Indications for Testing

• Immunocompromised patient with influenza-like illness and associated meningitis

Laboratory Testing

• Antibody testing by complement fixation of serum and cerebrospinal fluid

Differential Diagnosis

• Arboviruses
• Bacterial meningitis
• Influenza
• Listeria monocytogenes
• Rickettsia typhi (typhus fever)
• Tickborne illness
  • Borrelia burgdorferi (Lyme disease)
  • Ehrlichiosis
  • Rickettsia rickettsii (Rocky Mountain spotted fever)
• West Nile virus

Lymphocytic choriomeningitis (LCM) virus is spread by rodents. It can be deadly to immunocompromised patients but rarely affects healthy individuals.

Epidemiology

• Incidence – <5% seropositivity in U.S. adults
• Transmission
  • Rodents are the primary reservoir
  • Transmission to humans
    • Aerosolization of excreta and secreta of the common house mouse, pet hamster and pet rat
    • Recent reports of solid organ transplant transmission

Organism

• RNA virus in the Arenaviridae family

Risk Factors

• Immunocompromised state
• Pregnancy

Clinical Presentation

• Symptoms develop 5-10 days after exposure
  • Infection usually presents as an acute influenza-like illness
    • Most patients develop fevers of 101-104° F with chills and muscle rigidity
  • Other symptoms may include malaise, retro-orbital headache, photophobia, weakness, anorexia, nausea, light-headedness and sore throat
• Symptoms usually improve within 5 days to 3 weeks; patients may suffer relapse with meningeal symptoms
• Suspect in patients with marked leukopenia and thrombocytopenia on presentation
• Associated conditions – orchitis, aseptic meningitis, transient alopecia and maculopapular rash
• Congenital infections may cause stillbirths – hydrocephalus, chorioretinitis, or TORCH-negative hydrocephalus

Treatment

• Treatment is symptomatic

Tests generally appear in the order most useful for common clinical situations

General

• Jamieson DJ, Kourtis AP, Bell M, Rasmussen SA. Lymphocytic choriomeningitis virus: an emerging obstetric pathogen?. Am J Obstet Gynecol. 2006; 194 (6) :1532-1536.PubMed
• Kang SS, McGavern DB. Lymphocytic choriomeningitis infection of the central nervous system. Front Biosci. 2008; 13 :4529-4543.PubMed
• Kotton CN. Zoonoses in solid-organ and hematopoietic stem cell transplant recipients. Clin Infect Dis. 2007; 44 (6) :857-866.PubMed
• Rawlinson WD, Hall B, