Monkey poxSkin effects – disfiguring rashes – and flu-like symptoms have been well described, but few have investigated neurological and psychiatric problems virus can cause.
There are historical reports of neurological complications in people infected with a related smallpox virus and Art people vaccinated against smallpoxwhich contains related vaccinia virus. Therefore, my colleagues and I wanted to find out whether monkey pox causes similar problems.
We have reviewed all the evidence for the current monkey pox pandemic neurological or psychiatric problems in people with monkeypox. There are results published in the journal electronic clinical medicine.
A small but significant proportion of people (2 to 3 percent) with monkeypox become very ill and develop serious neurological problems, including seizures and encephalitis (inflammation of the brain that can cause long-term disability).
We also found that confusion occurred in the same number of people. However, it is important to note that these numbers are based on a few studies with a small number of participants.
In addition to serious and rare brain problems, we found evidence of a wider group of people with monkeypox who had more general neurological symptoms, including headache, muscle pain and fatigue.
It was unclear from the review of studies how severe these symptoms were or how long they lasted. It was also unclear how many people with monkeypox had mental health problems — such as anxiety and depression depression – as several studies have looked at it. Of those who did, low mood was often reported.
We do not know what factors cause these neuropsychiatric problems in people with monkeypox. We would like to know whether the strain of the monkeypox virus and the severity of the infection affect these problems. However, we were unable to properly examine this because it was not consistently reported in studies.
Although we found that people with monkeypox can have neuropsychiatric symptoms, the research in our work cannot say with certainty that it is the virus that causes these problems. Future studies investigating this will need to observe people without neuropsychiatric illness before contracting monkeypox.
If it is a virus that is causing these problems, the underlying biological processes are unclear and may involve direct entry of the virus into the nervous system, an immune system response, or something else entirely.
It is also possible that the stigma people feel as a result of contracting monkeypox and the disfiguring effect of the rashes may contribute to psychological disorders such as low mood.
Our study focused on data prior to the current monkeypox pandemic. Most of the data came from West Africa and people hospitalized with the infection, while the current pandemic has mainly affected North America and Western Europe.
It is unclear to what extent the symptoms of previous outbreaks will mirror what we are seeing now.
Supported by other recent studies
Important studies came out after we finished our work. Research in v New England Journal of Medicine included more than 500 people with monkeypox from 16 countries in the current outbreak.
Although no cases of encephalitis or convulsions have been reported, headache and fatigue have been found in more than a quarter of people infected with monkeypox, and mood deterioration in one in ten people.
However, there were two recently reported cases of monkeypox-confirmed encephalitis in Spain. Further follow-up is needed to determine the true extent of more serious problems such as encephalitis and seizures.
An outbreak of monkey pox remains a global problem and continued public health measures are needed, including improved access to vaccination.
Although monkeypox mainly causes flu-like symptoms and skin problems, our latest study – and subsequent studies – show that neuropsychiatric symptoms are not uncommon.
We do not expect a wave of serious brain problems, but complications such as encephalitis and seizures may occur in a small proportion of people. We need more research to find out if these symptoms persist over time and if they are caused by monkeypox.
James Brunton Badenochdoctor of science, Queen Mary University of London
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