Pediatric Lymphocytic Choriomeningitis Virus Clinical Presentation

Updated: Aug 15, 2018
  • Author: J Michael Klatte, MD; Chief Editor: Russell W Steele, MD  more...
  • Print
Presentation

History

Acquired lymphocytic choriomeningitis virus (LCMV) infection

One third of infections are subclinical.

One half of the clinical infections have neurologic involvement.

The typical biphasic disease is composed of a nonspecific influenza-like illness, followed by typical viral aseptic meningitis.

The first phase includes a fever, a headache, lymphadenopathy, and a maculopapular rash lasting 3-5 days.

A more severe headache, photophobia, a stiff neck, vomiting, and lethargy follow after approximately 4 days.

Patients may have a history of rodent exposure 1-3 weeks earlier (often 6-13 d, but may extend to 3 wk).

Other symptoms commonly seen include more prolonged fevers, malaise, myalgias, nausea or vomiting, a retro-orbital headache, anorexia, weakness, a sore throat, a cough, and seizures.

Unusual symptoms include orchitis, parotitis, pancreatitis, myocarditis, paresis or paralysis, alopecia, and arthritis (involving the metacarpophalangeal and proximal interphalangeal joints).

Congenital infection

Approximately 50-63% of mothers remember having had a nonspecific influenza-like illness during pregnancy.

Approximately 25-46% of mothers remember having had rodent exposure.

Next:

Physical

Acquired infection

Typical findings are nonspecific.

A fever up to 102-104°F (39-40°C) is typical.

Relative bradycardia may be present.

Diffuse lymphadenopathy, a maculopapular rash, or both may be present.

Pharyngitis without exudates may occur.

A stiff neck is common with CNS involvement.

Unusual manifestations include arthritis of the metacarpophalangeal and proximal interphalangeal joints; hepatosplenomegaly; papilledema; deafness; paralysis; and findings suggestive of unilateral orchitis, viral myocarditis, pneumonitis, psychosis, transverse myelitis, Guillain-Barré syndrome, transient or permanent hydrocephalus, and encephalitis.

Congenital infection

Neonates are usually appropriate for gestational age and are born at term.

Approximately 88-93% of infants have chorioretinopathy and/or other ocular manifestations, including chorioretinitis, scarring, atrophy, nystagmus, esotropia, microphthalmos, cataracts, and vitreitis. [14]

Approximately 34-43% of infants have macrocephaly. [14]

Hydrocephalus or intracranial periventricular calcifications have been documented in approximately 90% of infants who have undergone imaging studies.

Approximately 13-38% of infants have microcephaly, which is usually due to cortical dysplasia or atrophy. [14]

Hearing loss occurs in approximately 7% of cases, is typically bilateral and sensorineural, and auditory deficits in those affected range from severe to profound. [15]

Lack of involvement of multiple organ systems (namely, rarity of skin rashes, hepatosplenomegaly, and/or cardiac involvement) helps to differentiate congenital LCMV from other congenital infections. [1]

Previous
Next:

Causes

Exposure to the virus in feces, urine, semen, saliva, rodent blood, or transplanted organs [16] may result in human infection. Those with occupational exposure to mice are at risk for infection. [17]

Previous