Monkeypox Virus Infection: Donor and Candidate Evaluation for Solid Organ Transplantation

Clemente, Wanessa Trindade; Stucchi, Raquel; Santos, Daniel Wagner; Abdala, Edson; Pierrotti, Ligia; Santoro-Lopes, Guilherme

doi:10.53855/bjt.v26i1.505_ENG

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Brazilian Journal of Transplantation

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ORIGINAL ARTICLE • Braz. J. Transplant. 26 • 2023 • https://doi.org/10.53855/bjt.v26i1.505_ENG copy

Monkeypox Virus Infection: Donor and Candidate Evaluation for Solid Organ Transplantation

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Contextualization:

Since May 2022, cases of monkeypox (mpox) have been reported in several countries, with evidence of community transmission. In the current scenario, transmission has been identified in different continents, related to the local spread of the virus by intimate inter-human contact.

Objective:

The purpose of this article is to inform the transplant community about the possible implications of the disease for the population of transplant recipients and their donors.

Method:

This article presents guidelines for adapting the evaluation of donors and candidates for organ transplants, bearing in mind the potential risks resulting from the emergence of mpox in our midst. It is important to consider that this document reflects the opinion of specialists given the scarce evidence currently available.

Results and Conclusions:

Donor assessment and management recommendations are based on the potential risk of monkeypox virus (MPXV) transmission. The risk of transmission by transplantation is estimated to be low, taking into account the uncertainty about the duration of viremia in patients with mpox and the presence of viable virus in cells and tissues. It is recommended, however, that the physicians responsible for the patient are alert to evidence of infection and that they activate or notify the institutions in case there are indications of transmission through the transplant.

