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- Detection of mpox using polymerase chain reaction from the skin and oropharynx over the course of infection: A prospective studyPublication . Correia, Catarina; Alpalhão, M,; de Sousa, D,; Vieitez-Frade, J.; Pelerito, Ana; Cordeiro, Rita; Lopes de Carvalho, Isabel; Núncio, MS; Ferreira, J,; Filipe, P.To the Editor: Since early May 2022, 86,746 mpox virus (MPV) infections have been reported worldwide.1,2 However, its in vivo viral kinetics and infectivity remain unclear.3 We conducted a prospective observational study to determine how long MPV remains detectable in skin lesions and the oropharynx. (...)
- Demographic and Clinical Characteristics of Mpox Patients Attending an STD Clinic in LisbonPublication . Cid Brito, Margarida; Nuncio, M.S.; Lopes de Carvalho, Isabel; Cordeiro, Rita; Pelerito, AnaMpox is a viral disease caused by the monkeypox virus, which marked the year of 2022 with a global outbreak. While previously considered to be a zoonosis of almost exclusive animal-to-human transmission, the current outbreak has been attributed to human-to-human transmission, particularly sexual transmission. As a new sexually transmissible disease, we studied the epidemiological and clinical features, as well as the concomitant occurrence of other sexually transmissible diseases, treatment approach, and outcome of our 291 patients, in the current outbreak. We found a total of 169 concomitant sexually transmissible infections of bacterial and viral origins, corresponding to 107 patients. Neisseria gonorrhoeae was the most common agent, particularly in the anal location. With this work, we emphasize the need for a thorough epidemiological and medical history, as well as a concomitant complete laboratorial screening for other STIs in patients with confirmed or suspected mpox.
- Detection of Rickettsia in ticks using loop-mediated isothermal amplification (LAMP)Publication . Lansdell, Samantha; Hassan, Marwa M.; La Ragione, Roberto; Betson, Martha; Nuncio, MS; Lopes de Carvalho, Isabel; Zé-Zé, Líbia; de Sousa, Rita; Cutler, Sally; Davis, Joshua S.Objectives: The objective of the study was to develop a Loop-mediated Isothermal Amplification (LAMP) assay for screening of Rickettsia species circulating in ticks using the citrate synthase gene (gltA). The LAMP assay employed portable visualisation methods, making the assay more field-suitable. Furthermore, prior methods have not used gltA as the target, despite proven success in Polymerase Chain Reaction (PCR) methods. Methods: Using an alignment of 72 DNA sequences (comprised of 21 Rickettsia species) from GenBank we designed a novel set of gltA LAMP primers. Evaluation used DNA from 12 Rickettsia species as positive controls (extracted from cultures or naturally infected ticks) alongside a panel of negative controls representing different bacterial species. Subsequently this assay was used to screen 295 Ixodes ricinus and 24 I. hexagonus ticks collected from the UK (including northern and southern England and northern Scotland). Results: LAMP successfully detected 11 out of 12 (91.7%) Rickettsia species, excluding Rickettsia akari. Among 319 ticks collected in the UK, three were positive for Rickettsia (0.9%). All three positives were I. ricinus ticks, while none of the 24 I. hexagonus ticks were positive. Results were confirmed using a published PCR method. Sanger sequencing of PCR amplicons generated for each positive tick showed that they were all R. helvetica. Conclusions: This study introduces a novel field-applicable LAMP protocol for efficient Rickettsia screening in ticks to better assess its prevalence and consequent health risks. Furthermore, this assay has proven suitability for rickettsial detection in I. ricinus ticks, which has been reported as unsuccessful in previous European studies.
- Mpox Surveillance and Laboratory Response in Portugal: Lessons Learned from Three Outbreak Waves (2022-2025)Publication . Cordeiro, Rita; Francisco, Rafaela; Pelerito, Ana; Lopes de Carvalho, Isabel; Nuncio, MSBackground/Objectives: Mpox re-emerged in 2022 as a global health concern. Between 2022 and 2025, Portugal experienced three distinct outbreak waves, highlighting the critical role of laboratory surveillance and public health interventions. This study describes the epidemiological trends, diagnostic performance, and key lessons learned to improve outbreak preparedness. Methods: A total of 5610 clinical samples from 2802 suspected cases were analyzed at the National Institute of Health Doutor Ricardo Jorge using real-time PCR methods. Positivity rates and viral loads (Ct values) were assessed across different clinical specimen types, including lesion, anal, oropharyngeal swabs, and urine samples. Results: Mpox was confirmed in 1202 patients. The first outbreak accounted for 79.3% of cases (n = 953), followed by a significant reduction in transmission during subsequent waves. Lesion and rectal swabs provided the highest diagnostic sensitivity (95.1% and 87.9%, respectively). Oropharyngeal swabs contributed to diagnosis in cases without visible lesions, while urine samples showed limited utility. Conclusions: This study underscores the importance of sustained laboratory surveillance and adaptive public health strategies in controlling mpox outbreaks. Optimizing specimen collection enhances diagnostic accuracy, supporting early detection. Continuous monitoring, combined with targeted vaccination and effective risk communication, is essential to prevent resurgence and ensure rapid response in non-endemic regions.
- Undetected circulation of monkeypox virus in Portugal: Evidence for a 50-day gap before first detectionPublication . Cordeiro, Rita; Batista, Fernando da Conceição; Pelerito, Ana; De carvalho, Isabel; Lopo, Sílvia; Neves, Raquel; Rocha, Raquel; Palminha, Paula; Borrego, Maria José; Nuncio, MS; Gomes, João PauloAs mpox continues to spread globally, proactive monitoring and preparedness are crucial to minimize impact and enhance response strategies. Using a mathematical model combining a negative binomial distribution with Richards' logistic curve, we reconstructed the hidden phase of mpox transmission in Portugal, offering insights into the timing and dynamics of the initial outbreak. The analysis of 950 PCR-positive and 986 negative cases suggested that symptom onset occurred between March 24 and April 2, 2022, with March 27 identified as the most probable date. This study delineates the likely period of silent circulation of MPXV in Portugal, providing a clearer understanding of early outbreak dynamics and surveillance performance. Possible imperfections in early diagnostic testing and limited awareness of mpox may have contributed to delayed recognition of the outbreak. By demonstrating how retrospective mathematical modelling can estimate undetected transmission periods, our findings highlight the value of such approaches in epidemic reconstruction and underscore the importance of strengthening early surveillance systems to detect undiagnosed transmission of mpox in non-endemic countries.