Researchers from Brazil describe the clinical features of monkeypox virus (MPXV) infection in a 20-year-old nurse after a needlestick injury she sustained on July 9, 2022. The nurse was collecting disposable materials and was wearing personal protective equipment (PPE) when a needle punctured her glove.

The puncture site was immediately recognizable. Researchers collected blood, skin lesions and oropharyngeal samples from the infected nurse to test for MPXV deoxyribonucleic acid (DNA).

The source patient, a man in his 20s who reported having sex with men, had mild monkeypox that started 2 weeks before the needlestick incident. He had sore throat, cervical lymphadenopathy, and sparse lesions on his face, torso, and groin. The patient and nurse provided written consent for this report.

Overall, the nurse had 7 lesions: 1 each on the thumb (inoculation site) and palm of the right hand, dorsal left hand, and left thigh, and 3 on her face. Magnetic resonance imaging of the injury site on day 15 showed a neurovascular bundle and subcutaneous inflammation.

This case enabled observation of the natural progression of monkeypox through longitudinal clinical and laboratory monitoring of disease stages. The incubation period was 5 days. A cutaneous lesion and pain and inflammation at the inoculation site preceded generalized symptoms of fever and lymphadenopathy. The transmission route might have influenced the absence of a prodromal phase in the nurse because needlestick transmission parallels bite or scratch transmission from MPXV-infected animals to humans; in those cases, a febrile prodrome is uncommon. In addition, the nurse experienced severe injury site pain, which coincides with a series of cases in the current outbreak in which most patients who acquired MPXV by sexual or intimate contact were hospitalized for severe anorectal pain. The pain similarity suggests that the primary MPXV inoculation site is associated with painful lesions and possible neural impairment, as implied by the nurse’s magnetic resonance images.

Early Release – Monkeypox Virus Transmission to Healthcare Worker through Needlestick Injury, Brazil – Volume 28, Number 11—November 2022 – Emerging Infectious Diseases journal – CDC