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Viruses Jun 2023Despite monkeypox (mpox) being a public health emergency, there is limited knowledge about the risk of infectivity from skin viral loads during mpox infection. Thus, the... (Meta-Analysis)
Meta-Analysis Review
Despite monkeypox (mpox) being a public health emergency, there is limited knowledge about the risk of infectivity from skin viral loads during mpox infection. Thus, the aim of this study was to estimate cutaneous viral loads among mpox patients globally. Several databases, including Cochrane, EBSCOHost, EMBASE, ProQuest, PubMed, Scopus, and Web of Science, and preprint servers were searched concerning skin mpox viral loads in confirmed mpox subjects. In this systematic review and meta-analysis, a total of 331 articles were initially screened after the removal of duplicate entries. A total of nine articles were included in the systematic review and meta-analysis for the overall estimation of viral loads (Ct) using a random-effect model. The pooled cutaneous mpox viral load (lower Ct) was 21.71 (95% CI: 20.68-22.75) with a majority of positivity rates being 100%, highlighting a higher infectivity risk from skin lesions. The current results strongly support that skin mpox viral loads may be a dominant source of rapid transmission during current multi-national outbreaks. This important finding can help in constructing useful measures in relevant health policy.
Topics: Humans; Monkeypox virus; Mpox (monkeypox); Viral Load; Skin; Databases, Factual
PubMed: 37376686
DOI: 10.3390/v15061386 -
Journal of Medical Virology Apr 2023Since early May 2022, outbreaks of Monkeypox (Mpox) cases have emerged and become a global concern. Studies exploring the gastrointestinal symptoms and/or liver injury... (Meta-Analysis)
Meta-Analysis
Since early May 2022, outbreaks of Monkeypox (Mpox) cases have emerged and become a global concern. Studies exploring the gastrointestinal symptoms and/or liver injury of Mpox are still very limited. This systematic review and meta-analysis is the first to summarize the gastrointestinal symptoms reported by Mpox patients. We searched for Mpox studies published until October 21, 2022, in MEDLINE, EMBASE, SCOPUS, and organization websites. Mpox studies were observational studies that reported at least one of either gastrointestinal symptoms and/or liver injury in Mpox patients. Meta-analysis was done to obtain the pooled prevalence of gastrointestinal symptoms in Mpox patients. Subgroup analyses were done based on the study location, age groups, and Mpox Clades. The quality of included studies was assessed using the NIH Quality Assessment Tool. Overall, 31 studies that reported gastrointestinal symptoms and/or liver injury in Mpox patients were included. The reported gastrointestinal symptoms were abdominal pain, anorexia, diarrhea, nausea, and vomiting. There is a lack of reporting for liver injury. The most prevalent gastrointestinal symptoms in Mpox patients were anorexia (47%; 95% confidence interval [CI] 41%-53%), followed by vomiting (12%; 95% CI 11%-13%), nausea (10%; 95% CI 9%-11%), abdominal pain (9%; 95% CI 8%-10%), and diarrhea (5%; 95% CI 4%-6%). Additionally, the prevalence of proctitis, rectal/anal pain, and rectal bleeding were 11% (95% CI 11%-12%), 25% (95% CI 24%-27%), and 12% (95% CI 11%-13%), respectively. Anorexia was the most frequently reported gastrointestinal symptom in Mpox patients, followed by vomiting, nausea, abdominal pain, and diarrhea. Proctitis is a novel presentation of Mpox in the 2022 outbreak.
Topics: Humans; Mpox (monkeypox); COVID-19; Anorexia; Gastrointestinal Diseases; Vomiting; Diarrhea; Nausea; Abdominal Pain; Proctitis
PubMed: 36975777
DOI: 10.1002/jmv.28709 -
Pathogens (Basel, Switzerland) Mar 2023The accurate estimation of the prevalence of mpox-induced ophthalmic lesions will enable health departments to allocate resources more effectively during the ongoing... (Review)
Review
BACKGROUND
The accurate estimation of the prevalence of mpox-induced ophthalmic lesions will enable health departments to allocate resources more effectively during the ongoing mpox pandemic. The aim of this meta-analysis was to estimate the global prevalence of ophthalmic manifestations in mpox patients.
METHODS
A systematic search was carried out in seven databases-Pub Med, Scopus, Web of Science, EMBASE, ProQuest, EBSCOHost, and Cochrane-for studies published on or before 12 December 2022. The pooled prevalence of ophthalmic manifestations was estimated by the random effects model. Risk of bias assessment of the studies and sub-group analysis to explain heterogeneity were undertaken.
