猴痘（mpox）

据报道，继发性皮肤细菌感染见于 19% 的未接种疫苗患者。[150]McCollum AM, Damon IK. Human monkeypox. Clin Infect Dis. 2014 Jan;58(2):260-7. https://academic.oup.com/cid/article/58/2/260/335791 http://www.ncbi.nlm.nih.gov/pubmed/24158414?tool=bestpractice.com 也有关于继发性真菌感染的报道。[101]Centers for Disease Control and Prevention. Health alert network (HAN) health advisory: severe manifestations of monkeypox among people who are immunocompromised due to HIV or other conditions. September 2022 [internet publication]. https://emergency.cdc.gov/han/2022/han00475.asp 水疱皮疹导致皮肤屏障的完整性被破坏，从而容易发生细菌性皮肤感染，特别是在抓伤或有其他创伤时。可发生坏死性软组织感染和脓性肌炎。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1 亦有软组织脓肿和蜂窝织炎见诸报道。[141]Patel A, Bilinska J, Tam JCH, et al. Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series. BMJ. 2022 Jul 28;378:e072410. https://www.bmj.com/content/378/bmj-2022-072410 http://www.ncbi.nlm.nih.gov/pubmed/35902115?tool=bestpractice.com [206]Adler H, Gould S, Hine P, et al. Clinical features and management of human monkeypox: a retrospective observational study in the UK. Lancet Infect Dis. 2022 Aug;22(8):1153-62. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00228-6/fulltext http://www.ncbi.nlm.nih.gov/pubmed/35623380?tool=bestpractice.com [230]Mailhe M, Beaumont AL, Thy M, et al. Clinical characteristics of ambulatory and hospitalised patients with monkeypox virus infection: an observational cohort study. Clin Microbiol Infect. 2022 Aug 23 [Epub ahead of print]. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(22)00428-1/fulltext http://www.ncbi.nlm.nih.gov/pubmed/36028090?tool=bestpractice.com 手部病损感染可导致甲沟炎和淋巴管炎。[230]Mailhe M, Beaumont AL, Thy M, et al. Clinical characteristics of ambulatory and hospitalised patients with monkeypox virus infection: an observational cohort study. Clin Microbiol Infect. 2022 Aug 23 [Epub ahead of print]. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(22)00428-1/fulltext http://www.ncbi.nlm.nih.gov/pubmed/36028090?tool=bestpractice.com [231]Frade JV, Sousa I, Marques T, et al. Acute paronychia: an atypical presentation of monkeypox infection. Enferm Infecc Microbiol Clin. 2022 Oct 28 [Epub ahead of print]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9614016 http://www.ncbi.nlm.nih.gov/pubmed/36320449?tool=bestpractice.com

应给予抗生素治疗。对于坏死性软组织感染、蜂窝织炎、甲沟炎和化脓性肌炎，可能需要手术治疗。当前疫情暴发中的部分病例需要进行广泛的手术清创或截肢。[101]Centers for Disease Control and Prevention. Health alert network (HAN) health advisory: severe manifestations of monkeypox among people who are immunocompromised due to HIV or other conditions. September 2022 [internet publication]. https://emergency.cdc.gov/han/2022/han00475.asp

继发于感染的永久性凹陷性瘢痕和褪色是一种常见长期后遗症。[7]Beer EM, Rao VB. A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy. PLoS Negl Trop Dis. 2019 Oct;13(10):e0007791. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6816577 http://www.ncbi.nlm.nih.gov/pubmed/31618206?tool=bestpractice.com [150]McCollum AM, Damon IK. Human monkeypox. Clin Infect Dis. 2014 Jan;58(2):260-7. https://academic.oup.com/cid/article/58/2/260/335791 http://www.ncbi.nlm.nih.gov/pubmed/24158414?tool=bestpractice.com

有严重皮疹负荷的患者可能发生表皮脱落，类似于严重病例中的部分厚度（2 度）烧伤。最大限度减少不显性液体丢失以及促进皮肤愈合。确保充足水化和营养摄入。可能需进行清创术。罕见情况下，可能需要皮肤移植。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1

可见于高达 86% 有淋巴结肿大的病例。当与多处口咽病损同时出现时，患者可能有发生咽后脓肿或呼吸功能损害的风险。可能需皮质类固醇治疗。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1

