Monkeypox is an emerging infectious disease caused by an orthopoxvirus that was first identified in 1958. The virus is related to the smallpox virus and presents with a pustular rash after a viral prodrome. The disease was not seen outside of Africa until 2003, and a worldwide outbreak began in May 2022, affecting over 80,000 people to date. The outbreak has been declared a public health emergency of international concern by the World Health Organization (WHO) on July 23, 2022. This outbreak has shown atypical presentations, including skin lesions without prodrome, predominantly anogenital or oropharyngeal lesions, and proctitis. Monkeypox may be unknown or under-recognized outside of endemic areas. This blog post will focus on the potential neurological complications of monkeypox that you should be aware of.
The most common neurological manifestation of monkeypox is a prodromal headache that occurs in the majority of patients. The headache is usually generalised or frontal. Asthenia and myalgias are also common prodromal symptoms. Neuralgia and mood disturbances can also manifest. In some people, conjunctivitis can occur, and corneal lesions can cause scarring with vision loss. Rarely, encephalitis, with seizures, can occur. Viral neuroinvasiveness might be a particular concern in immunocompromised individuals.
A prospective cohort study of 528 patients with monkeypox during the current outbreak found that 218 (41%) of them had a concurrent HIV infection. There is concern for viral persistence in people with HIV/AIDS. HIV-infected individuals may be at higher risk for neurological complications.
Other Neurological Complications
Neurological complications of other orthopoxviruses, namely smallpox, might also manifest in patients with monkeypox infection. Additionally, parainfectious and postinfectious neurological complications that can occur with a variety of viral infections, such as Guillain-Barré syndrome, transverse myelitis, and acute disseminated encephalomyelitis, are possible complications too, but have not been reported so far.
Prevention and Treatment
Effective immunity can be obtained with the use of the smallpox vaccine. Additionally, some antivirals, such as tecovirimat and brincidofovir, have efficacy against the virus. So far, few major neurological complications, including two cases of encephalitis, have been reported during this outbreak. Nevertheless, clinicians must be vigilant for neurological manifestations of monkeypox, particularly in immunocompromised individuals. Biological samples, including CSF, should be collected for viral and immune studies.
Much remains unknown regarding monkeypox, particularly its potential neurological complications. However, clinicians must be aware of the potential for neurological complications, particularly in immunocompromised individuals. Monkeypox may be under-recognized outside of endemic areas, and clinicians must be vigilant for atypical presentations. Prevention and treatment of the disease should be focused on effective immunity with the use of the smallpox vaccine and antivirals. Biological samples should be collected for viral and immune studies to better understand the disease and its potential complications.