A brief review of the monkeypox virus and emerging concerns for neuroinvasiveness

Abstract

Background: Amidst the ongoing COVID-19 pandemic, monkeypox virus (MPXV) disease has been recognized as another disease of pandemic nature by the World Health Organization. Nearly four decades after the eradication of smallpox, as half of the world population is naïve to ortho-pox viruses (supposedly due to lack of immunity by vaccination), MPXV remains the most pathogenic species of the family of poxviruses.

Methods: The articles on MPXV were searched on PubMed/Medline and data were retrieved and analyzed.

Results: Although reported as a disease of milder exanthem and lower mortality as compared to smallpox, the MPXV disease tends to be neuroinvasive. This article highlights the neurological signs and symptoms of MPXV disease and discusses, in brief, the management strategies.

Conclusion: Neuroinvasive properties of the virus as demonstrated in in vitro studies, and further verified by neurological illnesses in patients, present a special threat to mankind. Clinicians must be prepared to recognize and treat these neurological complications and start treatment to limit long-lasting brain injury as seen in patients with COVID-19.

Keywords: Central nervous system; Monkeypox virus; Neurological; Pathogenesis.

Figure 1:

Modes of transmission of the monkeypox virus.

Figures 2:

(a and b) Potential pathways of “neurotropism” of the virus.

Figure 3:

Bar diagram showing proportion of symptoms in monkeypox illness (see Table 1 for details). Adapted from: 2022 Monkeypox Outbreak: Global Trends [Internet]. [Cited 2022 Dec 19]; Available from: https://worldhealthorg.shinyapps.io/mpx_global/. (S.R: Systemic rashes, G.R: Genital rashes, O.R: Oral rashes, G.L: General lymphadenopathy, L.L: Local lymphadenopathy, H: Headache, Fa: Fatigue, M: Myalgia, Fe: Fever, S.T: Sore throat, C: Chills, V: Vomiting, A: Asymptomatic).