Pediatric Lymphocytic Choriomeningitis Virus Workup

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

Laboratory Studies

The following studies are indicated in lymphocytic choriomeningitis virus (LCMV)

CBC count

Findings may include leukopenia, thrombocytopenia, or both early in infection.

Liver function tests

Findings may show mildly elevated serum transaminase and bilirubin levels.

Serology tests

An immunofluorescence assay that detects both immunoglobulin G (IgG) and immunoglobulin M (IgM) is commercially available and is the preferred test.

An enzyme-linked immunosorbent assay for IgM and IgG on serum or cerebrospinal fluid (CSF) is available at the Centers for Disease Control and Prevention.

A complement fixation assay exists but is insensitive and its use is discouraged for congenital and acquired infection.

The virus may be isolated from blood early in infection, from CSF later in infection, and, rarely, from urine or nasopharyngeal specimens using cell culture or direct intracerebral inoculation of weanling mice.

CSF examination

Elevated protein levels may be found.

Glucose levels are low in 25% of patients and are within the reference range in 75% of patients.

Lymphocytic pleocytosis is typical, with less than 30 to more than 8000 WBCs present.

One case of eosinophilic meningitis has been reported.

Polymerase chain reaction

This modality is used in research laboratories for the detection of the virus. A clinical assay is being validated. [18]

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Imaging Studies

Brain CT scanning

CT findings in infants with congenital LCMV infection may include noncommunicating hydrocephalus, cortical dysplasia and microcephaly, periventricular calcifications, and/or cerebellar hypoplasia.

Hydrocephalus or intracranial calcifications occur in 89% of affected newborns. [14]

Chest radiography

Diffuse infiltrates are rarely depicted.

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Procedures

Lumbar puncture

Findings may reveal increased opening pressure and provide CSF for testing.

Biopsy

For solid organ transplant recipients with suspected LCMV infection:

Biopsy of the transplanted organ, followed by immunohistochemical staining of the biopsy specimen, may reveal LCMV antigens within the affected donor organ tissues. [2]

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Histologic Findings

The leptomeninges are infiltrated by lymphocytes and histiocytes with few polymorphonuclear cells. This mononuclear cell infiltration may involve the meninges, choroid plexus, and ependyma.

Brain involvement results in infiltration of the perivascular Virchow-Robin spaces, cerebromalacia, neuroanalysis, glial proliferation, and perivascular edema.

Distinct findings in the fetus may include lymphocytic myocarditis and extramedullary hematopoiesis.

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