Ocular complications associated with acute monkeypox virus infection, DRC

      Background: Monkeypox (MPX) is an acute febrile rash illness caused by infection with a zoonotic Orthopoxvirus. The disease is endemic in parts of the Democratic Republic of the Congo (DRC). In 2010, the Centers for Disease Control and Prevention (CDC) partnered with the Congolese Ministry of Health to conduct enhanced surveillance for monkeypox in the Tshuapa Health District. As part of enhanced surveillance, health-workers investigate suspect cases, collecting diagnostic samples and information pertaining to signs and symptoms of illness. Of particular concern are ocular manifestations, which can lead to blindness.
      Methods & Materials: Data collected on MPX positive cases during 2010-2013 were analyzed to gain a better understanding of ocular complications in relation to demographics and symptoms of MPX illness. Cases were considered MPX positive if a single diagnostic specimen tested positive by real-time PCR at either CDC or the national laboratory in Kinshasa.
      Results: “Conjunctivitis” was reported for a total of 68 (23.1%) MPX cases. The majority were male (61.7%) and under 10 years of age (61.8%). 51.8% of the MPX cases that identified as “non-student child” and 17% that identified as “student” had reported “conjunctivitis”. Cases where “conjunctivitis” was reported had a higher frequency of other symptoms, such as nausea, chills/sweating, mouth ulcers, sore throat, lymphadenopathy, fatigue, and sensitivity to light compared to those with no reported “conjunctivitis”. 47% of cases with “conjunctivitis” reported being “bed-ridden”, compared to 16% of cases where “conjunctivitis” was not reported.
      Conclusion: A considerable number of MPX cases (23.1%) had “conjunctivitis” as a symptom of their illness. The majority of these were young children (<10 yrs.) who also had a higher frequency of other symptoms. These individuals were also more likely to be “bed-ridden”. MPX cases with “conjunctivitis” are at risk for corneal scarring, which can cause blindness. Understanding the underlying cause of “conjunctivitis” in monkeypox patients will be important, as some may be amenable to treatment (e.g., Triflourodine has been used to treat Orthopoxvirus-associated corneal lesions). Improving the availability of ophthalmologic resources in areas endemic for monkeypox may diminish risks for significant visual sequelae among patients.