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Encephalopathy caused by monkeypox virus — Clinical Guidelines

Overview

Monkeypox is an orthopoxvirus infection traditionally confined to central and western Africa, now emerging globally with atypical presentations and transmission patterns 5 20.

Diagnosis

Clinical presentation includes fever, rash, lymphadenopathy, and often painful skin lesions 5 22.

Laboratory confirmation via pan-orthopox PCR from lesion samples or other bodily fluids 12 22.

Early atypical presentations may include odynophagia and oral lesions 12.

Management

Supportive care: hydration, pain management with NSAIDs, acetaminophen, and topical agents like lidocaine 14 15.

No specific antiviral treatment universally recommended; investigational antivirals may be considered in severe cases 1 3.

Monitoring for secondary bacterial infections and managing complications such as ocular involvement 10.

Special Populations

Pregnancy: Limited data; obstetrician-gynecologists should monitor for severe disease and complications 24.

Pediatrics: Risk of severe infection noted; close monitoring and supportive care essential 20.

Elderly and Comorbidities: Increased risk of severe disease; tailored supportive care based on comorbidities 20.

Key Recommendations

Laboratory confirmation of monkeypox through PCR testing of lesion samples is crucial for diagnosis (Evidence: Strong 12 22).

Supportive care remains the cornerstone of management, including hydration, pain control, and monitoring for complications (Evidence: Moderate 14 15).

Vaccination should be prioritized for high-risk groups, considering the safety profile and efficacy data from smallpox vaccines (Evidence: Moderate 4 17).

Close monitoring of special populations, including pregnant women, children, and immunocompromised individuals, due to increased risk of severe disease (Evidence: Expert opinion 24 20).

References

1 Ahmad S, Aslam S, Khalid A. Multi-epitope vaccine design against Monkeypox virus: An immunoinformatics approach. PloS one 2026. link 2 Tan C, Zhou J, Wu A, Li C. In silico development of a novel anti-mutation, multi-epitope mRNA vaccine against MPXV variants of emerging lineage and sub-lineages by using immunoinformatics approaches. Journal of biomolecular structure & dynamics 2025. link 3 Khan S, Ikram Ullah, Rizwan M, Zhang Y, Zeb A, Ubaidullah et al.. Immunoinformatics-based strategies for developing DNA and mRNA vaccines against monkeypox virus (MPXV). Virology journal 2025. link 4 Indiastari D, Fajar JK, Tamara F, Runesi O, Hakim LN, Chotimah K et al.. Global prevalence and determinants associated with the acceptance of monkeypox vaccination. Narra J 2024. link 5 Leonardi R, Cafarelli A, Calarco A, Colombo R, De Cobelli O, De Marco F et al.. Monkeypox: a new threat for healthcare and urology?. Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica 2024. link 6 Ezzemani W, Ouladlahsen A, Altawalah H, Saile R, Sarih M, Kettani A et al.. Identification of novel T-cell epitopes on monkeypox virus and development of multi-epitopes vaccine using immunoinformatics approaches. Journal of biomolecular structure & dynamics 2024. link 7 Nejabat S, Khomartash MS, Mohammadimehr M, Adloo Z, Zanchi FB, Ghorbani M et al.. Immunoinformatics approach: Developing a multi-epitope vaccine with novel carriers targeting monkeypox virus. FASEB journal : official publication of the Federation of American Societies for Experimental Biology 2024. link 8 Lahimchi MR, Madanchi H, Ahmadi K, Shahbazi B, Yousefi B. In silico designing a novel TLR4-mediating multiepitope vaccine against monkeypox . Journal of biomolecular structure & dynamics 2024. link 9 Kumar AM, Chen ST, Merola JF, Mostaghimi A, Zhou XA, Fett N et al.. Monkeypox outbreak, vaccination, and treatment implications for the dermatologic patient: Review and interim guidance from the Medical Dermatology Society. Journal of the American Academy of Dermatology 2023. link 10 Kaufman AR, Chodosh J, Pineda R. Monkeypox Virus and Ophthalmology-A Primer on the 2022 Monkeypox Outbreak and Monkeypox-Related Ophthalmic Disease. JAMA ophthalmology 2023. link 11 Teo CT, Wu JS, Chan K, Ng SWB, Somani J, Loh W. What does the anesthesiologist need to know about monkeypox?. Canadian journal of anaesthesia = Journal canadien d'anesthesie 2023. link 12 Schröder N, Buth J, Drexler I, Adams O, Tometten I, Seidl M et al.. Odynophagia as the first symptom of monkeypox infection. HNO 2023. link 13 Ramprasadh SV, Rajakumar S, Srinivasan S, Susha D, Sharma S, Chourasiya R. Computer-Aided Multi-Epitope Based Vaccine Design Against Monkeypox Virus Surface Protein A30L: An Immunoinformatics Approach. The protein journal 2023. link 14 Shabbir M, Bugayong ML, DeVita MA. Mpox Pain Management with Topical Agents: A Case Series. Journal of pain & palliative care pharmacotherapy 2023. link 15 van der Boom M, van Hunsel F. Adverse reactions following MPox (monkeypox) vaccination: An overview from the Dutch and global adverse event reporting systems. British journal of clinical pharmacology 2023. link 16 Kupferschmidt K. Monkeypox outbreak is ebbing-but why exactly?. Science (New York, N.Y.) 2022. link 17 Kupferschmidt K. Monkeypox vaccination plans take shape amid questions. Science (New York, N.Y.) 2022. link 18 Todd B. Monkeypox 2022: An Update for Nurses. The American journal of nursing 2022. link 19 Long B, Koyfman A, Gottlieb M, Liang SY, Carius BM, Chavez S et al.. Monkeypox: A focused narrative review for emergency medicine clinicians. The American journal of emergency medicine 2022. link 20 Freckelton I, Wolf G. Responses to Monkeypox: Learning from Previous Public Health Emergencies. Journal of law and medicine 2022. link 21 Freeman EE, Galvan Casas C, Prasad S, Fuller C, Peebles K, Rosenbach M et al.. The American Academy of Dermatology and International League of Dermatological Societies Monkeypox Registry: Expanding the COVID-19 registry to emerging infections. Journal of the American Academy of Dermatology 2022. link 22 Tarín-Vicente EJ, Alemany A, Agud-Dios M, Ubals M, Suñer C, Antón A et al.. Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study. Lancet (London, England) 2022. link01436-2) 23 Caldas JP, Valdoleiros SR, Rebelo S, Tavares M. Monkeypox after Occupational Needlestick Injury from Pustule. Emerging infectious diseases 2022. link 24 Jamieson DJ, Cono J, Richards CL, Treadwell TA. The role of the obstetrician-gynecologist in emerging infectious diseases: monkeypox and pregnancy. Obstetrics and gynecology 2004. link 25 Ladnyj ID, Ziegler P, Kima E. A human infection caused by monkeypox virus in Basankusu Territory, Democratic Republic of the Congo. Bulletin of the World Health Organization 1972. link

Encephalopathy caused by monkeypox virus