Infectious Diseases

DERMATOPHYTE INFECTIONS

Trichophyton metagrophytes internal transcribed spacer genotype VIII, aka Trichophyton indotineae, is a newly identified dermatophyte that has lead to chronic, severe, refractory dermatophyte infections primarily in South Asia, though it has been reported globally. It can often be resistant to terbinafine and slow to respond to griseofulvin and azoles. Preferred treatment is itraconazole for 6-8wks or longer. Post-tinea xerosis and itch persistence may occur. (37418257)

VP-102 is a new drug-device combination that consists of an ampule of gentian violet/cantharadin/bittering agent mixture for application to molluscum. It was applied every 21 days until lesion clearance or up to 4 treatments. Assessed after 12 weeks, treatment was much more effective than vehicle, with ~50% clearance in treatment groups compared to ~15% in vehicle groups (2 parallel studies were published). Side effects were common, with discoloration occurring in 1/4-1/3 of patients. (32965495)

The accepted term will be Mpox after late 2023 (very strange in my opinion).
Orthopoxvirus closely related to smallpox.
3 genomic variants: clade I, IIa, and IIb. Before 2019, most cases were clade I in Central Africa. Clade IIb, however, is the cause of the 2022 multinational outbreak.
Most cases are in MSM in which coinfection with HIV is 26-52%, but overall prevalence rates or proportion of cases in MSM vs other were not published the article referenced here (36757705).
Lesions are highly infectious until complete reepithelialization (in contrast to HSV, in which crusted lesions have low infectivity).
Lesions are primarily via skin to skin contact, but also respiratory secretions during prolonged close contact.

Lesions evolve from small red macules to large umbillicated papules with concentration around the mouth, hands, and anogenital area; clade IIb manifestations often less striking in morphology than clade I, and lesions numbering 10 or fewer.
Prodromal symptoms and lymphadenopathy is much less common than it is in clade I disease, for which they are common.
Mortality is very uncommon in clade IIb (<0.05%) vs clade I (10%) do to possible differences in virulence of the virus but also host and other socilogical determinants.

In addition to clinical factors, swabbing the surface of the lesion for PCR testing. Unroofing lesions is not recommend as it is not necessary.
Gentle cleansing, maintain lesions moist with vaseline.
No FDA approved treatments, but tecovirimat for smallpox has been used as well as cidofovir and brincidofovir. No clear treatment guidelines are available.
2 smallpox vaccines are currently available for the prevention of mpox, and may be offered for high risk individuals or after exposures.