RESULTS
Overall, 12 studies were included, with 3239 confirmed mpox cases, among which 755 patients reported ophthalmic manifestations. The pooled prevalence of ophthalmic manifestations was 9% (95% confidence interval (CI), 3-24). Studies from Europe reported a very low prevalence of ocular manifestations of 0.98% (95% CI 0.14-2.31), compared to studies from Africa with a substantially higher prevalence of 27.22% (95% CI 13.69-43.26).
CONCLUSIONS
A wide variation in the prevalence of ocular manifestations among mpox patients was observed globally. Healthcare workers involved in mpox-endemic African countries should be aware of ocular manifestations for early detection and management.
PubMed: 36986374
DOI: 10.3390/pathogens12030452 -
Immunity, Inflammation and Disease Nov 2022The recent outbreak of Human Monkeypox (MPXV) in nonendemic regions of the world is of great concern.
BACKGROUND
The recent outbreak of Human Monkeypox (MPXV) in nonendemic regions of the world is of great concern.
OBJECTIVE
We aimed to systematically analyze the current epidemiology, clinical presentation, and outcomes of the Monkeypox virus.
METHOD
Systematic literature was conducted in PubMed, Embase, Google Scholar, and Scopus using predefined MESH terms by using "AND" and "OR." The following search terms were used: Monkeypox [MeSH] OR "Monkeypox virus" [MeSH] OR "POX" OR "Monkeypox" AND "Outbreak" AND "Outcomes" from December 2019 till 14th June 2022 without restrictions of language.
RESULTS
A total of 1074 (99.90%) patients tested positive for Monkeypox virus through RT-PCR while 1 (0.09) patient was suspected. There was a gender difference with male predominance (54.23% vs. 45.48%) compared with female patients. Mean age (±SD) of patients was 20.66 ± 16.45 years. The major symptoms were rash (100%), fever (96%), and other important symptoms were upper respiratory symptoms (97%), headache (95%), vomiting (95%), oral ulcers (96%), conjunctivitis (96%) and lymphadenopathy (85%). The average mean duration of treatment was 5 days, while the mean hospitalization duration was 13.3 ± 6.37 days. The outcome of 20 patients was available, 19 of 20 patients recovered fully from monkeypox, however, 1 patient was not able to survive resulting in death.
CONCLUSION
The recent monkeypox virus outbreak has shown that the virus could transmit in ways that were not previously expected. Further research is needed to understand the possible outcomes and association with humans and their different organ systems.
Topics: Adolescent; Adult; Child; Child, Preschool; Female; Humans; Male; Young Adult; COVID-19; Disease Outbreaks; Mpox (monkeypox); Monkeypox virus; Prognosis
PubMed: 36301040
DOI: 10.1002/iid3.722 -
Archives of Virology Jun 2023Since May 2022, there has been a global increase in the number of Mpox virus (MPXV) cases in countries that were previously considered non-endemic. In July 2022, the... (Review)
Review
Since May 2022, there has been a global increase in the number of Mpox virus (MPXV) cases in countries that were previously considered non-endemic. In July 2022, the World Health Organization (WHO) declared this outbreak a public health emergency of international concern. The objective of this systematic review is to examine the novel clinical features of Mpox and to assess the available treatment options for managing the disease in patients who are afflicted with it. We conducted a systematic search in several databases, including PubMed, Google Scholar, Cochrane Library, and the grey literature, from May 2022 to February 2023. We identified 21 eligible studies, which included 18,275 Mpox cases, for final qualitative analysis. The majority of cases were reported in men who have sex with men (MSM) and immunocompromised individuals with HIV (36.1%). The median incubation period was 7 days (IQR: 3-21). The novel clinical manifestations include severe skin lesions on the palms, oral and anogenital regions, as well as proctitis, penile edema, tonsillitis, ocular disease, myalgia, lethargy, and sore throat, without any preceding prodromal symptoms or systemic illness. In addition, fully asymptomatic cases were documented, and various complications, including encephalomyelitis and angina, were noted. Clinicians must be familiar with these novel clinical characteristics, as they can aid in testing and tracing such patients, as well as asymptomatic high-risk populations such as heterosexuals and MSM. In addition to supportive care, currently, there are several effective prophylactic and treatment strategies available to combat Mpox, including the vaccines ACAM2000 and MVA-BN7, as well as the immunoglobulin VIGIV and the antivirals tecovirimat, brincidofovir, and cidofovir against severe Mpox infection.
