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Lymphocytic Choriomeningitis Clinical Presentation

  • Author: Rupal M Mody, MD, MPH; Chief Editor: Burke A Cunha, MD  more...
 
Updated: Oct 02, 2014
 

History

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:
    • Fever
    • Malaise
    • Myalgias
    • Nausea or vomiting
    • Retro-orbital headache
    • Anorexia
  • 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:
      • Orchitis
      • Parotitis
      • Myocarditis
      • Paresis or paralysis (extremely rare)
      • Alopecia
      • 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
    • Leukopenia
    • Thrombocytopenia
    • Coagulopathy
    • Renal/liver dysfunction
    • Hemorrhagic foci in multiple tissues
  • Neurologic sequelae are rare.
  • Complete recovery is the rule, although convalescence may be prolonged.
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Physical

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)
    • Lymphadenopathy
  • Atypical clinical features of LCMV infection
    • Psychosis
    • Paralysis
    • Alterations in function of cranial, sensory, or autonomic nerves
    • Encephalitis rarely observed but may present as psychosis and paraplegia
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Causes

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.[7]
  • 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[11]
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Contributor Information and Disclosures
Author

Rupal M Mody, MD, MPH Staff Physician

Rupal M Mody, MD, MPH is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians, 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, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.

Acknowledgements

Diane H Johnson, MD Assistant Director, Assistant Professor, Department of Internal Medicine, Division of Infectious Diseases, Winthrop-University Hospital, State University of New York at Stony Brook School of Medicine

Diane H Johnson, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Medical Women's Association, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References
  1. Brown D, Lloyd G. Zoonotic virus. Infectious Diseases. Philadelphia, Pa: Mosby; 1999. 11.1-11.14.

  2. Childs JE, Glass GE, Korch GW, et al. Lymphocytic choriomeningitis virus infection and house mouse (Mus musculus) distribution in urban Baltimore. Am J Trop Med Hyg. 1992 Jul. 47(1):27-34. [Medline].

  3. Pedrosa PB, Cardoso TA. Viral infections in workers in hospital and research laboratory settings: a comparative review of infection modes and respective biosafety aspects. Int J Infect Dis. 2011 Jun. 15(6):e366-76. [Medline].

  4. Cunha BA. Meningitis. Schlossberg D, ed. Central Nervous System Infections. New York, NY: Springer-Verlag; 1990.

  5. Farmer TW, Janeway CA. Infection with the virus of lymphocytic choriomeningitis. Medicine (Baltimore). 1942. 2:11.

  6. McKee KT Jr. Hemorrhagic fever virus. Infectious Diseases. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1998. 2249-65.

  7. Peters CJ. Lymphocytic choriomeningitis virus, Lassa Virus, and the South American Hemorrhagic Fevers. Mandell, Douglas, Bennett, eds. Principles and Practice of Infectious Diseases. 6th ed. New York, NY: Churchill Livingstone; 2005. 2090-6.

  8. Wilson MR, Peters CJ. Diseases of the central nervous system caused by lymphocytic choriomeningitis virus and other arenaviruses. Handb Clin Neurol. 2014. 123:671-81. [Medline].

  9. Oldstone MB. Lessons learned and concepts formed from study of the pathogenesis of the two negative-strand viruses lymphocytic choriomeningitis and influenza. Proc Natl Acad Sci U S A. 2013 Mar 12. 110(11):4180-3. [Medline]. [Full Text].

  10. Peters CJ. Lymphocytic choriomeningitis virus--an old enemy up to new tricks. N Engl J Med. 2006 May 25. 354(21):2208-11. [Medline].

  11. Fischer SA, Graham MB, Kuehnert MJ, Kotton CN, Srinivasan A, Marty FM. Transmission of lymphocytic choriomeningitis virus by organ transplantation. N Engl J Med. 2006 May 25. 354(21):2235-49. [Medline].

  12. Razonable RR. Rare, unusual, and less common virus infections after organ transplantation. Curr Opin Organ Transplant. 2011 Dec. 16(6):580-7. [Medline].

  13. Barton LL. LCMV transmission by organ transplantation. N Engl J Med. 2006 Oct 19. 355(16):1737; author reply 1737-8. [Medline].

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Table 1. Differential Diagnosis of Lymphocytic Choriomeningitis (LCM)
DiagnosisSeasonUsual SourceRelative BradycardiaPharyngitisDiarrheaParotitisOrchitisCSF Glucose level
LCMFall/winterMouse, hamster++/--+/-+/-Normal or decreased
Typhoid feverYear-roundFood, water+++ (late)--Normal
Enteroviral illnessSummerWater-++--Normal
Arboviral illnessSummerMosquito-----Normal
LeptospirosisSummer/fallDogs, rats-----Normal
InfluenzaWinterPerson-+---Normal
MumpsWinter/springPerson---++/-Normal or decreased
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