Lymphocytic Choriomeningitis Virus (LCMV) Infection Clinical Presentation

Updated: Sep 11, 2017
  • Author: Philip J McDonald, MD; Chief Editor: Burke A Cunha, MD  more...
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Presentation

History

Clinical manifestations of lymphocytic choriomeningitis virus (LCMV) infection in immunocompetent individuals range from a flulike illness to severe CNS involvement with meningoencephalitis. 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 2-4 days, associated with typical signs of aseptic meningitis. [6, 8, 9, 16]

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 autumn. Smoking is a risk factor. [19] 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 experience 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
  • Photophobia
  • Anorexia

Symptoms may subside for 2-4 days and then recur with the following:

  • Increased headache
  • Nuchal rigidity
  • Decreased level of consciousness ranging from lethargy to coma
  • Occasionally, patients develop the following:
    • Orchitis
    • Parotitis
    • Myocarditis or pericarditis
    • Paresis or paralysis (extremely rare)
    • Alopecia
    • Arthritis of the hand

Immunosuppressed individuals (eg, solid organ transplant recipients) may develop a syndrome of multisystem organ involvement including the following: [20, 16]

  • Encephalitis/seizures
  • Respiratory failure
  • Leukopenia
  • Thrombocytopenia
  • Coagulopathy
  • Renal/liver dysfunction
  • Hemorrhagic foci in multiple tissues

Neurologic sequelae are rare but may include chronic headache, hydrocephalus, deafness, transverse myelitis, and Guillain-Barré syndrome. [11]

Complete recovery within 1-3 weeks is the rule, although convalescence may be prolonged.

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Physical

Typical clinical features of LCMV infection are as follows: [6, 8, 9]

  • 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 include the following:

  • Alterations in function of cranial, sensory, or autonomic nerves
  • Encephalitis manifesting as paraplegia or psychosis
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Causes

Infection is caused by the lymphocytic choriomeningitis virus (LCMV), a member of the family Arenaviridae.

Transmission is generally via inhalation of LCMV virions in the aerosolized excreta (urine or feces) from chronically infected rodents. [9]

Transmission is also possible through close contact with infected animals, via direct inoculation through the skin or mucous membranes.

Populations at high risk of LCMV infection include the following:

  • Individuals in locations with large mouse populations, particularly those who directly maintain homes and other properties.
  • Laboratory workers involved in the handling of mice or hamsters
  • Workers at facilities that breed mice for research or feeding purposes [19]
  • Six clusters (five in the United States) of donor-derived infection in solid organ transplant recipients [20, 14]
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