咽后壁脓肿

脓毒症的识别应使用既定标准迅速完成。患者治疗遵循与细菌性脓毒症相同的原则，应包括：广谱经验性抗生素治疗，理想的给药时机是在确诊后 1 小时内；快速静脉输液复苏，并评估患者反应；血管活性药物治疗；以及合理的气道管理和给氧。[229]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com

成人脓毒症

常见于重症，因为细胞内液往往通过发热、皮疹和毛细血管渗漏而丢失。伴发的全身炎症反应综合征亦可导致低血压。这些因素的共同作用导致肾脏血流量减少，从而促使急性肾损伤出现。通过尿量监测和血液生化指标进行早期识别可提示是否需给予静脉输液。

急性肾损伤

患者存在罹患细菌性肺炎的风险。[7]Beer EM, Rao VB. A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy. PLoS Negl Trop Dis. 2019 Oct;13(10):e0007791. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6816577 http://www.ncbi.nlm.nih.gov/pubmed/31618206?tool=bestpractice.com 应给予广谱抗生素治疗。重症肺炎会引起需要氧疗的缺氧，可能还要在重症监护病房内接受机械通气。

已有肺部受累伴结节性病变的报道。[101]Centers for Disease Control and Prevention. Health alert network (HAN) health advisory: severe manifestations of monkeypox among people who are immunocompromised due to HIV or other conditions. September 2022 [internet publication]. https://emergency.cdc.gov/han/2022/han00475.asp

肺炎概述

合并细菌性脓毒症以及可能的病毒性心肌炎可能加剧低血压。当低血压对充分补液无反应时，将需要使用正性肌力药物进行治疗。如果怀疑合并细菌性脓毒症，广谱抗生素应进行静脉给药。

低血压评估

心肌炎和心包炎病例已在当前的持续疫情暴发中见诸报道。病例呈自限性，需给予支持性治疗。[40]Thornhill JP, Barkati S, Walmsley S, et al. Monkeypox virus infection in humans across 16 countries: April–June 2022. N Engl J Med. 2022 Aug 25;387(8):679-91. https://www.nejm.org/doi/full/10.1056/NEJMoa2207323 http://www.ncbi.nlm.nih.gov/pubmed/35866746?tool=bestpractice.com [142]World Health Organization. Update 79: Monkeypox outbreak update: situation - transmission - countermeasures. August 2022 [internet publication]. https://www.who.int/publications/m/item/update-79-monkeypox-outbreak-update [232]Tan DHS, Jaeranny S, Li M, et al. Atypical clinical presentation of monkeypox complicated by myopericarditis. Open Forum Infect Dis. 2022 Aug;9(8):ofac394. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9416060 http://www.ncbi.nlm.nih.gov/pubmed/36043183?tool=bestpractice.com [233]Pinho AI, Braga M, Vasconcelos M, et al. Acute myocarditis: a new manifestation of monkeypox infection? JACC Case Rep. 2022 Sep 2 [Epub ahead of print]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9528887 http://www.ncbi.nlm.nih.gov/pubmed/36249878?tool=bestpractice.com [234]Rodriguez-Nava G, Kadlecik P, Filardo TD, et al. Myocarditis attributable to monkeypox virus infection in 2 patients, United States, 2022. Emerg Infect Dis. 2022 Sep 30;28(12). https://wwwnc.cdc.gov/eid/article/28/12/22-1276_article http://www.ncbi.nlm.nih.gov/pubmed/36179413?tool=bestpractice.com

已有 ACAM2000® 天花疫苗接种后发生心肌炎的记录，该疫苗在一些国家可能用于接触者的暴露后疫苗接种。在第三代天花疫苗接种后发生心肌炎的风险目前未知。心肌炎和心包炎也与 COVID-19 疫苗有关，并且近期的 COVID-19 疫苗接种也可能有关。

在当前疫情暴发中，还报道了一例伴心包积液的心包炎病例。[235]Shaik TA, Voloshyna D, Nasr TH, et al. Monkeypox-associated pericarditis: a maiden case. Cureus. 2022 Sep 26 [Epub ahead of print]. https://www.cureus.com/articles/115923-monkeypox-associated-pericarditis-a-maiden-case

