Monkeypox virus neurological manifestations in comparison to other orthopoxviruses

Abstract

Viral infectious diseases have various neurological manifestations, whether they are epidemic or pandemic in nature. Nonspecific encephalopathy is the most common central nervous system (CNS) manifestation. The spectrum of nervous evidence varies for viral pathogens. Some infectious viruses, such as the Ebola virus, exhibit direct neurotropism. Others, such as the Rift Valley fever virus, have the potential for neurotropism. Direct neurotropism is unknown in monkeypox virus, SARS-CoV-2, MERS-CoV, and even smallpox. As seen in the COVID-19, there may be evidence of para-infectious neurological syndrome. There have only been a few reports of neurological diseases caused by monkeypox infection. Future efforts to prevent the spread of infectious disease surges can reduce mortality complications, the therapeutic burden on the health-care system, and prevent further spread. This study describes the clinical and neurological complications of monkeypox infection, particularly encephalitis, as well as the laboratory diagnosis of these cases.

Keywords: Monkeypox virus; Nervous system; Neurology.

Fig. 1

The entry routes of orthopoxviruses into the CNS. Microglia macrophages provide immune monitoring in CNS. Orthopoxviruses find their way into the CNS (either through direct nerve infection in tissues or by infecting cells in the circulatory system). They eventually transmit the infection through the blood-brain barrier to the CNS.

Fig. 2

Suggested regulatory proteins and pathogenesis of Monkeypox virus.