Neurological and psychiatric presentations associated with human monkeypox virus infection: a systematic review and meta-analysis
Bibliographic record
Abstract
ABSTRACT Objectives Neuropsychiatric presentations of monkeypox (MPX) infection have not been well characterised, Despite evidence of nervous system involvement associated with two related Orthopoxviruses , in the case of smallpox infection (with the variola virus) and smallpox vaccination (which contains live vaccinia virus). In this systematic review and meta-analysis, we aim to determine the prevalence and describe the spectrum of neurological and psychiatric presentations of MPX. Design Systematic review and meta-analysis Data sources MEDLINE, EMBASE, PsycINFO, AMED and pre-print server (MedRxiv) searched up to 31/05/2022 Eligibility criteria for study selection and analysis Any study design of humans infected with MPX that reported neurological or psychiatric presentation. Studies which included more than ten individuals, and symptoms that were reported in a minimum of two separate studies were eligible for meta-analysis Data synthesis Results were pooled with random-effects meta-analysis to calculate generalised linear mixed models and corresponding 95% confidence intervals for each prevalence outcome. Heterogeneity was measured with the I 2 statistic. All included studies are summarised through a narrative synthesis. Risk of bias was assessed with the Newcastle Ottawa Scale and the Joanna Briggs Institute quality assessment tool. Results From 1,702 unique studies, we extracted data on 19 eligible studies (1,512 participants, 1,031 with confirmed infection using CDC criteria or PCR testing) most of which were cohort studies and case series with no controlled populations. Study quality was generally moderate. Six clinical features were eligible for meta-analysis, of which the most prevalent were myalgia in 55.5% [95%CI 12.1-91.9%], headache 53.8% [30.6-75.4%], fatigue 36.2% [2.0-94.0%], seizure 2.7% [0.6-10.2%], confusion 2.4% [1.1-5.2%] and encephalitis 2.0% [0.5-8.2%]. Heterogeneity significantly varied across clinical features (I 2 =0%-98.7%). Other reported presentations not eligible for meta-analysis included sensory-perceptual disturbance (altered vision, dizziness, and photophobia) and psychiatric symptoms (anxiety and depression). Conclusions There is preliminary evidence for a range of neurological and psychiatric presentations of MPX, ranging from commonly reported and nonspecific neurological symptoms (myalgia and headache) to rarer but more severe neurological complications, such as encephalitis and seizures. There is less evidence regarding the psychiatric sequelae of MPX, and although there are multiple reports of anxiety and depression the prevalence of these symptoms is unknown. MPX-related nervous system presentations may warrant surveillance within the current MPX outbreak, with prospective longitudinal studies evaluating the mid to long-term sequelae of the virus. Robust methods to evaluate the potential causality of MPX with these clinical features are required at an individual and epidemiological level. Systematic review registration PROSPERO ID 336649 SUMMARY BOX What is already known on this topic Neuropsychiatric symptoms can be highly disabling and have a detrimental effect on quality of life. Neuropsychiatric manifestations of monkeypox virus infection have not been well characterised, however, there is evidence of nervous system involvement with the related smallpox virus and vaccinia vaccine. What this study adds Preliminary evidence for a range of neurological and psychiatric presentations of monkeypox infection, ranging from commonly reported and nonspecific neurological symptoms (myalgia and headache) to rarer but more severe neurological complications, such as encephalitis and seizures. There is less evidence regarding the psychiatric sequelae of monkeypox infection, and although there are multiple reports of anxiety and depression the prevalence of these symptoms is unknown. This preliminary suspicion that there are monkeypox-related nervous system manifestations may warrant both surveillance within the current monkeypox outbreak and robust methods to evaluate the potential causality.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.005 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".