A 36-year-old Italian man is the first documented case of co-infection with the monkeypox virus, SARS-CoV-2 and HIV. According to the researchers who documented the case, these infections can overlap, especially in high-risk individuals.
The report, published in the Journal of Infection, states that the Italian man was in Spain between June 16 and 20, where he had unprotected sex with other men. Nine days later, he developed a fever (up to 39°C, 102ºF), and suffered from a sore throat, fatigue, headaches and swollen glands. On July 2, he tested positive for SARS-CoV-2, the virus that causes Covid-19.
“On the afternoon of the same day, a rash started to develop on his left arm. The following day small, painful vesicles surrounded by an erythematous halo appeared on the torso, lower limbs, face and glutes. On 5 July, due to a progressive and uninterrupted spread of vesicles that began to evolve into umbilicated pustules, he went to the emergency department of the Policlinico “G. Rodolico - San Marco” University Hospital in Catania, Italy, and was subsequently transferred to the Infectious Diseases unit,” the researchers report.
At the hospital in Catania, he tested positive for monkeypox. The man also tested positive for HIV, and based on his CD4 lymphocyte count (which is an indicator of immune response), “we could assume that the infection was relatively recent,” the study states.
“This case highlights how monkeypox and Covid-19 symptoms may overlap, and corroborates how in case of co-infection, anamnestic collection and sexual habits are crucial to perform the correct diagnosis,” the report continues. “Hence, clinicians should be aware of the possibility of SARS-CoV-2 and monkeypox virus co-infection, particularly in subjects with a recent history of travel to monkeypox-outbreak areas. If monkeypox is suspected, an oropharyngeal swab should be performed even in the absence of cutaneous manifestations as the skin may be spared, but the oral or rectal mucosa may be involved.”
The study adds that there is still not enough evidence to conclude that the co-infection of these three viruses can aggravate a patient’s condition.
According to the article, the case “emphasizes that sexual intercourse could be the predominant way of transmission” for the monkeypox virus. The virus, however, can also be transmitted “through close contact with infectious material from skin lesions, fomites, seminal fluids and oropharyngeal secretions.” The monkeypox virus is currently taking the biggest toll on men who have sex with men, with 98% of global cases recorded among this group. Anyone exposed to the virus, however, may be infected.