心肌炎

眼部感染可导致角膜溃疡/瘢痕和永久性视力丧失。[150]McCollum AM, Damon IK. Human monkeypox. Clin Infect Dis. 2014 Jan;58(2):260-7. https://academic.oup.com/cid/article/58/2/260/335791 http://www.ncbi.nlm.nih.gov/pubmed/24158414?tool=bestpractice.com [236]Mazzotta V, Mondi A, Carletti F, et al. Ocular involvement in monkeypox: description of an unusual presentation during the current outbreak. J Infect. 2022 Aug 18;85(5):573-607. https://www.journalofinfection.com/article/S0163-4453(22)00474-1/fulltext http://www.ncbi.nlm.nih.gov/pubmed/35987391?tool=bestpractice.com [237]Cash-Goldwasser S, Labuda SM, McCormick DW, et al. Ocular monkeypox: United States, July - September 2022. MMWR Morb Mortal Wkly Rep. 2022 Oct 21;71(42):1343-7. https://www.cdc.gov/mmwr/volumes/71/wr/mm7142e1.htm http://www.ncbi.nlm.nih.gov/pubmed/36264836?tool=bestpractice.com 眼部并发症可由自体接种导致。在当前正在发生的疫情暴发中，大约不到 1% 的患者存在眼部受累。[238]Centers for Disease Control and Prevention. Interim clinical considerations for management of ocular monkeypox virus infection. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/ocular-infection.html

患者可表现为结膜炎、睑缘炎、角膜炎、结膜下结节或眶周蜂窝织炎。[230]Mailhe M, Beaumont AL, Thy M, et al. Clinical characteristics of ambulatory and hospitalised patients with monkeypox virus infection: an observational cohort study. Clin Microbiol Infect. 2022 Aug 23 [Epub ahead of print]. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(22)00428-1/fulltext http://www.ncbi.nlm.nih.gov/pubmed/36028090?tool=bestpractice.com [239]Benatti SV, Venturelli S, Comi N, et al. Ophthalmic manifestation of monkeypox infection. Lancet Infect Dis. 2022 Sep;22(9):1397. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00504-7/fulltext http://www.ncbi.nlm.nih.gov/pubmed/35914539?tool=bestpractice.com [240]Meduri E, Malclès A, Kecik M. Conjunctivitis with monkeypox virus positive conjunctival swabs. Ophthalmology. 2022 Oct;129(10):1095. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9534064 http://www.ncbi.nlm.nih.gov/pubmed/35973854?tool=bestpractice.com [241]Scandale P, Raccagni AR, Nozza S. Unilateral blepharoconjunctivitis due to monkeypox virus infection. Ophthalmology. 2022 Nov;129(11):1274. https://www.aaojournal.org/article/S0161-6420(22)00632-7/fulltext http://www.ncbi.nlm.nih.gov/pubmed/36041955?tool=bestpractice.com [242]Ly-Yang F, Miranda-Sánchez A, Burgos-Blasco B, et al. Conjunctivitis in an individual with monkeypox. JAMA Ophthalmol. 2022 Oct 1;140(10):1022-4. https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2796171 http://www.ncbi.nlm.nih.gov/pubmed/36069834?tool=bestpractice.com [243]Foos W, Wroblewski K, Ittoop S. Subconjunctival nodule in a patient with acute monkeypox. JAMA Ophthalmol. 2022 Sep 7:e223742. https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2796172 http://www.ncbi.nlm.nih.gov/pubmed/36069930?tool=bestpractice.com [244]Milligan AL, Koay SY, Dunning J. Monkeypox as an emerging infectious disease: the ophthalmic implications. Br J Ophthalmol. 2022 Oct 10 [Epub ahead of print]. http://www.ncbi.nlm.nih.gov/pubmed/36216412?tool=bestpractice.com

建议所有眼部受累的患者进行眼科咨询。裂隙灯检查和散瞳眼底检查可能有助于确定是前段还是后段结构受累。[238]Centers for Disease Control and Prevention. Interim clinical considerations for management of ocular monkeypox virus infection. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/ocular-infection.html

推荐使用维生素 A 补剂。眼部润滑剂和盐水浸泡的眼垫可能有帮助。对于合并感染，可能需使用眼用抗生素/抗病毒药物。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1

