Monkeypox Virus: A Comprehensive Overview of Viral Pathology, Immune Response, and Antiviral Strategies

Abstract

Background: The years 2022–2023 witnessed a monkeypox virus (mpox) outbreak in some countries worldwide, where it exists in an endemic form. However, the number of infectious cases is continuously on the rise, and there has been an unexpected, drastic increase in cases that result from sustained transmission in non-endemic regions of the world. Under this scenario, it is pertinent for the world to be aware of healthcare threats to mpox infection. This review aimed to compile advanced data regarding the different aspects of mpox disease. Methods: A comprehensive strategy for the compilation of recent data was adopted to add data regarding mpox, biology, viral pathology, immune response, and brief details on the antiviral strategies under trial; the search was limited to 2016–2023. The aim is to make the scientific community aware of diverse aspects of mpox. Results: Consequently, detailed insights have been drawn with regard to the nature, epidemiology, etiology, and biological nature of mpox. Additionally, its host interaction and viral infectious cycle and immune interventions have been briefly elaborated. This comprehensively drawn literature review delivers brief insights into the biological nature, immune responses, and clinical developments in the form of therapeutics against mpox. This study will help scientists understand the biological nature and responses in hosts, which will further help clinicians with therapeutic handling, diagnosis, and treatment options. Conclusions: This study will provide updated information on mpox’s pathology, immune responses, and antiviral strategies. Moreover, it will also help the public to become educated on the healthcare-associated threat and take timely mitigation measures against expected mpox outbreaks in the future.

Pan‐microscopic examination of monkeypox virus in trophoblasts cells reveals new insights into virions release through filopodia‐like projections

“…How these viruses spread basal decidua through viremia, immune cell trafficking, or both is still unknown. Understanding inherent variations is necessary when studying complex human tissues, especially differentiated placentas, between individual donors and gestational ages 37,38 …”

Overview of reemerging mpox infection with a focus on neurological manifestations

“…Treatment modalities for mpox encompass the use of cidofovir, an antiviral drug effective against poxviruses, including mpox and vaccinia viruses. 31 Vaccinia immune globulin (VIG), combined with supportive care and other options, is recommended. 55 Tecovirimat, another effective antiviral drug against orthopoxviruses, is considered safe for human use.…”

“…30 Notably different from variola virus (causing smallpox) and vaccinia virus (used in smallpox vaccination), mpox cases have surged, driven by secondary transmission among the unvaccinated. 31 Mpox infections exhibit adenopathy, a characteristic feature distinguishing them from smallpox. 18 Lesions caused by mpox must be discerned from those of other encephalitis-causing viruses like varicella-zoster virus (VZV).…”

“…The DRC has reported 500 suspected cases of human disease in recent years, primarily due to the mpox virus 30 . Notably different from variola virus (causing smallpox) and vaccinia virus (used in smallpox vaccination), mpox cases have surged, driven by secondary transmission among the unvaccinated 31 . Mpox infections exhibit adenopathy, a characteristic feature distinguishing them from smallpox 18 .…”

Enhancing diagnostic accuracy in common human poxvirus infections during mpox outbreak: A dermoscopy review

“…A notable atypical outbreak of mpox occurred worldwide, leading to its announcement as an outbreak by the World Health Organization (WHO) in 2022. Since May 2022, there has been a rapid spread of human mpox cases in non‐endemic areas 19–21 . Clinical symptoms of human mpox typically include prodromal fever, fever, skin eruption, malaise, headache, and lymphadenopathy 20,22 .…”