Clinical manifestations of human Mpox infection: A systematic review and meta-analysis

Yon H 1 , Shin H 1 , Shin JI 2 , Shin JU 3 , Shin YH 4 , Lee J 5 Show all authors , Rhee SY 6 , Koyanagi A 7 , Jacob L 7 , Smith L 8 , Lee SW 9 , Rahmati M 10 , Ahmad S 11 , Cho W 6 , Yon DK 6

Affiliations 

  • 1 Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
  • 2 Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
  • 3 Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
  • 4 Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
  • 5 Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
  • 6 Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
  • 7 Research and Development Unit, CIBERSAM, ISCIII, Barcelona, Spain
  • 8 Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
  • 9 Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, South Korea
  • 10 Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
  • 11 Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
Rev Med Virol, 2023 Jul;33(4):e2446.
PMID: 37056203 DOI: 10.1002/rmv.2446

Abstract

Little is known about the ongoing monkeypox (mpox) outbreak, and the clinical features of mpox in patients worldwide have not been rigorously analysed. Thus, we aimed to investigate the clinical features associated with mpox infection and understand the pathophysiology and characteristics of the disease. For this systematic review and meta-analysis, we searched PubMed/MEDLINE, Embase, CINAHL, Google Scholar, and the Cochrane Database of Systematic Reviews for articles published till 16 September 2022. We used a random effects model to calculate the pooled prevalence and 95% confidence interval (CI). We used the I2 statistic to assess heterogeneity, Egger's test to assess publication bias, 95% prediction interval to determine the level of uncertainty, and the Newcastle-Ottawa Scale and Joanna Briggs Institute quality assessment tool to assess the risk of bias. Twenty-six relevant articles from 19 countries across 5 continents were included, and data on 5472 mpox patients with 18 unique features were analysed. The pooled prevalence of clinical features of mpox were rash (85.7%, 95% CI: 68.3-94.3; k = 21), chills (77.8%, 95% CI: 70.5-83.7; k = 3), and fever (62.3%, 95% CI: 51.3-71.6; k = 25), lymphadenopathy (58.6%, 95% CI: 47.2-69.2; k = 21), lethargy or exhaustion (46.8%, 95% CI: 30.7-63.5; k = 14), pruritus (40.6%, 95% CI: 28.5-54.0; k = 5), myalgia (36.0%, 95% CI: 24.3-49.7; k = 16), headache (34.6%, 95% CI: 23.4-47.8; k = 17), skin ulcer (31.1%, 95% CI: 18.6-47.1; k = 7), abdomen symptom (24.2%, 95% CI: 17.9-31.9; k = 11), pharyngitis (23.0%, 95% CI: 12.7-37.9; k = 14), respiratory symptom (19.5%, 95% CI: 6.8-44.6; k = 6), nausea or vomiting (13.0%, 95% CI: 4.6-31.9; k = 3), scrotal or penile oedema (10.7%, 95% CI: 6.3-17.7; k = 4), conjunctivitis (7.1%, 95% CI: 2.4-18.9; k = 6), and death (0.9%, 95% CI: 0.4-2.0; k = 26). This is the first international and comprehensive study to examine all clinical presentations of human mpox infection. Our systematic review proposes a comprehensive understanding of the current mpox outbreak and may serve as key data for future studies on the pathological mechanisms and epidemiology of mpox infections.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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