SYSTEMATIC REVIEW article
Front. Med.
Sec. Infectious Diseases: Pathogenesis and Therapy
This article is part of the Research TopicExploring the Link Between Infectious Diseases and Mental HealthView all 5 articles
Central nervous system symptoms in mpox patients without HIV co-infection: A meta-analysis
Provisionally accepted
- School of Clinical and Basic Medical Sciences, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Background: Co-infection of HIV in patients with the mpox virus (MPXV) poses a potential risk for influencing neurological manifestations. We aimed to synthesize the central nervous system (CNS) symptoms reported by mpox patients without HIV co-infection. Methods: We searched for mpox studies published in PubMed, Embase, Web of Science, Cochrane, CNKI, Wanfang Data, and Weipu Data from 1000/01/01 to 2023/11/19, for cohort studies, case series, case-control trials, and randomised controlled trials. Reviews, editorials, pre-prints, and conference proceedings were excluded. We only included studies that reported neurological manifestations in mpox patients without HIV, respectively. STATA v16•0 was used to perform forest plots that pooled the mean scores of CNS symptoms in mpox patients. Outcomes were presented by 95% confidence interval (95% CI) and heterogeneity was assessed using the I² statistic. Results: We identified 2311 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). Most 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. And Egger's test (p<0•05) suggested that the risk of publication bias in the included literature is low. Conclusions: MPXV may cause clinical nervous system injuries, including headache, myalgia, and fatigue/asthenia, as observed in approximately 25% (±3%) of the studied population.
Keywords: mpox, MPXV, Central nervous system symptoms, Meta-analysis, neurological manifestations
Received: 25 Jul 2025; Accepted: 18 Nov 2025.
Copyright: © 2025 Luan, Lv, Wang, Du, Wang and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Leiliang Zhang, armzhang@hotmail.com
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