Gastrointestinal Symptoms of Monkeypox Infection: A systematic review and meta‐analysis

Abstract

Since early May 2022, outbreaks of Monkeypox (Mpox) cases have emerged and become a global concern. Studies exploring the gastrointestinal symptoms and/or liver injury of Mpox are still very limited. This systematic review and meta-analysis is the first to summarize the gastrointestinal symptoms reported by Mpox patients. We searched for Mpox studies published until October 21, 2022, in MEDLINE, EMBASE, SCOPUS, and organization websites. Mpox studies were observational studies that reported at least one of either gastrointestinal symptoms and/or liver injury in Mpox patients. Meta-analysis was done to obtain the pooled prevalence of gastrointestinal symptoms in Mpox patients. Subgroup analyses were done based on the study location, age groups, and Mpox Clades. The quality of included studies was assessed using the NIH Quality Assessment Tool. Overall, 31 studies that reported gastrointestinal symptoms and/or liver injury in Mpox patients were included. The reported gastrointestinal symptoms were abdominal pain, anorexia, diarrhea, nausea, and vomiting. There is a lack of reporting for liver injury. The most prevalent gastrointestinal symptoms in Mpox patients were anorexia (47%; 95% confidence interval [CI] 41%-53%), followed by vomiting (12%; 95% CI 11%-13%), nausea (10%; 95% CI 9%-11%), abdominal pain (9%; 95% CI 8%-10%), and diarrhea (5%; 95% CI 4%-6%). Additionally, the prevalence of proctitis, rectal/anal pain, and rectal bleeding were 11% (95% CI 11%-12%), 25% (95% CI 24%-27%), and 12% (95% CI 11%-13%), respectively. Anorexia was the most frequently reported gastrointestinal symptom in Mpox patients, followed by vomiting, nausea, abdominal pain, and diarrhea. Proctitis is a novel presentation of Mpox in the 2022 outbreak.

Mpox gastrointestinal manifestations: a systematic review

“…[24][25][26] The GI complications reported in mpox patients include nausea, vomiting, diarrhoea, abdominal pain, rectal bleeding, rectal pain, rectal perforation (RPE), painful defecation, proctitis and tenesmus. 27 Nausea is defined as the uncomfortable feeling that comes before vomiting.…”

“…38 39 To the author's knowledge, one peer-reviewed metaanalysis has been completed and published on the topic of the GI manifestation of mpox. 27 While the previously published systematic review and meta-analysis may appear analogous regarding research inquiries, there are many noteworthy distinctions that warrant a novel systematic review. First, many of the findings regarding clinical manifestations were different due to the methodology timeline of the previous systematic review.…”

Current Evidence and Practice Guidelines of Systemic Complications of 2022 Mpox Outbreak: A Scoping Review

“…The most frequent GI symptoms are anorexia, vomiting, nausea, abdominal pain, and diarrhea. The individuals infected with Mpox belonging to clade I or IIa have a significantly greater likelihood of experiencing GI symptoms than those infected with clade IIb [ 10 ]. African studies (predominantly clade I) report a higher prevalence of nausea/vomiting and abdominal pain than non-African studies (predominantly clade II).…”

“…In comparison, diarrhea has been reported equally by both African and non-African studies. The current clade IIb outbreak does not present complications such as oral ulcers and dysphagia typically associated with clade I infection [ 10 , 11 ]. Conversely, symptoms such as proctitis presenting as rectal/anal pain and rectal bleeding are unique to the 2022 outbreak and have not previously been associated with Mpox infection [ 10 - 12 ].…”

“…The current clade IIb outbreak does not present complications such as oral ulcers and dysphagia typically associated with clade I infection [ 10 , 11 ]. Conversely, symptoms such as proctitis presenting as rectal/anal pain and rectal bleeding are unique to the 2022 outbreak and have not previously been associated with Mpox infection [ 10 - 12 ]. In many cases of Mpox infection, anal pain can be the primary symptom observed at the time of presentation.…”