Keywords
Monkeypox; Infection in transplants; Diseases transmitted by the donor

Category	WHO definition	Definition of the Brazilian Ministry of Health^a a Qualquer indivíduo que se enquadre na definição de caso suspeito ou provável de mpox do Ministério da Saúde do Brasil deve ser imediatamente notificado e deve fazer o teste laboratorial para confirmação diagnóstica, através do método de RT-PCR para detecção do DNA viral no material da lesão mucocutânea23
Suspect Case	A person who had contact^b b O contato (vínculo epidemiológico) é caracterizado pela história de exposição a um indivíduo potencialmente transmissor em qualquer uma das seguintes situações: contato próximo e prolongado sem proteção respiratória; contato físico direto, incluindo contato sexual; contato com materiais contaminados, como roupas ou roupas de cama. O risco de transmissão está presente desde o início dos primeiros sintomas do caso até a cura completa das lesões, caracterizada pela formação de nova camada de pele após descamação das crostas. with a probable or confirmed case of mpox within the 21 days before the onset of signs or symptoms and who has any of the following symptoms: acute onset of fever (>38.5°C), headache, myalgia (muscle pain/body aches ), back pain, profound weakness or fatigue OR A person who, as of January 1, 2022, has presented with an unexplained acute skin rash, mucosal lesions or lymph node enlargement. The rash can include single or multiple lesions in the anogenital region or anywhere else on the body. Mucosal lesions can be single or multiple, oral, conjunctival, urethral, penile, vaginal or anorectal. Anorectal lesions may also manifest as anorectal inflammation (proctitis), pain and/or bleeding. AND In which the clinical picture is not fully explained by other common causes of acute rash listed below among the possible differential diagnoses.	Individual of any age who, as of March 15, 2022, presents with a sudden onset of an acute rash suggestive of mpox, single or multiple, on any part of the body (including the genital region), with or without adenomegaly or a report of fever AND History of intimate contact with a stranger(s) and/or casual partner(s) in the last 21 days before the onset of signs and symptoms OR Have an epidemiological link^b b O contato (vínculo epidemiológico) é caracterizado pela história de exposição a um indivíduo potencialmente transmissor em qualquer uma das seguintes situações: contato próximo e prolongado sem proteção respiratória; contato físico direto, incluindo contato sexual; contato com materiais contaminados, como roupas ou roupas de cama. O risco de transmissão está presente desde o início dos primeiros sintomas do caso até a cura completa das lesões, caracterizada pela formação de nova camada de pele após descamação das crostas. with a suspect, probable or confirmed case of mpox in the 21 days before the onset of signs and symptoms OR History of travel to an endemic country or one with confirmed cases of mpox in the 21 days before the onset of signs and symptoms OR Have an epidemiological link^b b O contato (vínculo epidemiológico) é caracterizado pela história de exposição a um indivíduo potencialmente transmissor em qualquer uma das seguintes situações: contato próximo e prolongado sem proteção respiratória; contato físico direto, incluindo contato sexual; contato com materiais contaminados, como roupas ou roupas de cama. O risco de transmissão está presente desde o início dos primeiros sintomas do caso até a cura completa das lesões, caracterizada pela formação de nova camada de pele após descamação das crostas. with people with a history of travel to an endemic country or country with confirmed cases of monkeypox since March 15, 2022, in the 21 days before the onset of signs and symptoms.
Probable Case	An individual who meets the definition of a suspect case but without laboratory confirmation of infection by a specific molecular test for MPXV and who presents one or more of the following criteria: •Have an epidemiological link^b b O contato (vínculo epidemiológico) é caracterizado pela história de exposição a um indivíduo potencialmente transmissor em qualquer uma das seguintes situações: contato próximo e prolongado sem proteção respiratória; contato físico direto, incluindo contato sexual; contato com materiais contaminados, como roupas ou roupas de cama. O risco de transmissão está presente desde o início dos primeiros sintomas do caso até a cura completa das lesões, caracterizada pela formação de nova camada de pele após descamação das crostas. with a probable or confirmed case of mpox in the 21 days before the onset of symptoms; • Identifies as a man who has sex with men; • Had multiple and/or casual sex partners in the 21 days before the onset of symptoms. • Has detectable levels of anti-orthopoxvirus (OPXV) IgM antibody (within 4 to 56 days after rash onset) or a four-fold increase in IgG antibody titer in the absence of recent smallpox/mpox vaccination or other exposure known to OPXV. •Has a positive test result for OPXV infection not specific for MPXV.	suspect case, submitted to clinical and epidemiological investigation AND that developed a clinical picture compatible with mpox, but without the possibility of laboratory confirmation by real-time PCR and/or sequencing.
Confirmed Case	An individual who meets the suspect case definition and who is laboratory confirmed by MPXV-specific molecular testing (real-time PCR or sequencing).	Suspect case, submitted to clinical and epidemiological investigation AND that had a clinical picture compatible with mpox AND had laboratory confirmation by real-time PCR and/or sequencing.
Discarded case	An individual who meets the definition of a suspect case with a “Negative/Not Detectable” laboratory test result/report for mpox by molecular diagnosis (Real-Time PCR and/or Sequencing) OR a suspect case in which, during clinical, epidemiological and another compatible disease was diagnosed ^c c O diagnóstico diferencial de mpox inclui varicela, herpes zoster, sarampo, herpes simplex, zika, dengue, Chikungunya, infecções bacterianas de pele por Staphylococcus spp., escabiose, infecção gonocócica disseminada, sífilis primária ou secundária, cancroide, linfogranuloma venéreo, granuloma inguinal, molusco contagioso, reação alérgica (por exemplo, a plantas), entre outras1. mpox: monkeypox; MPXV: vírus Monkeypox; OPXV: Orthopoxvírus; IST: infecção sexualmente transmissível. with the picture presented by the patient. However, laboratory diagnosis of a sexually transmitted infection does not rule out the possibility of co-infection with MPXV.	An individual who meets the definition of a suspect case with a “Negative/Not Detectable” laboratory test result/report for MPXV by molecular diagnosis (real-time PCR and/or sequencing) OR A suspect case that during the clinical, epidemiological and laboratory investigation was diagnosed as another disease compatible with the observed condition ^c c O diagnóstico diferencial de mpox inclui varicela, herpes zoster, sarampo, herpes simplex, zika, dengue, Chikungunya, infecções bacterianas de pele por Staphylococcus spp., escabiose, infecção gonocócica disseminada, sífilis primária ou secundária, cancroide, linfogranuloma venéreo, granuloma inguinal, molusco contagioso, reação alérgica (por exemplo, a plantas), entre outras1. mpox: monkeypox; MPXV: vírus Monkeypox; OPXV: Orthopoxvírus; IST: infecção sexualmente transmissível. except STI.

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[1] * Corresponding author: wanclemente@yahoo.com.br