Central nervous system symptoms in mpox patients without HIV co-infection: a meta-analysis

Co-infection with HIV in patients infected with the mpox virus (MPXV) may pose a potential risk of influencing neurological manifestations. We aimed to synthesize the central nervous system (CNS) symptoms reported by mpox patients without HIV co-infection.

We conducted a search for studies on mpox published in PubMed, Embase, Web of Science, Cochrane, CNKI, Wanfang Data, and Weipu Data till 2023/11/19. The type of studies included were cohort studies, case series, case-control trials, and randomized controlled trials. Reviews, editorials, pre-prints, and conference proceedings were excluded. We only included studies that reported neurological manifestations in mpox patients without HIV. STATA (version 16.0) was used to create forest plots that pooled the mean scores of CNS symptoms in mpox patients. Outcomes were presented with 95% confidence interval (95% CI), and heterogeneity was assessed using the I ² statistic.

We identified 2,311 unique studies, of which 14 (with a total of 989 patients) met the inclusion criteria. The quality of each study was assessed using the Newcastle-Ottawa Scale (NOS) and the Agency for Healthcare Research and Quality (AHRQ) tool. The majority of the included articles were rated as medium quality. The major CNS clinical features were myalgia, headache, and fatigue/asthenia, with pooled mean scores of 0.22 (95% CI: 0.13-0.31), 0.25 (95% CI: 0.17-0.33) and 0.28 (95% CI: 0.21-0.37) in mpox patients without HIV. The results of the sensitivity analysis showed that the meta-analysis results were stable. Additionally, Egger's test (p < 0·05) suggested that a low risk of publication bias in the included literature.

The MPXV may cause clinical nervous system injuries, including headache, myalgia, and fatigue/asthenia, as observed in approximately 25% (±3%) of the studied population.

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024464199, CRD42024464199.