Monkeypox Virus in high-risk population groups: Clinical course and Implications

Monkeypox (mpox) has re-emerged as a significant global health concern, with the 2022 outbreak underscoring its impact on vulnerable populations, particularly those with co-infections or compromised immune systems. This review explores the current evidence on mpox in three high-risk scenarios: pregnancy, immunocompromised individuals, and co-infections with varicella-zoster virus (chickenpox), SARS-CoV-2 (COVID-19), and HIV. Pregnant individuals with mpox are at a heightened risk of adverse outcomes, including fetal loss and congenital infection, although data remain limited. Immunocompromised patients, especially those with advanced HIV or other forms of immunosuppression, are more likely to experience severe or disseminated mpox infections. Historical reports have documented co-infection with the varicella-zoster virus, which may complicate the clinical diagnosis. Although mpox and COVID-19 co-infections are relatively rare, they highlight the importance of maintaining clinical vigilance for concurrent infections. Notably, HIV co-infection has been common in recent outbreaks. In individuals with well-controlled HIV, mpox typically follows a similar clinical course; however, in those with untreated HIV or low CD4 counts, mpox is associated with more severe disease and higher mortality. This review discusses the clinical features, diagnostic challenges, and management considerations of mpox in these populations, offering updated insights into its behavior in the context of pregnancy, immunosuppression, and co-infection.