建议使用外用的抗病毒药物。外用抗病毒药物曲氟尿苷（三氟胸苷）已被用于治疗眼部牛痘，并且可被用于加速症状的缓解和预防瘢痕形成引起的长期损害。[245]Hu G, Wang MJ, Miller MJ, et al. Ocular vaccinia following exposure to a smallpox vaccinee. Am J Ophthalmol. 2004 Mar;137(3):554-6. http://www.ncbi.nlm.nih.gov/pubmed/15013881?tool=bestpractice.com 建议在咨询眼科医生的情况下使用曲氟尿苷治疗猴痘角膜炎。对于某些出现近眼部病变的患者，也可以预防性地使用以防止自体接种；但是，必须考虑到长期使用会有角膜上皮毒性的风险。应避免使用外用皮质类固醇，因其可能导致角膜损伤或病毒持续存在。[238]Centers for Disease Control and Prevention. Interim clinical considerations for management of ocular monkeypox virus infection. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/ocular-infection.html

应考虑将 tecovirimat 用于所有重症（包括有眼部症状）患者。请参阅“治疗流程”。

在咨询传染病专家的情况下，可根据具体情况考虑使用牛痘免疫球蛋白。然而，建议谨慎用于活动性角膜炎患者，因为在一项动物模型研究中观察到角膜瘢痕形成增加。[238]Centers for Disease Control and Prevention. Interim clinical considerations for management of ocular monkeypox virus infection. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/ocular-infection.html 请参阅“新兴治疗”。

角膜炎

既往并不认为扁桃体并发症是猴痘的典型特征。然而，在当前正在发生的暴发中，它们很少被报告（例如，扁桃体炎、扁桃体周围蜂窝织炎、扁桃体/扁桃体周围脓肿、坏死性扁桃体炎），可能是被动口交的结果。[40]Thornhill JP, Barkati S, Walmsley S, et al. Monkeypox virus infection in humans across 16 countries: April–June 2022. N Engl J Med. 2022 Aug 25;387(8):679-91. https://www.nejm.org/doi/full/10.1056/NEJMoa2207323 http://www.ncbi.nlm.nih.gov/pubmed/35866746?tool=bestpractice.com [141]Patel A, Bilinska J, Tam JCH, et al. Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series. BMJ. 2022 Jul 28;378:e072410. https://www.bmj.com/content/378/bmj-2022-072410 http://www.ncbi.nlm.nih.gov/pubmed/35902115?tool=bestpractice.com [146]Tarín-Vicente EJ, Alemany A, Agud-Dios M, et al. Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study. Lancet. 2022 Aug 27;400(10353):661-9. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01436-2/fulltext http://www.ncbi.nlm.nih.gov/pubmed/35952705?tool=bestpractice.com [246]Davido B, D'Anglejan E, Baudoin R, et al. Monkeypox outbreak 2022: an unusual case of peritonsillar abscess in a person previously vaccinated against smallpox. J Travel Med. 2022 Sep 17;29(6):taac082. http://www.ncbi.nlm.nih.gov/pubmed/35876271?tool=bestpractice.com [247]Mathieson T, Dulguerov N, Mermod M. Monkeypox mucosal lesions. IDCases. 2022 Aug 17;29:e01600. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9403496 http://www.ncbi.nlm.nih.gov/pubmed/36032178?tool=bestpractice.com [248]Meng X. Clinical manifestations of the pharynx in human monkeypox. Travel Med Infect Dis. 2022 Sep 26;50:102465. https://www.sciencedirect.com/science/article/pii/S1477893922002113 http://www.ncbi.nlm.nih.gov/pubmed/36174912?tool=bestpractice.com 根据临床表现，可能需要给予气道管理、抗生素治疗和手术治疗。

[Figure caption and citation for the preceding image starts]: 右侧扁桃体肿大，可见脓疱性病变和黄绿色渗出物，悬雍垂轻微偏斜BMJ. 2022 Jul 28;378:e072410; CC-BY-NC 4.0 licence [Citation ends].

扁桃体炎

当前持续暴发的疫情中，偶见会厌炎报道。[40]Thornhill JP, Barkati S, Walmsley S, et al. Monkeypox virus infection in humans across 16 countries: April–June 2022. N Engl J Med. 2022 Aug 25;387(8):679-91. https://www.nejm.org/doi/full/10.1056/NEJMoa2207323 http://www.ncbi.nlm.nih.gov/pubmed/35866746?tool=bestpractice.com  可能需要给予紧急处理（特别是气道管理）。

