First ever case of coronavirus, HIV and monkeypox reported at the same time

(ORDO NEWS) — A 36-year-old Italian man was diagnosed with all three viruses at once after a five-day trip to Spain.

Doctors from the University of Catania, the P. Giaccone University Hospital in Palermo and the Rodolico San Marco Polyclinic reported the first known case in which a patient was simultaneously diagnosed with a coronavirus disease, monkeypox and HIV infection.

The patient is a 36-year-old Italian man with bipolar disorder. Nine days after a brief trip to Spain where he had unprotected sex with men, he developed a range of symptoms of Covid-19, including fatigue, a fever of 39 degrees, fever, and a sore throat.

The diagnosis was made on July 2 (in 2021, the patient was vaccinated against coronavirus with two doses of the vaccine from Pfizer and BioNTech, and in January 2022 he recovered).

Soon, small painful vesicles formed on the trunk, lower extremities, face, buttocks, surrounded by a rash that was also present in the perianal region.

After a few more days, there were more skin lesions, the vesicles turned into pustules – small tubercles on the skin with purulent contents.

Only then did the man turn to one of the medical facilities in the city of Palermo, where he was tested for monkeypox. The result was positive.

Then the patient decided to examine for sexually transmitted infections (STIs). Test results for viral hepatitis, herpes simplex, gonorrhea, chlamydia, and lymphogranuloma venereum were negative, in contrast to the test for HIV infection.

Since the viral load was equal to 234 thousand copies per milliliter of blood, scientists assumed that the infection occurred relatively recently (the man was tested for HIV in September 2021, then he was healthy).

“On the fifth day, by July 9, almost all constitutional symptoms have passed (reflect the activity of the pathological process.).

On the sixth day, nasopharyngeal swabs for SARS-CoV-2 and monkeypox virus were still positive despite no new skin lesions.

Since the symptoms disappeared, the patient was discharged and sent to self-isolation at home. On July 19th he returned for a new oropharyngeal swab for monkeypox virus, still positive.

The crusts have healed almost completely, leaving a small scar. For the treatment of HIV, a combination of dolutegravir, abacavir and lamivudine was prescribed, ”the authors of the report said.

According to scientists, the described case shows that in case of co-infection, a complete anamnesis, taking into account the patient’s sexual life, is crucial for making the correct diagnosis.

If monkeypox is suspected, doctors recommended taking a smear from the oropharynx, even if there are no obvious signs on the skin, because the mucous membrane of the mouth and rectum may already be affected. Then you need to conduct a full screening for STIs.

More research is needed to understand the consequences of triple infection. The main trump card in the treatment of such patients is timely diagnosis, the scientists concluded.


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