing on the face, neck, the v of the chest, and a fever, ask if they have a pet rat. There’s nothing you can treat it with but at least you know what it is. It doesn’t usually kill people.”
Add to the list a virus seen in a tick that is primarily in the Northeast, U.S., but is moving south and west, according to Dr. Rosen.
“Suspect possible tick exposure in someone who has a high fever, low platelet count and hemorrhagic phenomenon—so, petechia, purpura. Ask them if they have been out hunting or hiking and might have been exposed to a tick if it’s in the Northeast.”
References:
- Visconti A, Murray B, Rossi N, et al. Cutaneous manifestations of SARS-CoV-2 infection during the Delta and Omicron waves in 348 691 UK users of the UK ZOE COVID Study app. Br J Dermatol. 2022 Dec;187(6):900-908. doi: 10.1111/bjd.21784. Epub 2022 Oct 10. PMID: 35869671; PMCID: PMC9349964.
- Desai AN, Thompson GR 3rd, Neumeister SM, Arutyunova AM, Trigg K, Cohen SH. Compassionate Use of Tecovirimat for the Treatment of Monkeypox Infection. JAMA. 2022 Oct 4;328(13):1348-1350. doi: 10.1001/jama.2022.15336. PMID: 35994281; PMCID: PMC9396467.