Sept. 14, 2022 -- The monkeypox virus can lead to neurologic complications such as brain inflammation, according to a new report published by the CDC’s Monkeypox Emergency Response Team.

Public health officials identified two encephalomyelitis cases linked with monkeypox in previously healthy young men in Colorado and Washington, DC. Encephalomyelitis is a brief but widespread attack of inflammation in the brain and spinal cord.

In the two cases, brain inflammation symptoms developed between 5 to 9 days after the start of monkeypox.

The patient in Colorado, who is in his 30s, first had a fever, chills, fatigue, and a rash and tested positive for monkeypox. Nine days later, he developed progressive weakness and numbness in the upper and lower extremities on the left side of his body. He also had urinary retention and periodic occasions with a prolonged erection.

During hospitalization, brain scans showed evidence of encephalomyelitis, and the typical causes of brain inflammation were ruled out. He was given tecovirimat, the monkeypox antiviral treatment known as TPOXX, as well as steroids for inflammation and immunoglobulin infusions for his immune system. Due to concerns about spinal cord inflammation, he also got a plasma exchange, which improved symptoms.

After hospitalization, he was sent to outpatient rehab therapy and used a walking device for about a month. He was also referred to outpatient neurosurgery for ongoing issues with spinal cord inflammation, the CDC said.

The patient in Washington, DC, also in his 30s, first had a fever, muscle pain and a rash and tested positive for monkeypox. Five days later, he had trouble controlling his bowel movements and bladder, and he had progressive weakness in both legs.

During hospitalization, his condition worsened for the first 2 days, and he had an altered mental state with reduced alertness. He was transferred to the intensive care unit, where brain scans showed evidence of encephalomyelitis. He also received tecovirimat, steroids, immunoglobulin infusions, and plasma exchange. He improved a lot due to the plasma exchange, and after five sessions, he was able to speak and follow commands again.

After hospitalization, he was discharged to inpatient rehab and used a walking device. He was given rituximab, a monoclonal antibody medication, for immunosuppressive therapy.

In most cases, monkeypox is painful but not life-threatening, the CDC said. Typical symptoms include a characteristic rash, fever, fatigue, headache, and muscle pain. But some serious complications can occur, particularly if someone has a weakened immune system.

On Monday, public health officials in Los Angeles County confirmed the first U.S. death due to monkeypox. The person was severely immunocompromised.

On Tuesday, Los Angeles County officials reported the country’s first monkeypox case in a health care worker who was exposed on the job, according to The Los Angeles Times.

“We have identified a health care worker with monkeypox who appears to have been exposed to the virus at their worksite,” Rita Singhal, MD, MPH, chief medical officer for the L.A. County Department of Public Health, told city officials during a meeting.

“This is the first case of monkeypox in a health care worker in the United States that has been linked to a worksite exposure,” she said.

Health department officials said they spoke with the CDC on the case, the newspaper reported, but declined to answer additional questions about the health care worker’s condition or how the exposure occurred. Singhal said public health officials will share information about infection prevention with medical professionals, including guidance on personal protective equipment, emphasizing that the risk for health care workers “remains very low.”

Los Angeles County has reported 1,900 monkeypox cases, marking one of the highest counts in the U.S., the newspaper reported. California leads the states with the 4,300 cases, followed by 3,700 in New York, according to the latest CDC data.

Globally, the U.S. has reported the highest number of cases with 22,630, followed by Spain with nearly 7,000 and Brazil with 6,000. More than 59,000 cases have been reported in 102 countries, according to the latest CDC data, including 19 deaths in 10 countries.

Show Sources

CDC: “Two Cases of Monkeypox-Associated Encephalomyelitis — Colorado and the District of Columbia, July-August 2022.”

Los Angeles Times: “Nation’s first MPX case in healthcare worker exposed on the job is reported in L.A. County.”

CDC: “Monkeypox: 2022 U.S. Map & Case Count, updated Sept. 13, 2022.”

CDC: “2022 Monkeypox Outbreak Global Map, updated Sept. 13, 2022.”

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