The incidence of monkeypox, a viral zoonotic disease first identified in humans in 1970, has increased sharply in the United States and Europe since May 2022.1,2 Historically, monkeypox only occurred sporadically in these areas in the early 21st century. Given her recent COVID-19 pandemic, concerns have been raised regarding human-to-human transmission of monkeypox, especially in light of the lack of understanding of what is driving the increase in cases. increase.
In general, dermatological problems such as skin rashes are the most reported symptoms occurring on the face and extremities of monkeypox patients.3 Neuropsychiatric effects may represent another component of sequelae. However, these symptoms have not been fully characterized or consistently reported in the literature.
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It is very likely that monkeypox is neuroinvasive and has some effect on the brain cells themselves.
To provide more insight into the potential neurological effects of monkeypox, and why they develop, infectious disease expert W. Ian Lipkin, MD, John Snow, professor of epidemiology, Columbia We spoke with the director of the Center for Infection and Immunity at the University’s Mailman School. Caleb McEntire, M.D., Ph.D., an expert in neurology, Ph.D. in Public Health, New York, and Clinical Fellow in Neurology at Massachusetts General Hospital in Boston.
Monkeypox and Neurological Symptoms: What We Know and What We Miss
According to Dr. Lipkin, there are minimal data describing the neurological and psychiatric signs of monkeypox, and there are major gaps in knowledge about the symptoms of the disease.
The most common symptoms of monkeypox, which have neurological origins, may also be related to the infection as a whole. “It’s likely due to a reaction,” Dr. Lipkin explained.
July 2022 meta-analysis uploaded to medrex sib Of 19 studies in a pooled cohort of 1512 individuals with monkeypox (44.8% female), the most common neurological features included myalgia (55.5%), headache (53.8%), and fatigue. (36.2%) included nonspecific neurological symptoms such as and confusion (2.4%).Four In addition, more rare but severe symptoms such as seizures (2.7%) and encephalitis (2.0%) were reported.Four
Although not included in the meta-analysis, neurological symptoms reported in several studies included sensory perceptual disturbances such as visual disturbances, dizziness and photophobia, as well as psychiatric symptoms such as anxiety and depression.Four
The results of this meta-analysis are considered preliminary. However, the researchers concluded that “the observed incidence of monkeypox-associated neurological symptoms warrants both surveillance in the current monkeypox outbreak and a robust method for assessing potential causality.” It is possible,” he wrote.Four
Furthermore, Dr. Lipkin said that anxiety and depression may largely reflect social and physical stigma associated with “painful and disfiguring infections” rather than the disease process itself. “There’s a lot we don’t know about the pathology of monkeypox and its long-term sequelae,” he said.
To date, monkeypox-related neurological complications are very rare, Dr. McEntire explained. “In other types of pox, such as smallpox and encephalitis, it’s quite . . . frequent neurological signs,” he said.
However, Dr. McEntire noted that monkeypox seen prior to this outbreak “generally had little to do with human-to-human transmission,” adding that “mutations that increase neurotropism There may be some,” he added.
Development of monkeypox-associated neurological symptoms
The current “unknown” associated with the current monkeypox surge is how neurological symptoms may develop as a result of infection. This is a case where evidence of monkeypox was found in the cerebrospinal fluid, with direct neurotropism, allowing the monkeypox virus to enter and affect the brain.”
Dr. McEntire suggested that other smallpox vaccines, such as smallpox, may provide clues as to how monkeypox can cause neurological symptoms. “Smallpox has been detected so reliably in the perivenous region in many patients that it is definitely neurotropic,” he says, noting that the description of smallpox can be extrapolated to monkeypox. He added that the evidence to suggest so far has not accumulated much.
“It’s very likely that monkeypox is neuroinvasive and has some effect on the brain cells themselves,” Dr. McEntire said. It could be just because it can cause a lot of systemic inflammation.”
Prevention of monkeypox
Given the rare neurological manifestations in monkeypox patients and the limited evidence available on this topic, there is also little guidance on how to reduce the risk of neurological effects in infected patients. “Like many of these things, the most effective way to prevent the neurological symptoms of monkeypox is to encourage public health measures to prevent the spread of monkeypox,” said Dr. McEntire. .
“Look at COVID-19,” Dr. McEntire said. Not found,” he added. “In practice, the most effective interventions are those that stop the spread of the disease in the first place, and that requires a coordinated public health messaging effort by national and local governments. [and] federal government. “