会厌炎

当前持续暴发的疫情中，由于病损可导致重度阴茎水肿，因此偶见包皮嵌顿/包茎报道。[141]Patel A, Bilinska J, Tam JCH, et al. Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series. BMJ. 2022 Jul 28;378:e072410. https://www.bmj.com/content/378/bmj-2022-072410 http://www.ncbi.nlm.nih.gov/pubmed/35902115?tool=bestpractice.com [146]Tarín-Vicente EJ, Alemany A, Agud-Dios M, et al. Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study. Lancet. 2022 Aug 27;400(10353):661-9. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01436-2/fulltext http://www.ncbi.nlm.nih.gov/pubmed/35952705?tool=bestpractice.com [161]Gomez-Garberi M, Sarrio-Sanz P, Martinez-Cayuelas L, et al. Genitourinary lesions due to monkeypox. Eur Urol. 2022 Sep 9 [Epub ahead of print]. https://www.sciencedirect.com/science/article/pii/S0302283822026252 http://www.ncbi.nlm.nih.gov/pubmed/36096858?tool=bestpractice.com 包皮嵌顿是医学急症，如果具备缺血或坏死证据，则可能需要给予手术治疗。

[Figure caption and citation for the preceding image starts]: 阴茎病损和阴茎水肿的病情进展BMJ. 2022 Jul 28;378:e072410; CC-BY-NC 4.0 licence [Citation ends].

嵌顿包茎

当前持续暴发的疫情中，偶见肛周/腹股沟脓肿和直肠穿孔报道。[141]Patel A, Bilinska J, Tam JCH, et al. Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series. BMJ. 2022 Jul 28;378:e072410. https://www.bmj.com/content/378/bmj-2022-072410 http://www.ncbi.nlm.nih.gov/pubmed/35902115?tool=bestpractice.com [146]Tarín-Vicente EJ, Alemany A, Agud-Dios M, et al. Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study. Lancet. 2022 Aug 27;400(10353):661-9. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01436-2/fulltext http://www.ncbi.nlm.nih.gov/pubmed/35952705?tool=bestpractice.com 肠道病变可能呈渗出性，并且引起严重的组织水肿，从而导致梗阻。病变可导致肠道狭窄和形成瘢痕。[101]Centers for Disease Control and Prevention. Health alert network (HAN) health advisory: severe manifestations of monkeypox among people who are immunocompromised due to HIV or other conditions. September 2022 [internet publication]. https://emergency.cdc.gov/han/2022/han00475.asp 可能需要给予抗生素治疗和手术治疗。已报道一例结肠造口术解除并发肛门脓肿的病例。[249]Kapmaz M, Uymaz DS, Özcan G, et al. A complicated case of monkeypox and viral shedding characteristics. J Infect. 2022 Oct 20 [Epub ahead of print]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9584764 http://www.ncbi.nlm.nih.gov/pubmed/36273642?tool=bestpractice.com

当前持续暴发的疫情中，偶见尿潴留（例如由于重度阴茎水肿或尿道炎所致）报道。[141]Patel A, Bilinska J, Tam JCH, et al. Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series. BMJ. 2022 Jul 28;378:e072410. https://www.bmj.com/content/378/bmj-2022-072410 http://www.ncbi.nlm.nih.gov/pubmed/35902115?tool=bestpractice.com [161]Gomez-Garberi M, Sarrio-Sanz P, Martinez-Cayuelas L, et al. Genitourinary lesions due to monkeypox. Eur Urol. 2022 Sep 9 [Epub ahead of print]. https://www.sciencedirect.com/science/article/pii/S0302283822026252 http://www.ncbi.nlm.nih.gov/pubmed/36096858?tool=bestpractice.com 可能需要给予导尿。病变可导致尿道狭窄和形成瘢痕。[101]Centers for Disease Control and Prevention. Health alert network (HAN) health advisory: severe manifestations of monkeypox among people who are immunocompromised due to HIV or other conditions. September 2022 [internet publication]. https://emergency.cdc.gov/han/2022/han00475.asp

