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Lymphocytic Choriomeningitis Workup

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

Laboratory Studies

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  • Lymphocytic choriomeningitis virus (LCMV) infection is initially diagnosed based on a suggestive history that is confirmed by various laboratory investigations.[7]
  • Leukopenia and thrombocytopenia may be observed early in the course of illness.
  • LCMV can be isolated from the blood early in the course and, later, from the CSF. LCMV may be isolated from the blood or CSF in either cell culture or the intracerebral inoculation of weanling mice (the most reliable method).
  • Immunohistochemical staining and reverse transcription-polymerase chain reaction (RT-PCR) of tissues may be useful.
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Other Tests

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  • Acute lymphocytic choriomeningitis (LCM) can also be diagnosed via detection of immunoglobulin M (IgM) antibodies by enzyme-linked immunosorbent assay (ELISA) from serum or CSF. This is the preferred diagnostic test.
  • Less than 25% of patients with LCMV infection have depressed CSF glucose levels.
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Procedures

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  • Lumbar puncture: In patients with meningeal signs, CSF is frequently abnormal, consisting of an increased opening pressure, increased protein levels, and a lymphocytic pleocytosis, usually in the range of several hundred WBCs.
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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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