{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T21:22:17Z","timestamp":1793913737732,"version":"4.8.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":56,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100016302","name":"Coalition for Epidemic Preparedness Innovations","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016302","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Trop Med Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Mpox in people living with HIV (PLHIV) with advanced immunosuppression is poorly understood in sub-Saharan Africa, where high HIV prevalence intersects with limited access to mpox-specific antivirals. Urgent evidence is needed to guide clinical management and improve outcomes for this vulnerable population in resource-limited settings with outbreaks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      We report a 30-year-old Ugandan man with advanced HIV (CD4\u202f55\u202fcells\/\u00b5L, HIV-1 RNA 645,000 copies\/mL) who presented with 2\u00a0weeks of widespread mucocutaneous disease, circumferential necrotic penile ulceration with severe dysuria, and periocular involvement. Mpox was confirmed by real-time PCR from multiple anatomical sites, with sequencing identifying Clade I (subclade Ib) infection. Longitudinal sampling showed consistently low\n                      <jats:italic>Ct<\/jats:italic>\n                      values in skin and genital lesions despite rising salivary\n                      <jats:italic>Ct<\/jats:italic>\n                      values, indicating differential compartmental viral clearance. Serial pus cultures from ulcerated lesions yielded multi-resistant gram-negative bacilli and coagulase-negative staphylococci, with sustained resistance to first-line agents throughout the clinical course. Meropenem remained the only antimicrobial to which isolates were consistently susceptible across all sampling points, suggestive of evolving polymicrobial wound colonisation under antibiotic selection pressure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Management and outcome<\/jats:title>\n                    <jats:p>Empirical ceftriaxone and metronidazole proved ineffective. Culture-guided escalation to intravenous meropenem, along with intensive wound care, pain management, ocular prophylaxis, and resumption of antiretroviral therapy (ART), resulted in gradual clinical improvement. The patient was discharged after 4\u00a0weeks with healed skin lesions and mild residual ocular discomfort. At 3\u00a0months, immune reconstitution was observed (CD4 173\u202fcells\/\u00b5L; HIV-1 RNA 72 copies\/mL) with complete functional recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Severe Clade Ib (subclade Ib) mpox in advanced HIV can present with genital necrosis, ocular involvement, persistent lesion-site viral burden, and multidrug-resistant bacterial superinfection. Even in the absence of specific antivirals, favourable outcomes can be achieved through integrated HIV care, early culture-guided antimicrobial stewardship, and proactive ocular management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s41182-026-01010-9","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T07:36:23Z","timestamp":1782286583000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Severe Clade I (subclade Ib) mpox in advanced HIV complicated by multidrug-resistant bacterial superinfection and ocular involvement: a case report from Uganda"],"prefix":"10.1186","volume":"54","author":[{"given":"Raymond Ernest","family":"Kaweesa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda","family":"Nairuba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey","family":"Odoch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney Abraham","family":"Tumusiime","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Mukisa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie Daphine","family":"Ntabadde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Violet","family":"Ankunda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pontiano","family":"Kaleebu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Nsereko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Serwanga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"issue":"3","key":"1010_CR1","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1111\/all.15633","volume":"78","author":"B Cabanillas","year":"2023","unstructured":"Cabanillas B, Murdaca G, Guemari A, Torres MJ, Azkur AK, Aksoy E, et al. 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Ethical approval was obtained from the Uganda Virus Research Institute Research and Ethics Committee (UVRI-REC; reference GC\/127\/1068) and registered with the Uganda National Council for Science and Technology (UNCST; approval NS934ES). The patient provided written informed consent for participation, clinical documentation, and publication of anonymised data and images.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"148"}}