Pediatric Lymphocytic Choriomeningitis Virus Clinical Presentation

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



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]



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]