Lymphocytic Choriomeningitis Clinical Presentation
- Author: Rupal M Mody, MD, MPH; Chief Editor: Burke A Cunha, MD more...
Clinical manifestations of lymphocytic choriomeningitis virus (LCMV) infection range from a flulike illness to severe CNS involvement with encephalitis. Phase 1 of LCM typically manifests as fever and headache, often with lymphadenopathy and a maculopapular rash, resolving after 3-5 days. In many patients, a more-severe headache returns within 4 days, possibly associated with typical signs of viral meningoencephalitis.[4, 6, 7, 10]
Patients with LCMV infection may report a history of exposure to rodents, hamsters, or the excreta of these animals 1-3 weeks before the onset of symptoms. Infection is most common in the fall. Approximately one third of LCMV infections cause no symptoms, and up to one half of infected individuals have a nonspecific febrile illness without neurologic involvement. The remainder of patients experiences classic biphasic symptoms associated with LCMV infection and meningitis or encephalitis.
- Initial nonspecific symptoms of LCMV infection include the following:
- Nausea or vomiting
- Retro-orbital headache
- Symptoms may subside for 2-4 days and then recur with the following:
- Increased headache
- Stiff neck
- Lethargy (usually mild) ranging to encephalitis
- Occasionally, patients develop the following:
- Paresis or paralysis (extremely rare)
- Arthritis of the hand
- Immunosuppressed individuals may develop hemorrhagic fever syndrome (seen in organ transplant recipients); symptoms include the following:[11, 10]
- Altered mentation/seizures
- Respiratory insufficiency
- Renal/liver dysfunction
- Hemorrhagic foci in multiple tissues
- Neurologic sequelae are rare.
- Complete recovery is the rule, although convalescence may be prolonged.
See the list below:
- Typical clinical features of LCMV infection[4, 6, 7]
- Fever (generally 39-40°C)
- Relative bradycardia
- Nonexudative pharyngitis
- Papilledema (rare)
- Nuchal rigidity (mild)
- Erythematous maculopapular rash (rare)
- Atypical clinical features of LCMV infection
- Alterations in function of cranial, sensory, or autonomic nerves
- Encephalitis rarely observed but may present as psychosis and paraplegia
See the list below:
- LCM is caused by infection with LCMV, a member of the family Arenaviridae.
- LCMV infection is contracted through contact with excretions or secretions from chronically infected rodents. Viral particles are inoculated through the skin or mucous membranes or inhalation of infected aerosols.
- Populations at high risk of LCMV infection include the following:
- Laboratory workers involved in the handling of mice or hamsters
- Individuals who inhabit locales with large mouse populations
- Reported in organ transplant recipients (liver, lung, kidney) in 2003 and 2005
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|Diagnosis||Season||Usual Source||Relative Bradycardia||Pharyngitis||Diarrhea||Parotitis||Orchitis||CSF Glucose level|
|LCM||Fall/winter||Mouse, hamster||+||+/-||-||+/-||+/-||Normal or decreased|
|Typhoid fever||Year-round||Food, water||+||+||+ (late)||-||-||Normal|
|Mumps||Winter/spring||Person||-||-||-||+||+/-||Normal or decreased|