Arenaviruses Clinical Presentation

  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Burke A Cunha, MD   more...
 
Updated: May 20, 2011
 

History

Clinically apparent arenavirus infections typically present with fever, headache, myalgia, and malaise. Relative bradycardia and hyperesthesia are common as well. Thereafter, the various diseases pursue different courses as follows:

Lymphocytic choriomeningitis virus

This usually benign infection generally begins with fever, myalgia, and headache. Leukopenia and thrombocytopenia are revealed on laboratory studies.

The illness can be biphasic.

The second febrile period and some of the late complications (see Complications) may be immunologic in origin.

Lassa fever

Most infections due to the Lassa virus are mild or subclinical.

Severe multisystem disease is believed to occur in 5-10% of total infections.

Incubation period is 7-18 days.

Illness begins insidiously with fever, weakness, malaise, joint and/or lumbar pain, cough, and severe headache.

In severe cases, illness progresses to include prostration, dehydration, abdominal pain, and facial or neck edema. Serum aminotransferases may be elevated. Note that Lassa fever stands alone among causes of viral hepatitis to have aspartate aminotransferase (AST) levels substantially higher than alanine aminotransferase (ALT) levels. This pattern has been classic for alcoholic hepatitis.

Lymphopenia, thrombocytopenia, and defects of qualitative platelet function are found during this stage.

South American hemorrhagic fevers

Junin and Machupo viruses are similar in severity, and anecdotal reports suggest that Guanarito infections may be somewhat more severe overall.

The illnesses begin somewhat insidiously with fever, malaise, myalgia, and lumbar pain.

Progression may occur over 3-4 days, with prostration, unremitting fever, and mucosal bleeding. Hemorrhage along the gingival margins is characteristic.

After 1-2 weeks, most patients improve, but approximately one third progress to profound cutaneous and mucosal hemorrhages, delirium, and convulsions or a combination of CNS and bleeding findings. Capillary leak syndrome also may occur.

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Physical

The major physical examination findings observed in the major Arenavirus illnesses are as follows:

Lymphocytic choriomeningitis virus

Conjunctival injection, facial flushing, generalized lymphadenopathy, and orthostatic hypotension are common.

Fever and more severe headaches may recur 2-4 days after recovery from the first phase, with overt lymphocytic pleocytotic meningitis with elevated cerebrospinal (CSF) protein. Papilledema may be noted.

Lassa fever

Pharyngitis, often exudative, occurs early. Conjunctivitis also may be seen.

Later, in severe disease, CNS signs can be seen, including tremors, confusion, encephalopathy, and seizures. Focal CNS signs usually are absent, and CSF is normal.

Bleeding is seen in only 15-20% of patients, it usually is limited to mucosal surfaces, and it is limited in severity.

South American hemorrhagic fever

Conjunctival injection, facial flushing, generalized lymphadenopathy, and orthostatic hypotension are common signs.

Many patients have a petechial and/or vesicular palatal enanthem and skin petechiae.

At the point of further progression, CNS signs can include tremor of hands and tongue, hyperesthesias, decreased deep-tendon reflexes, and lethargy.

Especially with deteriorating illness, leukopenia and thrombocytopenia are common but aminotransferase elevations are uncommon.

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Contributor Information and Disclosures
Author

Sandra G Gompf, MD, FACP, FIDSA  Associate Professor of Infectious Diseases and International Medicine, University of South Florida College of Medicine; Chief, Infectious Diseases Section, Director, Occupational Health and Infection Control Programs, James A Haley Veterans Hospital

Sandra G Gompf, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Kevin M Smith, MD  Fellow in Infectious Disease and International Medicine, University of South Florida College of Medicine

Kevin M Smith, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Ulyee Choe, DO  Fellow, Department of Infectious Diseases, University of South Florida College of Medicine

Ulyee Choe, DO is a member of the following medical societies: American College of Physicians, American Osteopathic Association, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel R Lucey, MD, MPH  Chief, Fellowship Program Director, Department of Internal Medicine, Division of Infectious Diseases, Washington Hospital Center; Professor, Department of Internal Medicine, Uniformed Services University of the Health Sciences

Daniel R Lucey, MD, MPH is a member of the following medical societies: Alpha Omega Alpha and American College of Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

Joseph F John Jr, MD, FACP, FIDSA, FSHEA  Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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