PDF(Pubmed)
Abstract：
BACKGROUND: Limited data is available regarding the severity and mortality of Mpox in individuals with immunocompromised conditions. Therefore, we performed this meta-analysis to understand the impact of HIV- or non-HIV-associated immunosuppression on the severity of Mpox requiring hospitalization and mortality.
METHODS: A thorough literature search was performed from 2022 up to January 2024. The results were presented as odds ratios (ORs). We only included patients who required hospitalization for severity rather than isolation.
RESULTS: A total of 34 studies were included in this analysis. Our analysis did not find a significant difference in the hospitalization risk between HIV-positive individuals and those who were HIV-negative (OR = 1.03; P = 0.85; 7 studies; CD4 count of fewer than 200 cells/µL was less than 0.5% across all studies). Patients with a CD4 count lower than 200 cells/µL or an unsuppressed RNA viral load (> 200 copies/ml) had a significantly higher hospitalization risk (OR = 5.3, P < 0.001) and (OR = 3, P < 0.001), respectively. Most of the reported deaths were reported in patients with HIV with CD4 counts below 200 cells/µL, with some fatal cases occurring in non-HIV immunosuppressed patients, particularly organ transplant recipients. Based on the autopsy findings, Mpox was confirmed in multiple organs, particularly the digestive tract, lung, and testes. Furthermore, some studies documented cases of death that were suspected to be related to hemophagocytic lymphohistiocytosis (HLH) and immune reconstitution inflammatory syndrome (IRIS). Most of the death reports showed concomitant non-Mpox infections at the time of hospitalization and death CONCLUSIONS: Our finding shows that Mpox acts as an opportunistic pathogen in immunocompromised individuals. These individuals should be prioritized for early care and closely monitored for signs of deteriorating clinical conditions. Clinical manifestations and autopsy findings strongly suggest Mpox dissemination to multiple organs, particularly the digestive tract, and lungs. However, the presence of concomitant non-Mpox infections complicates the assessment of the attribution of Mpox to death. Caution should be exercised when interpreting data suggesting poorer outcomes in individuals with non-HIV immunosuppression, as current evidence is scarce and further research is needed.
METHODS: A thorough literature search was performed from 2022 up to January 2024. The results were presented as odds ratios (ORs). We only included patients who required hospitalization for severity rather than isolation.
RESULTS: A total of 34 studies were included in this analysis. Our analysis did not find a significant difference in the hospitalization risk between HIV-positive individuals and those who were HIV-negative (OR = 1.03; P = 0.85; 7 studies; CD4 count of fewer than 200 cells/µL was less than 0.5% across all studies). Patients with a CD4 count lower than 200 cells/µL or an unsuppressed RNA viral load (> 200 copies/ml) had a significantly higher hospitalization risk (OR = 5.3, P < 0.001) and (OR = 3, P < 0.001), respectively. Most of the reported deaths were reported in patients with HIV with CD4 counts below 200 cells/µL, with some fatal cases occurring in non-HIV immunosuppressed patients, particularly organ transplant recipients. Based on the autopsy findings, Mpox was confirmed in multiple organs, particularly the digestive tract, lung, and testes. Furthermore, some studies documented cases of death that were suspected to be related to hemophagocytic lymphohistiocytosis (HLH) and immune reconstitution inflammatory syndrome (IRIS). Most of the death reports showed concomitant non-Mpox infections at the time of hospitalization and death CONCLUSIONS: Our finding shows that Mpox acts as an opportunistic pathogen in immunocompromised individuals. These individuals should be prioritized for early care and closely monitored for signs of deteriorating clinical conditions. Clinical manifestations and autopsy findings strongly suggest Mpox dissemination to multiple organs, particularly the digestive tract, and lungs. However, the presence of concomitant non-Mpox infections complicates the assessment of the attribution of Mpox to death. Caution should be exercised when interpreting data suggesting poorer outcomes in individuals with non-HIV immunosuppression, as current evidence is scarce and further research is needed.
摘要：
背景：关于免疫功能受损个体中水痘的严重程度和死亡率的数据有限。因此,我们进行了这项荟萃分析,目的是了解HIV或非HIV相关的免疫抑制对需要住院治疗的水痘严重程度和死亡率的影响.
方法：从2022年至2024年1月进行了全面的文献检索。结果以比值比(OR)表示。我们仅包括因严重程度而需要住院治疗而不是隔离的患者。
结果：本分析共纳入34项研究。我们的分析没有发现HIV阳性者和HIV阴性者之间的住院风险存在显着差异（OR=1.03；P=0.85；7项研究；在所有研究中，小于200个细胞/μL的CD4计数小于0.5％）。CD4计数低于200细胞/μL或RNA病毒载量未抑制（>200拷贝/ml）的患者住院风险明显较高（OR=5.3，P<0.001）和（OR=3，P<0.001），分别。大多数报告的死亡是在CD4计数低于200细胞/μL的HIV患者中报告的，一些致命病例发生在非HIV免疫抑制患者中，尤其是器官移植受者。根据尸检结果,在多个器官中确认了水痘，尤其是消化道，肺，和睾丸。此外，一些研究记录了怀疑与噬血细胞淋巴组织细胞增多症(HLH)和免疫重建炎症综合征(IRIS)相关的死亡病例.大多数死亡报告显示在住院和死亡时同时发生非痘感染。结论：我们的发现表明，在免疫功能低下的个体中，痘是一种机会性病原体。应优先考虑这些人的早期护理，并密切监测临床状况恶化的迹象。临床表现和尸检结果强烈提示水痘传播到多个器官，尤其是消化道，还有肺.然而,伴随的非水痘感染的存在使水痘归因死亡的评估变得复杂.在解释表明非HIV免疫抑制患者预后较差的数据时，应谨慎行事。由于目前的证据很少，需要进一步的研究。
方法：从2022年至2024年1月进行了全面的文献检索。结果以比值比(OR)表示。我们仅包括因严重程度而需要住院治疗而不是隔离的患者。
结果：本分析共纳入34项研究。我们的分析没有发现HIV阳性者和HIV阴性者之间的住院风险存在显着差异（OR=1.03；P=0.85；7项研究；在所有研究中，小于200个细胞/μL的CD4计数小于0.5％）。CD4计数低于200细胞/μL或RNA病毒载量未抑制（>200拷贝/ml）的患者住院风险明显较高（OR=5.3，P<0.001）和（OR=3，P<0.001），分别。大多数报告的死亡是在CD4计数低于200细胞/μL的HIV患者中报告的，一些致命病例发生在非HIV免疫抑制患者中，尤其是器官移植受者。根据尸检结果,在多个器官中确认了水痘，尤其是消化道，肺，和睾丸。此外，一些研究记录了怀疑与噬血细胞淋巴组织细胞增多症(HLH)和免疫重建炎症综合征(IRIS)相关的死亡病例.大多数死亡报告显示在住院和死亡时同时发生非痘感染。结论：我们的发现表明，在免疫功能低下的个体中，痘是一种机会性病原体。应优先考虑这些人的早期护理，并密切监测临床状况恶化的迹象。临床表现和尸检结果强烈提示水痘传播到多个器官，尤其是消化道，还有肺.然而,伴随的非水痘感染的存在使水痘归因死亡的评估变得复杂.在解释表明非HIV免疫抑制患者预后较差的数据时，应谨慎行事。由于目前的证据很少，需要进一步的研究。