梗阻性尿路病

重度疾病患者有发生脑炎、横贯性脊髓炎和癫痫发作的风险。[7]Beer EM, Rao VB. A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy. PLoS Negl Trop Dis. 2019 Oct;13(10):e0007791. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6816577 http://www.ncbi.nlm.nih.gov/pubmed/31618206?tool=bestpractice.com [101]Centers for Disease Control and Prevention. Health alert network (HAN) health advisory: severe manifestations of monkeypox among people who are immunocompromised due to HIV or other conditions. September 2022 [internet publication]. https://emergency.cdc.gov/han/2022/han00475.asp [251]Badenoch JB, Conti I, Rengasamy ER, et al. Neurological and psychiatric presentations associated with human monkeypox virus infection: a systematic review and meta-analysis. EClinicalMedicine. 2022 Oct;52:101644. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9533950 http://www.ncbi.nlm.nih.gov/pubmed/36246957?tool=bestpractice.com [252]Billioux BJ, Mbaya OT, Sejvar J, et al. Neurologic complications of smallpox and monkeypox: a review. JAMA Neurol. 2022 Sep 20 [Epub ahead of print]. https://jamanetwork.com/journals/jamaneurology/fullarticle/2796513 http://www.ncbi.nlm.nih.gov/pubmed/36125794?tool=bestpractice.com 目前正在发生的暴发很少报告神经系统并发症。[252]Billioux BJ, Mbaya OT, Sejvar J, et al. Neurologic complications of smallpox and monkeypox: a review. JAMA Neurol. 2022 Sep 20 [Epub ahead of print]. https://jamanetwork.com/journals/jamaneurology/fullarticle/2796513 http://www.ncbi.nlm.nih.gov/pubmed/36125794?tool=bestpractice.com 但已有脑脊髓炎的报道。并发症分别在发病后 5 天和 9 天内出现。[253]Pastula DM, Copeland MJ, Hannan MC, et al. Two cases of monkeypox-associated encephalomyelitis: Colorado and the District of Columbia, July - August 2022. MMWR Morb Mortal Wkly Rep. 2022 Sep 23;71(38):1212-5. https://www.cdc.gov/mmwr/volumes/71/wr/mm7138e1.htm http://www.ncbi.nlm.nih.gov/pubmed/36136957?tool=bestpractice.com 目前尚不清楚这是否是病毒直接侵入中枢神经系统的结果，或是全身感染引发的一种副感染性自身免疫过程。治疗主要为支持性治疗。抗病毒药物可能有作用，但没有支持性证据。对于同时感染，可能需使用抗生素/抗病毒药物。如果需要，应给予抗惊厥药物。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1

脑炎

在当前正在发生的疫情暴发中报告了一例 HIV 阳性男子发生急性关节炎。[250]Fonti M, Mader T, Burmester-Kiang J, et al. Monkeypox associated acute arthritis. Lancet Rheumatol. 2022 Sep 12 [Epub ahead of print]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9533963 http://www.ncbi.nlm.nih.gov/pubmed/36247685?tool=bestpractice.com 在先前的文献中从未报告过猴痘相关的关节炎或骨髓炎病例。

传统牛痘接种可能会在湿疹存在的情况下引起全身性水疱疹，被称为牛痘性湿疹。具有疫苗接种史，或暴露于伴湿疹而接种疫苗者，对于诊断十分关键。水疱液聚合酶链反应检测提示牛痘 DNA 呈阳性，但猴痘 DNA 则呈阴性。牛痘性湿疹应与全身性牛痘进行鉴别（参阅下文）。tecovirimat 在欧洲获批用于疫苗接种后并发症的治疗。其他抗病毒药物亦可推荐使用。牛痘免疫球蛋白在美国获得许可，用于治疗因牛痘疫苗接种而引发的并发症。

[Figure caption and citation for the preceding image starts]: 天花疫苗接种者躯干上的牛痘性湿疹皮损CDC/Moses Grossman，MD/加利福尼亚应急办公室 (California Emergency Preparedness Office, Calif/EPO) [Citation ends].

全身性（播散性）牛痘是一种自限性疾病，是在无固有皮肤病的情况下发生的疫苗病毒血症。tecovirimat 在欧洲获批用于疫苗接种后并发症的治疗。其他抗病毒药物亦可推荐使用。牛痘免疫球蛋白在美国获得许可，用于治疗因牛痘疫苗接种而引发的并发症。

渐进性痘疹起病部位局限，但在接种部位呈持续进行性扩散，可能具有潜在的致死性。它出现于呈现显著免疫抑制者（例如先天性免疫缺陷、细胞毒性药物化疗，或晚期 HIV 疾病）。渐进性痘疹较为罕见，但若不给予治疗，可危及生命。tecovirimat 在欧洲获批用于疫苗接种后并发症的治疗。其他抗病毒药物亦可推荐使用。牛痘免疫球蛋白在美国获得许可，用于治疗因牛痘疫苗接种而引发的并发症。