Topics: Male; Humans; Monkeypox virus; Homosexuality, Male; Mpox (monkeypox); Sexual and Gender Minorities
PubMed: 37386209
DOI: 10.1007/s00705-023-05808-4 -
Cureus Oct 2022The recent monkeypox (MPVX) outbreak has been characterized by an unprecedented increase in cases, unlike any other outbreaks in the past. The disease pattern and... (Review)
Review
The recent monkeypox (MPVX) outbreak has been characterized by an unprecedented increase in cases, unlike any other outbreaks in the past. The disease pattern and transmissibility are also different from previous outbreaks. This systematic review aimed to evaluate whether the current outbreak has significant contrasting features from the previous ones, necessitating changes in prevention and control guidelines. A thorough literature search related to MPVX infection was performed on the online databases PubMed, Google Scholar, and ScienceDirect using appropriate keywords "MPVX", "men who have sex with men (MSM)", "transmission", and "smallpox vaccination", for choosing relevant articles from the inception of MPVX in 1970 to August 31, 2022. We identified 5110 cases of MPVX, documented in 63 articles on MPVX. We discovered that the median age of MPVX infection has slowly increased since its inception, and currently, it is more common in adults. Compared to previous outbreaks, a significantly greater male preponderance is witnessed in the current outbreak. Only 238 (4.65%) out of the 5110 evaluated patients were vaccinated with the smallpox vaccine in our review. There were 107 mortalities, most of which were children below the age of 10 years. Out of the 1534 cases identified in 2022, 1134 (73.92%) patients admitted that they had been involved in sexual relations within the last 21 days (MSM/gay/bisexual). We found that in contrast to previous outbreaks, human-to-human transmission is more common in this outbreak, with most cases having no link with endemic countries. There are evolving traits and undetected transmission modes of MPVX infection that require new disease mitigation strategies.
PubMed: 36451652
DOI: 10.7759/cureus.30841 -
BMJ Global Health Aug 2022Monkeypox (MPX) is an important human Orthopoxvirus infection. There has been an increase in MPX cases and outbreaks in endemic and non-endemic regions in recent...
BACKGROUND
Monkeypox (MPX) is an important human Orthopoxvirus infection. There has been an increase in MPX cases and outbreaks in endemic and non-endemic regions in recent decades. We appraised the availability, scope, quality and inclusivity of clinical management guidelines for MPX globally.
METHODS
For this systematic review, we searched six databases from inception until 14 October 2021, augmented by a grey literature search until 17 May 2022. MPX guidelines providing treatment and supportive care recommendations were included, with no exclusions for language. Two reviewers assessed the guidelines. Quality was assessed using the Appraisal of Guidelines for Research and Evaluation II tool.
RESULTS
Of 2026 records screened, 14 guidelines were included. Overall, most guidelines were of low-quality with a median score of 2 out of 7 (range: 1-7), lacked detail and covered a narrow range of topics. Most guidelines focused on adults, five (36%) provided some advice for children, three (21%) for pregnant women and three (21%) for people living with HIV. Treatment guidance was mostly limited to advice on antivirals; seven guidelines advised cidofovir (four specified for severe MPX only); 29% (4/14) tecovirimat, and 7% (1/14) brincidofovir. Only one guideline provided recommendations on supportive care and treatment of complications. All guidelines recommended vaccination as post-exposure prophylaxis (PEP). Three guidelines advised on vaccinia immune globulin as PEP for severe cases in people with immunosuppression.
CONCLUSION
Our results highlight a lack of evidence-based clinical management guidelines for MPX globally. There is a clear and urgent need for research into treatment and prophylaxis including for different risk populations. The current outbreak provides an opportunity to accelerate this research through coordinated high-quality studies. New evidence should be incorporated into globally accessible guidelines, to benefit patient and epidemic outcomes. A 'living guideline' framework is recommended.
PROSPERO REGISTRATION NUMBER
CRD42020167361.
Topics: Adult; Antiviral Agents; Child; Databases, Factual; Disease Outbreaks; Female; Humans; Mpox (monkeypox); Pregnancy
PubMed: 35973747
DOI: 10.1136/bmjgh-2022-009838 -
Journal of Medical Virology Feb 2023Monkeypox is a zoonotic disease, endemic in central and west African regions, and has re-emerged, currently causing an outbreak as of May 2022. In this systematic... (Review)
Review
A systematic review and clinical atlas on mucocutaneous presentations of the current monkeypox outbreak: With a comprehensive approach to all dermatologic and nondermatologic aspects of the new and previous monkeypox outbreaks.
