2017–2019 Nigeria outbreak
According to the Nigeria Centre for Disease Control (NCDC), between 1971 and 1978, only 10 human monkeypox infections were reported in the country.In September 2017, human monkeypox re-emerged in Nigeria, 39 years since it had been last reported. The subsequent 2017–18 Nigerian human monkeypox outbreak was, at that time, the largest ever outbreak of clade II of the virus, with 118 confirmed cases. Unlike previous outbreaks of this clade, infection was predominantly among young male adults and human-to-human transmission appears to have readily occurred. Seven deaths (5 male, 2 female, case fatality rate of 6%) were reported, including a baby and four HIV/AIDS patients. Additionally, a pregnant woman in her second trimester had a spontaneous miscarriage due to monkeypox infection.The Niger Delta University Teaching Hospital reported that a substantial number of its young adult cases had concomitant genital ulcers, syphilis and HIV infection. Monkeypox spread around southeast and south Nigeria with some states and the federal government of Nigeria seeking ways to contain it. By December 2017 it spread to Akwa Ibom, Abia, Bayelsa, Benue, Cross River, Delta, Edo, Ekiti, Enugu, Imo, Lagos, Nasarawa, Oyo, Plateau, Rivers and Federal Capital Territory. The outbreak started in September 2017 and remained ongoing across multiple states as of May 2019. The Centers for Disease Control and Prevention reported cases of American travelers contracting Monkeypox upon return from Lagos and Ibadan.
Some dogs have a coat variation based upon a similar mechanism.The classification of the disease has much to do with the appearance and location of the lesions (phenotype characteristics). As this is a rare condition, it is possible that more than one genotype could cause a similar phenotype. Different genes have been implicated, but the number of patients studied in each case is very low. There is some evidence that interleukins 1 and 6, tumor necrosis factor α, and intercellular adhesion molecule-1 are upregulated in ILVEN, similar to psoriasis. Histopathology
-The plaques are characterized histologically by hyperkeratosis which is a thickening of the outer layer of skin. Hyperkeratosis is often associated with an abnormal amount of keratin production. Also characteristic is moderate acanthosis a thickening of the stratum spinosum with elongation of rete ridges.- Characteristic histologic feature is regular alternation of slightly raised parakeratotic areas without a granular layer (hypogranulosis) and slightly depressed orthokeratotic areas with prominent granular layer (hypergranulosis). Orthokeratotic hyperkeratosis is characterised by hyperkeratosis with non-nucleated cells. Parakeratotic hyperkeratosis is characterised by hyperkeratosis with nucleated cells. - The orthokeratotic area shows a basket-weave-pattern. - The dermis shows scattering of chronic inflammatory infiltrate (Munros microabscess) sometimes giving a spongiform appearance. This is very similar to linear psoriasis, but it has been noted that the diseases are distinct entities by immunohistochemical analyses. Immunohistochemistry
Patients with ILVEN with and without associated psoriasis, the number of Ki-67 positive nuclei, tended to be lower than is typically found in psoriasis.