Molecular detection of potential alternative pathogens among MPXV-negative suspected mpox cases in Sierra Leone, 2025.

@article{harding2026molecular,
  title = {{Molecular detection of potential alternative pathogens among MPXV-negative suspected mpox cases in Sierra Leone, 2025.}},
  author = {Doris Harding and Mignane Ndiaye and Martin Faye and Aboubacry Gaye and Fatou Kiné Top and Mamadou Aliou Barry and Allan K O Campbell and Mouhamed Kane and Fay Chalobah and Alusine Fofanah and Simon Ruhweza and Andy Mahine Diouf and Komba Koninga and Moussa Moise Diagne and Mamadou Cissé and Aminata Koroma and Oumar Faye and Ndongo Dia and Cheikh Loucoubar and Diom Yero Sow and James Squire and Mohamed Boie Jalloh and Mamadou Diarrassouba and Boubacar Diallo and Mohamed Alex Vandi and Abdourahmane Sow and Issiaka Sombié and Foday Sahr and Isata Wurie and Amadou Alpha Sall and Donald S Grant and Ibrahima Socé Fall and Johnny A Norman},
  journal = {New microbes and new infections},
  year = {2026},
  month = oct,
  doi = {10.1016/j.nmni.2026.101872},
  url = {https://europepmc.org/article/MED/42997038},
  note = {CC BY-NC-ND},
}

TY  - JOUR
TI  - Molecular detection of potential alternative pathogens among MPXV-negative suspected mpox cases in Sierra Leone, 2025.
AU  - Doris Harding
AU  - Mignane Ndiaye
AU  - Martin Faye
AU  - Aboubacry Gaye
AU  - Fatou Kiné Top
AU  - Mamadou Aliou Barry
AU  - Allan K O Campbell
AU  - Mouhamed Kane
AU  - Fay Chalobah
AU  - Alusine Fofanah
AU  - Simon Ruhweza
AU  - Andy Mahine Diouf
AU  - Komba Koninga
AU  - Moussa Moise Diagne
AU  - Mamadou Cissé
AU  - Aminata Koroma
AU  - Oumar Faye
AU  - Ndongo Dia
AU  - Cheikh Loucoubar
AU  - Diom Yero Sow
AU  - James Squire
AU  - Mohamed Boie Jalloh
AU  - Mamadou Diarrassouba
AU  - Boubacar Diallo
AU  - Mohamed Alex Vandi
AU  - Abdourahmane Sow
AU  - Issiaka Sombié
AU  - Foday Sahr
AU  - Isata Wurie
AU  - Amadou Alpha Sall
AU  - Donald S Grant
AU  - Ibrahima Socé Fall
AU  - Johnny A Norman
PY  - 2026
DA  - 2026/10/21
JO  - New microbes and new infections
DO  - 10.1016/j.nmni.2026.101872
UR  - https://europepmc.org/article/MED/42997038
AB  - Infectious disease outbreaks often rely on syndromic case definitions, which frequently result in "dead-end" diagnostic cases where patients meet clinical criteria but test negative for the target etiology. The 2025 Mpox epidemic in Sierra Leone highlighted a critical gap in regional surveillance: the need to identify alternative etiologies presenting with Mpox-like cutaneous manifestations. These Mpox clinical mimics can circulate simultaneously and pose significant diagnostic challenges that may hinder the effectiveness of clinical and public health interventions. Characterizing these co-circulating pathogens during an active epidemic can improve understanding of the pathogens associated with similar clinical presentations in the region and inform diagnostic strategies during outbreaks. This retrospective laboratory-based surveillance study was conducted in Sierra Leone between June 16 and August 27, 2025, across eight health districts (Port Loko, Kambia, Karene, Bombali, Tonkolili, Koinadugu, Falaba, and Western Area Rural). We analyzed all clinical specimens, including lesion swabs, vaginal swabs, and crust samples previously tested negative for the monkeypox virus (MPXV) via molecular screening. Specimens were screened using multiplex PCR targeting a broad panel of pathogens, including Varicella-zoster virus, herpes simplex viruses type 1 & 2, Cytomegalovirus, Epstein-Barr virus, human herpesviruses Type 6 & 7, Haemophilus ducreyi, Treponema pallidum and Chlamydia trachomatis. Among the 263 MPXV-negative cases tested, at least one targeted pathogen was identified in 58.2% (153/263) of the samples. Varicella-zoster virus was the most detected pathogen identified (43.3%, n = 114), alongside other significant detections including Herpes simplex virus type 2 (7.2%, n = 19), Cytomegalovirus (6.8%, n = 18), and Epstein-Barr virus (6.1%, n = 16). Notably, the study identified several co-detections between Herpesviruses and a rare occurrence of Haemophilus ducreyi (1.1%, n = 3), twice co-detected with Varicella-zoster virus. These findings highlight the potential value of integrating multiplex differential molecular screening into Mpox outbreak surveillance to identify alternative etiologies among MPXV-negative suspected cases. Combining broader pathogen screening with clinical assessment could inform patient management and strengthen outbreak preparedness and response.
SN  - 2052-2975
ER  -