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Lymphocytic Choriomeningitis

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

Background

Lymphocytic choriomeningitis virus (LCMV) is a single-stranded RNA virus that belongs to the family Arenaviridae (so named because of its appearance on electron microscopy, which resembles grains of sand). Other members of this family include Lassa virus and the Tacaribe group. Infection with LCMV results in a febrile, self-limited, biphasic disease called lymphocytic choriomeningitis (LCM), which is often complicated by aseptic meningitis. Infected but asymptomatic (carrier state) rodents, most commonly house mice, domestic mice, and hamsters, serve as reservoirs for LCMV.[1, 2] LCMV is most commonly transmitted via inhalation of infected excreta. Contamination of skin scratches is an important route of LCMV infection in pet handlers and laboratory technicians.[2, 3]

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Pathophysiology

The initial viremia of LCMV infection (phase 1) extensively seeds extra-CNS tissue. The secondary viremia (phase 2) infects the meninges and, less commonly, the cortical tissue. The leptomeninges are infiltrated mainly by lymphocytes and histiocytes, with few neutrophils. In LCMV encephalitis, the same type of inflammatory cells is observed in the perivascular Virchow-Robin spaces. LCMV is not cytotoxic. It appears that the host's immune response to the infected cells produces the various manifestations of this disease. Natural killer (NK) cells are first to respond, followed by the production of interferon by cytotoxic T cells. In addition, LCMV can suppress the production of acetylcholine neuronal cells in cell culture.[4, 5, 6, 7, 8]

LCM may affect the autonomic nervous system, various sensory modalities, and cranial nerves. Some cases of LCM become chronic, potentially resulting in hydrocephalus. Other organs, especially the testes, heart, and joints, may be involved. Orchitis is usually unilateral. Cardiac involvement is typical of viral myocarditis. The metacarpal phalangeal joint and the proximal interphalangeal joint are the most common sites of arthritis caused by LCM. The objective swelling, redness, and pain resolve within a few weeks.[6, 7, 9]

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Epidemiology

Frequency

United States

The exact incidence of LCMV infection is unknown, although the seroprevalence is approximately 5%. Local variations in the frequency of LCMV infection depend on the rodent populations. LCMV infection in humans is most common in autumn.[7]

International

North America, South America, and Europe are the only continents where LCM has been definitively proven to occur.[7]

Mortality/Morbidity

LCMV infection carries a mortality rate of less than 1%. Death may be attributable to complications of encephalitis or to a massive hemorrhagic syndrome. As with other arenaviruses, immunosuppression may predispose to a fatal hemorrhagic fever syndrome.[10]

Race

LCMV infection has no racial predilection.

Sex

LCMV infection has no sexual predilection.

Age

LCMV infection is more common in young adults, although illness may occur in any age group.[7]

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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)
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
Enteroviral illness Summer Water - + + - - Normal
Arboviral illness Summer Mosquito - - - - - Normal
Leptospirosis Summer/fall Dogs, rats - - - - - Normal
Influenza Winter Person - + - - - Normal
Mumps Winter/spring Person - - - + +/- Normal or decreased
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