Mpox in the New York Metropolitan area, Summer 2022
Rachel Gnanaprakasam1, Marina
Keller2, Rebecca Glassman3, Marc
El-Khoury4, Donald S Chen5, Nicholas
Feola6, Jared Feldman7, Vishnu
Chaturvedi8
1 Infectious Diseases Fellow, Infectious Diseases,
Westchester Medical Center,
Rachel.Gnanaprakasam@wmchealth.org
2Infectious Diseases/Associate Hospital
Epidemiologist, Infectious Diseases, Westchester Medical Center,
marina.keller@wmchealth.org
3Internist, Department of Medicine, Westchester
Medical Center,
Rebecca.Glassman@wmchealth.org
4Chair Infectious Diseases, Program Director,
Infectious Diseases, Westchester Medical Center,
Marc.ElKhoury@wmchealth.org
5Hospital Epidemiologist, Infection Prevention,
Westchester Medical Center
Donald.Chen@wmchealth.org
6Pharmacists, Department of Pharmacy, Westchester
Medical Center,
Nick.Feola@wmchealth.org
7Resident in Internal Medicine, Department of
Medicine, Westchester Medical Center,
Jared.Feldman@wmchealth.org
8Chief of Microbiology/Professor of Pathology,
Microbiology, and Immunology, Department of Pathology, Westchester
Medical Center,
Vishnu.Chaturvedi@wmchealth.org
Corresponding author : Marina Keller, 100 Woods Road, Valhalla,
NY 10595, (845)741-8895,
marina.keller@wmchealth.org,
ORCID ID 0000-0002-9796-3190
Running title: Mpox in New York
Abstract: Early in the 2022 Mpox (MPX) global outbreak,
caseloads in the New York Metropolitan area climbed rapidly before other
US urban areas. This case series summarizes the authors’ clinical
experience detecting and treating MPX, during a quickly evolving
outbreak. Clinical outcomes were recorded with a focus on varied
clinical presentation and outcomes such as complications and response to
experimental tecovirimat therapy. A focal or multifocal rash was the
most common presenting symptom in 91% of patients. Almost two thirds
(62%) of patients had anogenital involvement. Proctitis was one of the
most painful presentations with 75% requiring antiviral treatment and 3
patients needing hospitalization for pain management. Most patients
responded promptly to antiviral treatment with tecovirimat. Five out of
10 patients treated with tecovirimat reported symptom resolution within
48 – 72 hours of therapy and another 3 saw resolution within first 96
hours. Two patients had poor response to tecovirimat. This series
includes the only reported case of an HIV positive, immunocompetent
patient who experienced recurrent anal ulcers due to Mpox and required a
second course of tecovirimat. Other unique presentations included
urethritis, abscess formation and MPX infection post-vaccination.
Control of this current Mpox outbreak was possible due to timely
diagnosis and the availability of both a licensed vaccine and an
investigational drug.
Keywords: Mpox, Monkeypox, Orthopox, outbreak, tecovirimat,
Jynneos