| Monkeypox virus (MPXV), an emerging zoonotic poxvirus, has recently gained global attention due to its rising prevalence and capacity to cause systemic disease in humans. MPXV infection affects multiple organ systems beyond the typical skin manifestations, resulting in a wide range of clinical outcomes. In this review, we provide a comprehensive overview of the systemic physiological pathologies and clinical epidemiology associated with monkeypox virus (MPXV), with a particular focus on viral dissemination in various organ tissues. We also assess the effects of MPXV on the genitourinary, circulatory, nervous, cutaneous, respiratory, lymphatic, and gastrointestinal systems. Furthermore, we discuss current diagnostic methods and emerging therapeutic agents. Special emphasis is placed on the distinct clinical challenges faced by immunocompromised populations, including HIV-positive patients, transplant recipients, and pregnant women. By integrating real-world clinical reports with genomic data, this review underscores the necessity of precise identification for effective outbreak management. Ultimately, we highlight the importance of coordinated research and development (R&D) to refine vaccination strategies and antiviral treatments, ensuring a robust global response to the evolving threat of MPXV. |