猴痘

检查

对于疑似感染的患者，应尽快实施检测。[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 对于所有符合病例定义的个体，均应给予检测。[72]World Health Organization. Laboratory testing for the monkeypox virus: interim guidance. May 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-laboratory-2022.1 应基于临床和流行病学因素（与感染可能性评估相关），确定是否检测在患者检测结果出来之前，仍应隔离患者。

地区公共卫生实验室可进行检测。目前尚无市售试剂盒。

使用实时 PCR 或传统 PCR 的核酸扩增检测（nucleic acid amplification testing, NAAT），鉴于其准确性和敏感性，为首选实验室检查。NAAT 可通用于正痘病毒 检测，亦可特定用于猴痘病毒检测（倾向于后者）。测序对于确定病毒进化枝和理解其流行病学十分具有帮助。[72]World Health Organization. Laboratory testing for the monkeypox virus: interim guidance. May 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-laboratory-2022.1 [73]UK Health Security Agency. Monkeypox: diagnostic testing. July 2022 [internet publication]. https://www.gov.uk/guidance/monkeypox-diagnostic-testing

推荐样本类型为皮损组织，包括皮损渗出物拭子、一个以上皮损的病灶组织，或皮损结痂。[72]World Health Organization. Laboratory testing for the monkeypox virus: interim guidance. May 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-laboratory-2022.1

参考实验室还可能要求采集咽喉拭子、加入乙二胺四乙酸（ethylenediamine tetra-acetic acid, EDTA）的血液或尿液。建议对确诊病例的高危接触者进行口咽拭子采样，这些接触者已出现全身症状，但没有皮疹或病损可供采样。[73]UK Health Security Agency. Monkeypox: diagnostic testing. July 2022 [internet publication]. https://www.gov.uk/guidance/monkeypox-diagnostic-testing

根据地区或国家操作常规，进行样本采集、包装和送检。样本送检之前，将猴痘可能性通知实验室。关于实验室安全处理此类标本，以及将此类病毒学样本进一步转送至参考实验室，已有当地规程可供参考。将用于检测其他感染的样本单独包装。

参考实验室采用 PCR 检测痘病毒 DNA 时，应自动检测样本是否有水痘带状疱疹病毒。混合感染时，水痘带状疱疹病毒 DNA 可能呈阳性。

检查

对所有疑似感染患者都应进行该项检查。

小型研究发现白细胞增多常见，淋巴细胞增多和血小板减少在患病期间见于超过 1/3 的患者。[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

白细胞增多和血小板减少可能是重度疾病或有并发症疾病的一种征象。[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

检查

对所有疑似感染患者都应进行该项检查。

小型研究显示，低血尿素氮在患病期间常见。[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

低血尿素氮可能是重度疾病或有并发症疾病的一种征象。[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

检查

对所有疑似感染患者都应进行该项检查。

小型研究显示，转氨酶升高和低白蛋白血症在患病期间常见。[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 [29]Huhn GD, Bauer AM, Yorita K, et al. Clinical characteristics of human monkeypox, and risk factors for severe disease. Clin Infect Dis. 2005 Dec 15;41(12):1742-51. https://academic.oup.com/cid/article/41/12/1742/344953 http://www.ncbi.nlm.nih.gov/pubmed/16288398?tool=bestpractice.com

转氨酶升高和低白蛋白血症可能是重度疾病或有并发症疾病的一种征象。[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

检查

世界卫生组织（World Health Organization , WHO）目前不建议将血清学检测用于诊断。如果检测样本产生不确定性结果，则血清学检测（至少间隔 21 天，收集成对血清样本，第一次采血在患病第一周进行）能帮助诊断。近期免疫接种可能对血清学检测产生干扰。[72]World Health Organization. Laboratory testing for the monkeypox virus: interim guidance. May 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-laboratory-2022.1 不过，WHO 和疾病预防控制中心在其病例定义中，将血清学检测作为一种选择。[42]World Health Organization. Surveillance, case investigation and contact tracing for monkeypox. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Surveillance-2022.2 [66]Centers for Disease Control and Prevention. Case definitions for use in the 2022 monkeypox response. June 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/case-definition.html 参阅诊断标准章节。

检查

如果怀疑皮肤病灶存在细菌超级感染，或怀疑体弱患者存在细菌感染，则应在患者处于隔离状态时，且在给予抗生素治疗前，进行检查。

检查

对于所有疑似感染患者，如果具有疟疾流行地区近期旅行史，则应进行该检查。

对于任何到过疟疾流行地区的发热患者，尤其是在发热之前 3 周内去过疟疾流行地区的患者，始终应排除疟疾混合感染的可能性。

抗原检测给实验室工作人员带来的感染隐患小于制备厚血膜涂片和薄血膜涂片带来的隐患。必须首先将猴痘风险告知实验室，按照当地政策组织标本的安全运输。