Monkeypox is a zoonotic disease, endemic in central and west African regions, and has re-emerged, currently causing an outbreak as of May 2022. In this systematic review, we aimed to characterize the current face of the disease, with a detailed categorization of mucocutaneous, as well as systemic symptoms of the disease. We searched four main online databases with the keywords "monkeypox" and "Orthopoxvirus". A total of 46 articles were included, with a cumulative number of 1984 confirmed cases. Patients were predominantly men who have sex with men, who were mostly in their 30s, with a history of unprotected sexual contact or international travel. Among mucocutaneous manifestations, anogenital lesions were the most commonly observed, followed by lesions on the limbs, face, trunk, and palms or soles. Among lesion types, vesiculopustular, pustular or pseudo-pustular, vesicular-umbilicated and papular lesions were the most common, mainly presenting asynchronously, with less than 10 lesions on each patient. Almost all patients also reported systemic manifestations, namely fever, lymphadenopathy, fatigue, myalgia, headaches, pharyngitis, and proctitis. Sexual contact is the main pathway of transmission in the current outbreak, with viral shedding in bodily fluids playing a key role. We've compared these idiosyncratic findings of the new outbreak with previous outbreaks. We've also gathered and categorized images from our included studies to make a "clinical atlas" for this "new" face of monkeypox, which can be of utmost importance for clinicians to be familiarized with, and have a clear picture of monkeypox for their differential diagnoses.
Topics: Male; Animals; Humans; Female; Homosexuality, Male; Sexual and Gender Minorities; Disease Outbreaks; Mpox (monkeypox); Zoonoses
PubMed: 36254380
DOI: 10.1002/jmv.28230 -
F1000Research 2023A zoonotic, double-stranded DNA virus belonging to the genus Orthopoxvirus, the mpox virus (MPXV) is most common in tropical regions of Central and West Africa. The... (Meta-Analysis)
Meta-Analysis
BACKGROUND
A zoonotic, double-stranded DNA virus belonging to the genus Orthopoxvirus, the mpox virus (MPXV) is most common in tropical regions of Central and West Africa. The frequency of monkeypox (mpox) cases, however, has sharply climbed globally since May 2022.
OBJECTIVES
To establish the threat of mpox in terms of the oral lesions caused in sufferers.
MATERIALS AND METHODS
After a thorough study of the literature identified in the PubMed, Web of Science, and Cochrane library databases using the PRISMA framework, 103 papers were found. Using inclusion and exclusion criteria, we chose research that was relevant for our review before shortlisting 14 papers that conformed to the review's guidelines.
RESULTS
In the 14 selected studies, it was found that oral lesions were among the first clinical signs of a mpox affliction, with ulcers on the dorsal surface of tongue lips being the most common areas affected.
CONCLUSION
The rarely observed oral lesions of mpox infection may help in the diagnosis and management of this condition. It is critical to keep in mind that recognising and detecting oral lesions in mpox patients opens the door to more research and efficient patient management.
Topics: Mpox (monkeypox); Humans; Monkeypox virus; Animals; Mouth Diseases
PubMed: 38845619
DOI: 10.12688/f1000research.137363.2 -
Heliyon Aug 2023Mpox virus infection is a significant public health concern worldwide due to its potential severity and the likelihood of outbreaks occurring across different regions.... (Review)
Review
Mpox virus infection is a significant public health concern worldwide due to its potential severity and the likelihood of outbreaks occurring across different regions. Ophthalmic manifestations of the disease have been linked with more severe cases, leading to the need for hospitalization and antiviral therapy. A systematic review and meta-analysis were conducted following PRISMA guidelines to summarize the literature available on this topic. The review revealed that ophthalmic manifestations, such as conjunctivitis and periocular umbilicated lesions, are the most common in Mpox virus infections. However, severe manifestations, such as corneal opacity, that can potentially cause blindness may also occur. Antiviral treatment with tecovirimat and topical management for conjunctivitis can be considered for severe cases. However, the evidence quality is poor due to the predominance of case reports and imprecise characterization of the ophthalmic manifestations. Overall, ophthalmologists and healthcare professionals should be aware of these manifestations for early diagnosis and timely treatment.
PubMed: 37576249
DOI: 10.1016/j.heliyon.2023.e18561