{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:32:57Z","timestamp":1787031177194,"version":"build-2736575974"},"reference-count":12,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,3]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>Mpox, a zoonotic disease caused by the monkeypox virus (MPXV), has reemerged as a significant global public health threat, particularly in sub-Saharan Africa, where more than 50,000 cases have been reported since 2022. Although HIV-related immunosuppression is a known risk factor for severe MPXV infection, the intersection of mpox, HIV, and critical illness has been largely overlooked in ongoing outbreaks in East and Central Africa. We describe a case of a 45-year-old woman in Uganda, living with WHO stage 3 HIV and active pulmonary tuberculosis (TB), who developed mpox-associated sepsis and acute hypoxemic respiratory failure. One month after initial mpox diagnosis and receipt of supportive care, she developed high fever, hypotension, and hypoxemia and was hospitalized. Painful oropharyngeal and mucocutaneous lesions limited her adherence to oral antiretroviral and anti-TB therapy. Despite oxygen therapy, judicious fluid resuscitation, and empiric antibiotics, the patient deteriorated rapidly and died on hospital day two. This case illustrates the emerging burden of mpox-related critical illness in persons living with HIV in sub-Saharan Africa. In this context, we propose key actions to improve the international mpox response, focusing on the clinical management of mpox-associated sepsis and critical illness.<\/jats:p>","DOI":"10.4269\/ajtmh.25-0125","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T12:04:53Z","timestamp":1751371493000},"page":"581-583","source":"Crossref","is-referenced-by-count":3,"title":["Mpox, HIV, and a Compounding Sepsis Crisis in Africa"],"prefix":"10.4269","volume":"113","author":[{"given":"Barnabas","family":"Bakamutumaho","sequence":"first","affiliation":[{"name":"Department of Arbovirology and Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda;"},{"name":"Immunizable Diseases Unit, Uganda Virus Research Institute, Entebbe, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Cummings","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York;"},{"name":"Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shevin T.","family":"Jacob","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom;"},{"name":"Walimu, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph F.","family":"Wamala","sequence":"additional","affiliation":[{"name":"World Health Organization, Pretoria, South Africa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Nsereko","sequence":"additional","affiliation":[{"name":"Entebbe Regional Referral Hospital, Entebbe, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Obuku","sequence":"additional","affiliation":[{"name":"Medical Research Council\/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hakim","family":"Sendagire","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilber","family":"Sabiiti","sequence":"additional","affiliation":[{"name":"Division of Infection and Global Health, University of St. Andrew\u2019s, St. Andrew\u2019s, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Bosco","family":"Nsubuga","sequence":"additional","affiliation":[{"name":"Entebbe Regional Referral Hospital, Entebbe, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce J.","family":"Kirenga","sequence":"additional","affiliation":[{"name":"Makerere Lung Institute, Makerere University, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Kyobe Bosa","sequence":"additional","affiliation":[{"name":"Ministry of Health, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misaki","family":"Wayengera","sequence":"additional","affiliation":[{"name":"Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"N Engl J Med","first-page":"666","article-title":"Evolving epidemiology of mpox in Africa in 2024","volume":"392","author":"Ndembi","year":"2025"},{"key":"b2","series-title":"JAMA","first-page":"1652","article-title":"Mpox clinical presentation, diagnostic approaches, and treatment strategies: A review","volume":"332","author":"Titanji","year":"2024"},{"key":"b3","series-title":"JAMA","first-page":"762","article-title":"Assessment of clinical criteria for sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Seymour","year":"2016"},{"key":"b4","article-title":"Mpox Outbreak in Uganda Situation Update \u2013 4 March 2025","year":"2025"},{"key":"b5","article-title":"Mpox \u2013 Democratic Republic of the Congo","year":"2024"},{"key":"b6","series-title":"BMJ Glob Health","first-page":"e013126","article-title":"Mpox (monkeypox) risk and mortality associated with HIV infection: A national case-control study in Nigeria","volume":"8","author":"Yinka-Ogunleye","year":"2023"},{"key":"b7","series-title":"IJID One Health","first-page":"100050","article-title":"High prevalence and non-suppression of HIV\/AIDS in the East and Central African region heightens risk of severe outcomes for Clade I monkeypox virus infection, and may be a driver for subsequent adaptation","volume":"6","author":"Bosa","year":"2025"},{"key":"b8","series-title":"Lancet","first-page":"200","article-title":"Global, regional, and national sepsis incidence and mortality, 1990\u20132017: Analysis for the Global Burden of Disease Study","volume":"395","author":"Rudd","year":"2020"},{"key":"b9","series-title":"Crit Care","first-page":"212","article-title":"Aetiology and outcomes of sepsis in adults in sub-Saharan Africa: A systematic review and meta-analysis","volume":"23","author":"Lewis","year":"2019"},{"key":"b10","article-title":"The Antiviral Tecovirimat is Safe but Did Not Improve Clade I Mpox Resolution in Democratic Republic of the Congo","year":"2024"},{"key":"b11","article-title":"IMAI District Clinician Manual: Hospital Care Adolescents and Adults","year":"2012"},{"key":"b12","article-title":"Clinical Management and Infection Prevention and Control for Monkeypox: Interim Rapid Response Guidance","year":"2022"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/3\/article-p581.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/3\/article-p581.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/3\/article-p581.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T13:13:56Z","timestamp":1756905236000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/3\/article-p581.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,3]]},"references-count":12,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.25-0125","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,3]]}}}