{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T04:40:56Z","timestamp":1784263256390,"version":"3.55.0"},"reference-count":27,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,10,27]],"date-time":"2022-10-27T00:00:00Z","timestamp":1666828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001871","name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","doi-asserted-by":"publisher","award":["UIDB\/04295\/2020"],"award-info":[{"award-number":["UIDB\/04295\/2020"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001871","name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","doi-asserted-by":"publisher","award":["UIDP\/04295\/2020"],"award-info":[{"award-number":["UIDP\/04295\/2020"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infectious Disease Reports"],"abstract":"<jats:p>Monkeypox, a neglected and re-emergent zoonotic disease caused by monkeypox virus (MPXV) infection, has been endemic in Central and Western Africa for decades. More recently, an outbreak has spread to a global level, occurring in sites with no previous reported cases and being clustered among men who have sex with men, suggesting new modes of transmission. There is an urgent need for research for a better understanding of the genomic evolution and changing epidemiology of the Orthopoxvirus group. Our work aimed to characterize the clinical and epidemiological features of a cohort of patients with MPXV infection in a Portuguese hospital, admitted between 5 May and 26 July 2022. In this retrospective observational study, aggregate data of a case series on the presentation, clinical course, and outcomes of confirmed MPXV infections are reported. The study included 40 men and 1 woman, with a mean age of 37.2 years old; 92.7% identified as men who have sex with men, 90.2% had unprotected sex or sex with multiple or anonymous partners in the previous month, and 39.0% reported to have had sex with an MPXV-confirmed case; 59.5% had previously known human immunodeficiency virus (HIV) infection, all of whom were under antiretroviral therapy, and no patients had acquired immunodeficiency syndrome (AIDS) criteria. About a quarter of patients were observed only a week after symptom onset. All patients had skin or mucosal lesions and the anogenital region was the most frequent lesion site. There were no statistically significant clinical differences between HIV-positive and negative individuals. Four patients were admitted to the inpatient clinic, two of whom had proctitis with difficult-to-manage anal pain. There were no reported deaths. Our findings suggest the sexual route as a relevant mode of transmission of MPXV and confirm the mostly benign presentation of this disease.<\/jats:p>","DOI":"10.3390\/idr14060083","type":"journal-article","created":{"date-parts":[[2022,10,27]],"date-time":"2022-10-27T20:37:58Z","timestamp":1666903078000},"page":"810-823","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Clinical and Epidemiological Features of Hospitalized and Ambulatory Patients with Human Monkeypox Infection: A Retrospective Observational Study in Portugal"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7798-7064","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Caria","sequence":"first","affiliation":[{"name":"Departamento de Doen\u00e7as Infeciosas, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, 1069-166 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel","family":"Pinto","sequence":"additional","affiliation":[{"name":"Departamento de Doen\u00e7as Infeciosas, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, 1069-166 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ema","family":"Leal","sequence":"additional","affiliation":[{"name":"Departamento de Doen\u00e7as Infeciosas, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, 1069-166 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasco","family":"Almeida","sequence":"additional","affiliation":[{"name":"Departamento de Doen\u00e7as Infeciosas, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, 1069-166 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gon\u00e7alo","family":"Crist\u00f3v\u00e3o","sequence":"additional","affiliation":[{"name":"Departamento de Doen\u00e7as Infeciosas, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, 1069-166 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Catarina","family":"Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"Departamento de Doen\u00e7as Infeciosas, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, 1069-166 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margarida","family":"Torres","sequence":"additional","affiliation":[{"name":"Departamento de Doen\u00e7as Infeciosas, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, 1069-166 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Beatriz","family":"Santos","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Interna, Hospital do Esp\u00edrito