Monkeypox Virus Immune Evasion and Eye Manifestation: Beyond Eyelid Implications

Abstract

Monkeypox virus (MPXV), belonging to the Poxviridae family and Orthopoxvirus genus, is closely related to the smallpox virus. Initial prodromal symptoms typically include headache, fever, and lymphadenopathy. This review aims to detail various ocular manifestations and immune evasion associated with the monkeypox viral infection and its complications, making it appropriate as a narrative review. Common external ocular manifestations of MPXV typically involve a generalized pustular rash, keratitis, discharges, and dried secretions related to conjunctival pustules, photophobia, and lacrimation. Orthopoxviruses can evade host immune responses by secreting proteins that antagonize the functions of host IFNγ, CC and CXC chemokines, IL-1β, and the complement system. One of the most important transcription factors downstream of pattern recognition receptors binding is IRF3, which controls the expression of the crucial antiviral molecules IFNα and IFNβ. We strongly recommend that ophthalmologists include MPXV as part of their differential diagnosis when they encounter similar cases presenting with ophthalmic manifestations such as conjunctivitis, blepharitis, or corneal lesions. Furthermore, because non-vaccinated individuals are more likely to exhibit these symptoms, it is recommended that healthcare administrators prioritize smallpox vaccination for at-risk groups, including very young children, pregnant women, older adults, and immunocompromised individuals, especially those in close contact with MPXV cases.

Mpox (Monkeypox) Virus and Its Co-Infection with HIV, Sexually Transmitted Infections, or Bacterial Superinfections: Double Whammy or a New Prime Culprit?

“…Severe symptoms due to primary MPXV infection in humans implicate multiple organs and systems, which are aligned with the broad tropism of this virus (Figure 3, left) [2,50]. Humans get infected with MPXV via mucosa or skin, thereby leading to primary infection in the eye (e.g., conjunctivitis, blepharitis, and keratitis), respiratory system, skin, and genital sites (e.g., anal pain, proctitis, and genital lesions) [38,39,[50][51][52][53]. MPXV infection can also cause neurologic symptoms, e.g., headache and, rarely, encephalitis.…”

The Global Health Threat of Monkeypox Virus: Understanding Its Biology, Transmission, and Potential Therapeutic Interventions

“…However, the reservoirs for human infections remain unidentified, highlighting the need for further research in this area. 12 The virus’s ability to infect a range of hosts can be attributed to its broad cellular tropism, facilitated by specific virus-host cell surface interactions. 13 …”

“…These immune evasion strategies make MPXV a challenging pathogen to combat and highlight the need for effective vaccines and therapeutics to enhance the host’s immune response against this virus. 12 Understanding these evasion mechanisms is crucial for developing such interventions. 11 …”

“…However, the reservoirs for human infections remain unidentified, highlighting the need for further research in this area. 12 The virus's ability to infect a range of hosts can be attributed to its broad cellular tropism, facilitated by specific virus-host cell surface interactions. 13 The pathogenesis of MPXV is a complex process that involves viral entry, replication, spread within the host, and immune response modulation.…”

Mpox: An Overview of Pathogenesis, Diagnosis, and Public Health Implications

“…The image presented in this figure was sourced from Lucena-Neto et al[22] and edited using the software GIMP 2.8 (available at https://www.gimp.org/downloads/oldstable/, accessed on 5 April 2024) in compliance with the terms of use for CC BY 4.0 DEED license (https://creativecommons.org/licenses/by/4.0/, accessed on 5 April 2024).…”