A man in his thirties presented immediately on return from a one‐month trip to Europe with widespread pustular lesions, tender lymphadenopathy, fever, and headache. Initial contact was with his general practitioner, who notified the local Public Health Unit and the Infectious Diseases Unit. He identified as a man who has sex with men. He had a background of human immunodeficiency virus (HIV) infection, which was well controlled (CD4+ cells, 1190 cells/mm3 [reference interval (RI), 560–1580 cells/mm3]; HIV viral load not detected [limit of quantitation, 20 RNA copies/mL]) with bictegravir 50 mg, emtricitabine 200 mg, and tenofovir alafenamide 25 mg daily. He first noticed a lesion resembling a pimple on the forehead while still overseas, which progressed over the six days before his return (Box 1) followed by a clustering of similar lesions over his right buttock, but no mucosal lesions. More lesions then developed over his thigh and hand. He reported intermittent rectal paraesthesia and spasm, in addition to fever and mild generalised headache. Tender inguinal and cervical lymphadenopathy became established, along with fatigue and malaise. He did not report sore throat, cough, diarrhoea, dysuria, or neck stiffness. He had had sexual contact with known cases of mpox (formerly monkeypox) in Europe. He was admitted to hospital in a single negative pressure room, with contact and airborne precautions. Full blood count and chemistry were normal, and C‐reactive protein was 17 mg/L (RI, < 5 mg/L). Testing for Chlamydia trachomatis and Neisseria gonorrhoeae was negative. Swabs were taken from the perianal lesion and sent for National Association of Testing Authorities (NATA)‐accredited in‐house Orthopoxvirus group real‐time polymerase chain reaction (PCR) test targeting the OPG105 gene. Positive by real‐time PCR, monkeypox virus (MPXV) DNA from both the perianal lesion and throat specimens was subsequently confirmed using two additional conventional PCR tests targeting the OPG105 and OPG185 genes. Whole genome sequencing and phylogenetic analyses (Supporting Information) of a genome sequence obtained from the perianal specimen (MPXV_QLD_MX00001_2022, GenBank accession number OP235282) demonstrated placement within the human MPXV (hMPXV) sublineage B.1 of clade IIb and was most closely related to other recent 2022 MPXV sequences from the United States, Europe, Australia and Canada (Box 2). Additional laboratory methods are included in the Supporting Information.
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Ei T Aung is supported by an Australian Government Research Training Program scholarship administered by Monash University and a Research Entry Scholarship from the Chapter of Sexual Health Medicine of the Royal Australasian College of Physicians. Christopher K Fairley (GNT1172900) and Eric PF Chow (GNT1172873) are supported by National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grants. Jason J Ong is supported by an NHMRC Emerging Leadership Investigator Grant (GNT1193955).
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