Mpox and encephalitis

Key points:

• Mpox, formerly known as monkeypox, can lead to rare but severe neurological complications.
• Encephalitis is the most common neurological complication of mpox infection, causing inflammation of the brain.
• Vaccination and early treatment are crucial in preventing severe outcomes of mpox infection.

Introduction

When you think about mpox (formerly known as monkeypox), you might picture the skin lesions characteristic of the disease.

But this viral infection can have far-reaching effects beyond the skin, sometimes impacting the brain itself.

The 2022 outbreak

The global mpox outbreak of 2022 brought this once-rare disease into the spotlight.

As cases surged around the world, medical professionals observed a small but significant number of patients developing neurological symptoms. This wasn’t entirely unexpected – viruses in the same family as mpox, such as smallpox, have long been known to occasionally affect the brain. However, the scale of the outbreak meant we were seeing these rare complications more frequently than ever before.

Understanding mpox encephalitis

Encephalitis is an inflammation of the brain, often caused by viral infections. Encephalitis has been known to be associated with mpox in what is termed ‘mpox encephalitis’.

Symptoms of mpox encephalitis can include:

• Confusion and disorientation
• Seizures
• Personality changes
• Weakness or paralysis
• Loss of consciousness

The severity can range from mild, temporary symptoms to life-threatening conditions or permanent brain damage. Mpox encephalitis can also sadly lead to death.

Serious but preventable

Current data suggest that neurological complications of mpox are relatively rare. However, when they do occur, they can be severe.

The good news is that mpox-associated encephalitis is preventable. Vaccination against mpox has shown to be highly effective in preventing severe outcomes, including neurological complications. For those who do contract the virus, early antiviral treatment can significantly reduce the risk of the infection spreading to the brain.

Call to action

There is much work to be done for the future.

Continued vaccination efforts: Ensuring wide availability and uptake of the mpox vaccine, especially in high-risk populations.

Enhanced surveillance: Developing better systems to track and study neurological complications of mpox.

Research Investment: Funding studies to understand the mechanisms of mpox encephalitis and develop treatments.

Public Education: Raising awareness about the full spectrum of mpox symptoms, including potential neurological ones.

Healthcare Provider Training: Equipping medical professionals to rapidly respond to neurological complications of mpox.

Final thoughts

The story of mpox and its neurological complications is a reminder of the complex and often unpredictable nature of viral diseases. As we’ve learned from past outbreaks—be it polio, HIV, or more recently, COVID-19 – viruses can affect the brain in ways we can’t always predict. By staying informed, investing in research, and prioritising prevention, we can work towards minimising the neurological impact of mpox and other emerging viral threats.

The brain is our most precious organ. Protecting it from infectious onslaughts must remain a top public health priority.

References

• Sharma, Rohit et al. “A Rare Co-occurrence of Monkeypox Encephalitis and Neurosyphilis.” Cureus vol. 15,3 e35945. 9 Mar. 2023, doi:10.7759/cureus.35945.
• Jezek, Z et al. “Human monkeypox: clinical features of 282 patients.” The Journal of infectious diseases vol. 156,2 (1987): 293-8. doi:10.1093/infdis/156.2.293.
• Badenoch, James B et al. “Neurological and psychiatric presentations associated with human monkeypox virus infection: A systematic review and meta-analysis.” EClinicalMedicine 52 (2022): 101644. doi:10.1016/j.eclinm.2022.101644.