Santo, Ilha Terceira, 9700-049 Angra do Hero\u00edsmo, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00e9lder","family":"Pinheiro","sequence":"additional","affiliation":[{"name":"Departamento de Doen\u00e7as Infeciosas, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, 1069-166 Lisboa, Portugal"},{"name":"Faculdade de Ci\u00eancias M\u00e9dicas, Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"P\u00f3voas","sequence":"additional","affiliation":[{"name":"Departamento de Doen\u00e7as Infeciosas, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, 1069-166 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Seixas","sequence":"additional","affiliation":[{"name":"Departamento de Doen\u00e7as Infeciosas, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, 1069-166 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Lino","sequence":"additional","affiliation":[{"name":"Departamento de Doen\u00e7as Infeciosas, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, 1069-166 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orlando","family":"Cardoso","sequence":"additional","affiliation":[{"name":"Departamento de Doen\u00e7as Infeciosas, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, 1069-166 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Jos\u00e9","family":"Manata","sequence":"additional","affiliation":[{"name":"Departamento de Doen\u00e7as Infeciosas, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, 1069-166 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0428-6643","authenticated-orcid":false,"given":"Ana","family":"Virgolino","sequence":"additional","affiliation":[{"name":"Instituto de Sa\u00fade Ambiental (ISAMB), Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"Laborat\u00f3rio Associado TERRA, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Maltez","sequence":"additional","affiliation":[{"name":"Departamento de Doen\u00e7as Infeciosas, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, 1069-166 Lisboa, Portugal"},{"name":"Instituto de Sa\u00fade Ambiental (ISAMB), Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"Laborat\u00f3rio Associado TERRA, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,27]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2022, July 23). Smallpox, Historic Milestone Underscores Urgent Need to Invest in Global Health Security and Universal Health Coverage. Available online: https:\/\/www.who.int\/csr\/disease\/smallpox\/en\/."},{"key":"ref_2","unstructured":"World Health Organization (2022, July 23). Smallpox Vaccines. Available online: https:\/\/www.who.int\/csr\/disease\/smallpox\/vaccines\/en\/."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"20120150","DOI":"10.1098\/rstb.2012.0150","article-title":"Vacated Niches, Competitive Release and the Community Ecology of Pathogen Eradication","volume":"368","year":"2013","journal-title":"Philos. Trans. R. Soc. B Biol. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1111\/j.1699-0463.1959.tb00328.x","article-title":"A Pox-like Disease in Cynomolgus Monkeys","volume":"46","author":"Andersen","year":"1959","journal-title":"Acta Pathol. Microbiol. Scand."},{"key":"ref_5","first-page":"599","article-title":"Isolation and Properties of the Causal Agent of a New Variola-like Disease (Monkeypox) in Man","volume":"46","author":"Marennikova","year":"1972","journal-title":"Bull. World Health Organ."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Doty, J.B., Malekani, J.M., Kalemba, L.N., Stanley, W.T., Monroe, B.P., Nakazawa, Y.U., Mauldin, M.R., Bakambana, T.L., Dja Liyandja, T.L., and Braden, Z.H. (2017). Assessing Monkeypox Virus Prevalence in Small Mammals at the Human-Animal Interface in the Democratic Republic of the Congo. Viruses, 9.","DOI":"10.3390\/v9100283"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"772","DOI":"10.3390\/idr14050079","article-title":"Monkeypox: From A Neglected Tropical Disease to a Public Health Threat","volume":"14","author":"Antunes","year":"2022","journal-title":"Infect. Dis. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1093\/infdis\/156.2.293","article-title":"Human Monkeypox: Clinical Features of 282 Patients","volume":"156","author":"Szczeniowski","year":"1987","journal-title":"J. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1016\/S1473-3099(19)30294-4","article-title":"Outbreak of Human Monkeypox in Nigeria in 2017\u20132018: A Clinical and Epidemiological Report","volume":"19","author":"Aruna","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Beer, E.M., and Bhargavi Rao, V. (2019). A Systematic Review of the Epidemiology of Human Monkeypox Outbreaks and Implications for Outbreak Strategy. PLoS Negl. Trop. Dis., 13.","DOI":"10.1371\/journal.pntd.0007791"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2661","DOI":"10.1099\/vir.0.81215-0","article-title":"A Tale of Two Clades: Monkeypox Viruses","volume":"86","author":"Likos","year":"2005","journal-title":"J. Gen. Virol."