Multisystem complications of monkeypox: A systematic review from Low- and Middle-Income Countries in Africa

Background: Monkeypox, a zoonotic viral disease primarily endemic to Africa, has seen a global resurgence, raising concerns due to its potential for severe multisystem complications. While often self-limiting, the burden of monkeypox is heightened in Low- and Middle-Income Countries (LMICs), particularly in Africa, where healthcare resources are limited. Objective: To review the multisystem complications of monkeypox in LMICs across Africa, highlighting clinical challenges and gaps in healthcare management. Methods: A comprehensive systematic review was conducted using PubMed and Google Scholar to identify studies addressing monkeypox complications. Relevant literature covering dermatological, respiratory, neurological, gastrointestinal, cardiovascular, and ocular systems was reviewed, with a focus on clinical complications and healthcare constraints in African LMICs. Results: The review identified significant multisystem complications of monkeypox infection, including impetigo, cellulitis, and septic shock in the dermatologic system; bronchitis and severe pneumonia in the respiratory system; encephalitis and seizures in the neurologic system; haemorrhagic colitis, gastrointestinal bleeding, and severe dehydration in the gastrointestinal system; and viral myocarditis, pericarditis, congestive heart failure, arrhythmias, thrombotic events, and dilated cardiomyopathy in the cardiovascular system. In African LMICs, these complications are exacerbated by limited diagnostic tools, antiviral therapies, and inadequate healthcare infrastructure. Socioeconomic challenges, including poor healthcare access and limited public health awareness, further compound the weaknesses in the health system. Conclusion: Monkeypox presents complications across multiple organ systems. In African LMICs, healthcare barriers exacerbate disease burden. Strengthening infrastructure, improving diagnostics, and increasing awareness are key to mitigating the impact of monkeypox complications.