Bacterial pneumonia and pleuritis after Monkeypox (Mpox) infection raises concerns

Medical News: A recent case in Poland has shed light on the potential complications following a monkeypox virus (MPXV) infection. The patient, a 34-year-old man, developed bacterial pneumonia and cryptogenic pleuritis after a probable monkeypox infection. These findings have raised new concerns about the possible long-term impacts of MPXV on human health. This Medical News report explores the details of this case and the potential link between the initial viral infection and subsequent severe pulmonary conditions.


Bacterial pneumonia and pleuritis after Monkeypox (Mpox) infection raises concerns
Chest X-ray during second admission to the ward revealed fluid in the left pleural cavity reaching the third rib.

The case was reported by researchers from Wroclaw Medical University and the Lower Silesian Oncology, Pulmonology and Hematology Center, Poland. The study, authored by Dr Hubert Dawid Ciepłucha and colleagues, examined the unusual progression of the patient’s symptoms. The case study aimed to summarize the key findings and explore the potential implications for other individuals recovering from monkeypox.
 
Overview of the Case
The patient in this case was initially diagnosed with a probable MPXV infection, although confirmation through virological testing was not possible. His symptoms included a fever, malaise, sore throat, and umbilicated vesicles on the genital area and other parts of his body. These symptoms, typical of monkeypox, resolved within two weeks. However, two months later, the patient experienced severe pneumonia, which required hospitalization, and later developed pleuritis.
 
The diagnosis of MPXV was based on the clinical picture, history, and epidemiological context, as the infection occurred during the height of the monkeypox epidemic in Europe. The absence of virological confirmation presents a challenge, but the likelihood of MPXV as the cause is high due to the characteristic symptoms and risk factors.
 
Progression to Pneumonia
In mid-August 2022, two months after the initial infection, the patient was hospitalized with severe community-acquired pneumonia. His symptoms included a high fever, cough, chest pain, and shortness of breath. Laboratory tests showed elevated inflammatory markers, such as C-reactive protein and procalcitonin, which are indicative of a bacterial infection. Despite the severity of the pneumonia, the patient responded well to intravenous antibiotic therapy, and he was discharged after one week.
 
The most concerning aspect of this case is the occurrence of pneumonia after the resolution of the initial monkeypox infection. While monkeypox-related pneumonia has been described in previous studies, most cases involved viral pneumonia or secondary bacterial infections during the acute phase of the disease. In this case, pneumonia developed much later, raising questions about the potential long-term effects of MPXV on the immune system.
 
Th e Onset of Pleuritis
Shortly after recovering from pneumonia, the patient developed pleuritis, an inflammation of the pleura, the membrane surrounding the lungs. Pleuritis is commonly caused by viral infections, but bacterial and autoimmune causes are also possible. Despite undergoing extensive diagnostic testing, including PCR tests for tuberculosis and pleural biopsies, the exact cause of the pleuritis could not be determined.
 
The fluid extracted from the patient’s pleural cavity during thoracocentesis was an exudate, indicating an inflammatory process. Interestingly, pleuritis caused by MPXV has been reported in animal studies, but no human cases have been described until now. This case may represent the first documented instance of pleuritis following monkeypox infection in a human, although more research is needed to confirm this association.
 
Link Between Monkeypox and Pulmonary Complications
The potential link between the initial MPXV infection and the subsequent pulmonary complications is still under investigation. Monkeypox pneumonia has been described in both humans and animals, with viral and bacterial etiologies. In this case, the pneumonia was likely bacterial, given the patient’s rapid response to antibiotics. However, the timing of the pneumonia, two months after the resolution of the monkeypox symptoms, raises questions about whether the viral infection may have compromised the patient’s immune system, making him more susceptible to secondary bacterial infections.
 
The case also highlights the possibility of non-specific pleuritis following MPXV infection. Viral pleuritis can be challenging to diagnose, as the inflammatory process may not always be directly linked to the viral infection. In this case, the patient’s pleuritis was not responsive to antibiotics, further suggesting a possible viral cause. The presence of fluid in the pleural cavity and the histopathological findings point to an inflammatory process, but the exact etiology remains unknown.
 
Potential Implications for Public Health
The findings from this case raise important questions about the long-term effects of MPXV infection, particularly regarding the risk of pulmonary complications. While the majority of monkeypox cases resolve without severe complications, this case suggests that some individuals may be at risk of developing pneumonia or pleuritis weeks or months after the initial infection.
 
One of the key challenges in managing monkeypox-related complications is the lack of virological confirmation in many cases. As seen in this case, the absence of PCR testing for MPXV complicates the diagnosis and treatment of potential complications. Public health authorities may need to consider routine follow-up for patients recovering from monkeypox, particularly those who experience respiratory symptoms after the acute phase of the infection.
 
Conclusions
This case of bacterial pneumonia and cryptogenic pleuritis following probable MPXV infection highlights the need for further research into the potential long-term effects of monkeypox on the respiratory system. While the exact link between the viral infection and the subsequent pulmonary complications remains unclear, the case raises important questions about the immune response to MPXV and the possibility of viral-induced immunosuppression.
 
Future studies should investigate whether individuals recovering from monkeypox are at an increased risk of developing respiratory complications, and if so, what factors may contribute to this increased risk. The findings from this case also underscore the importance of comprehensive diagnostic testing for patients presenting with unexplained respiratory symptoms following monkeypox infection.
 
The study findings were published in the peer-reviewed journal: Infectious Disease Reports.
https://www.mdpi.com/2036-7449/15/6/71
 
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