},{"key":"ref_12","unstructured":"World Health Organization (2022, October 19). Monkeypox: Experts Give Virus Variants New Names. Available online: https:\/\/www.who.int\/news\/item\/12-08-2022-monkeypox--experts-give-virus-variants-new-names."},{"key":"ref_13","first-page":"459","article-title":"Clinico-Epidemiological Features of Monkeypox Patients with an Animal or Human Source of Infection","volume":"66","author":"Jezek","year":"1988","journal-title":"Bull. World Health Organ."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.3201\/eid1309.070175","article-title":"Spectrum of Infection and Risk Factors for Human Monkeypox, United States, 2003","volume":"13","author":"Reynolds","year":"2007","journal-title":"Emerg. Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Ogoina, D., Izibewule, J.H., Ogunleye, A., Ederiane, E., Anebonam, U., Neni, A., Oyeyemi, A., Etebu, E.N., and Ihekweazu, C. (2019). The 2017 Human Monkeypox Outbreak in Nigeria\u2014Report of Outbreak Experience and Response in the Niger Delta University Teaching Hospital, Bayelsa State, Nigeria. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0214229"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"5077","DOI":"10.1016\/j.vaccine.2020.04.062","article-title":"Human Monkeypox\u2014After 40 Years, an Unintended Consequence of Smallpox Eradication","volume":"38","author":"Simpson","year":"2020","journal-title":"Vaccine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1056\/NEJMoa032299","article-title":"The Detection of Monkeypox in Humans in the Western Hemisphere","volume":"350","author":"Reed","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1800509","DOI":"10.2807\/1560-7917.ES.2018.23.38.1800509","article-title":"Two Cases of Monkeypox Imported to the United Kingdom, September 2018","volume":"23","author":"Vaughan","year":"2018","journal-title":"Eurosurveillance"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Bunge, E.M., Hoet, B., Chen, L., Lienert, F., Weidenthaler, H., Baer, L.R., and Steffen, R. (2022). The Changing Epidemiology of Human Monkeypox\u2014A Potential Threat? A Systematic Review. PLoS Negl. Trop. Dis., 16.","DOI":"10.1371\/journal.pntd.0010141"},{"key":"ref_20","first-page":"2200424","article-title":"Ongoing Monkeypox Virus Outbreak, Portugal, 29 April to 23 May 2022","volume":"27","author":"Duque","year":"2022","journal-title":"Eurosurveillance"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1056\/NEJMoa2207323","article-title":"Monkeypox Virus Infection in Humans across 16 Countries\u2014April\u2013June 2022","volume":"387","author":"Thornhill","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e072410","DOI":"10.1136\/bmj-2022-072410","article-title":"Clinical Features and Novel Presentations of Human Monkeypox in a Central London Centre during the 2022 Outbreak: Descriptive Case Series","volume":"378","author":"Patel","year":"2022","journal-title":"BMJ"},{"key":"ref_23","first-page":"2200503","article-title":"Frequent Detection of Monkeypox Virus DNA in Saliva, Semen, and Other Clinical Samples from 12 Patients, Barcelona, Spain, May to June 2022","volume":"27","author":"Fuertes","year":"2022","journal-title":"Eurosurveillance"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/S0140-6736(22)01436-2","article-title":"Clinical Presentation and Virological Assessment of Confirmed Human Monkeypox Virus Cases in Spain: A Prospective Observational Cohort Study","volume":"400","author":"Alemany","year":"2022","journal-title":"Lancet"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Hutson, C.L., Carroll, D.S., Gallardo-Romero, N., Weiss, S., Clemmons, C., Hughes, C.M., Salzer, J.S., Olson, V.A., Abel, J., and Karem, K.L. (2011). Monkeypox Disease Transmission in an Experimental Setting: Prairie Dog Animal Model. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0028295"},{"key":"ref_26","first-page":"465","article-title":"Human Monkeypox: Secondary Attack Rates","volume":"66","author":"Jezek","year":"1988","journal-title":"Bull. World Health Organ."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1016\/S1473-3099(22)00228-6","article-title":"Clinical Features and Management of Human Monkeypox: A Retrospective Observational Study in the UK","volume":"22","author":"Adler","year":"2022","journal-title":"Lancet Infect. Dis."}],"container-title":["Infectious Disease Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7449\/14\/6\/83\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:04:29Z","timestamp":1760144669000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7449\/14\/6\/83"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,27]]},"references-count":27,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["idr14060083"],"URL":"https:\/\/doi.org\/10.3390\/idr14060083","relation":{},"ISSN":["2036-7449"],"issn-type":[{"value":"2036-7449","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,27]]}}}