Monkeypox: new clinical features and presentations

Monkeypox: laboratory diagnosis

The monkeypox virus (MPXV), the etiological agent of monkeypox or simian smallpox, is a virus of DNA genetic material, of the genus Orthopoxvirus, belonging to the family Poxviridae. Some species of the Orthopoxvirus genus are pathogenic for humans (eg, smallpox, vaccinia, cowpox, rabbitpox and monkeypox itself), all of which are antigenically related.

There are basically two genetically distinct variants (clades) of the monkeypox virus: the West African clade (historically associated with less severe and transmissible disease, which appears to be linked to this current outbreak) and the Congo Basin (Central Africa).

Read too: Monkeypox in children and adolescents

The growing number of infections around the world, including 3,984 confirmed cases and 1 death in Brazil (data updated on August 24, 2022), has aroused the attention of the community and, naturally, increased interest and demand for diagnostic laboratory tests for the monkeypox.

molecular tests

Laboratory confirmation of infection caused by MPXV occurs through nucleic acid amplification tests (NAAT). Through real-time or conventional polymerase chain reaction (PCR), associated or not with sequencing, it is possible to detect specific sequences (fragments) of viral DNA in the collected materials (preferably from vesicle secretion and/or lesion).

Certain validated PCR protocols were developed for the detection of the Orthopoxvirus genus, without, however, identifying the species. Other protocols (recommended) are specific for MPXV (thus confirming the etiology), some of which include clade differentiation (West Africa versus Central Africa).

Other assays are capable of detecting, in a single analysis and sample, in addition to MPXV, other related viruses (eg, varicella zoster, infectious molluscum), thus allowing a better clinical-laboratory differentiation and the consequent diagnostic clarification.

Molecular tests currently used in public and private laboratories in Brazil are using “in house” methodologies, that is, with inputs/reagents prepared and validated by the laboratories themselves, following available international processes and conventions.

The first requests for registration of commercial molecular tests have already been filed with the National Health Surveillance Agency (Anvisa) and, at the moment, they are in priority for analysis by the agency. Everything indicates that over the next few weeks these kits will already be approved and available, greatly increasing the processing capacity of samples throughout the national territory.

Final message

Faced with a possible exponential growth in the number of Monkeypox cases in Brazil and in the world, it is important to know and increase the availability of laboratory tests used for the diagnosis of this zoonosis.

Molecular methodologies (PCR) are capable of detecting, with high sensitivity and specificity, certain sequences of the genetic material of the virus (DNA) and, therefore, are considered the “gold standard” method for diagnosis.

Due, in large part, to the demands generated by the Covid-19 pandemic, Clinical Laboratories and suppliers are better prepared (eg: labor, supplies, equipment, logistics, infrastructure) to carry out molecular tests and, therefore, , could make a decisive contribution to the control of this current outbreak.

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