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A systematic review to identify novel clinical characteristics of monkeypox virus infection and therapeutic and preventive strategies to combat the virus


Since May 2022, there has been a global increase in the number of Mpox virus (MPXV) cases in countries that were previously considered non-endemic. In July 2022, the World Health Organization (WHO) declared this outbreak a public health emergency of international concern. The objective of this systematic review is to examine the novel clinical features of Mpox and to assess the available treatment options for managing the disease in patients who are afflicted with it. We conducted a systematic search in several databases, including PubMed, Google Scholar, Cochrane Library, and the grey literature, from May 2022 to February 2023. We identified 21 eligible studies, which included 18,275 Mpox cases, for final qualitative analysis. The majority of cases were reported in men who have sex with men (MSM) and immunocompromised individuals with HIV (36.1%). The median incubation period was 7 days (IQR: 3–21). The novel clinical manifestations include severe skin lesions on the palms, oral and anogenital regions, as well as proctitis, penile edema, tonsillitis, ocular disease, myalgia, lethargy, and sore throat, without any preceding prodromal symptoms or systemic illness. In addition, fully asymptomatic cases were documented, and various complications, including encephalomyelitis and angina, were noted. Clinicians must be familiar with these novel clinical characteristics, as they can aid in testing and tracing such patients, as well as asymptomatic high-risk populations such as heterosexuals and MSM. In addition to supportive care, currently, there are several effective prophylactic and treatment strategies available to combat Mpox, including the vaccines ACAM2000 and MVA-BN7, as well as the immunoglobulin VIGIV and the antivirals tecovirimat, brincidofovir, and cidofovir against severe Mpox infection.

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Data availability

Data are available from the corresponding author upon reasonable request.



Advisory Committee on Immunization Practices


Deoxyribonucleic acid


Emergency use authorization




Human immunodeficiency virus


Sexually transmitted diseases


Mpox virus




Men who have sex with men


Real-time polymerase chain reaction


Vaccinia Immune Globulin Intravenous


United States Centers for Disease Control


United States Food and Drug Administration


World Health Organization


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All authors meet the ICMJE criteria for authorship. SC and MG conducted the literature search and data extraction and drafted the manuscript. KCA, PR, MBC, MRC, and RG revised the manuscript. All authors have reviewed and approved the final version of the manuscript.

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Correspondence to Santenna Chenchula.

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Chenchula, S., Ghanta, M.K., Amerneni, K. et al. A systematic review to identify novel clinical characteristics of monkeypox virus infection and therapeutic and preventive strategies to combat the virus. Arch Virol 168, 195 (2023).

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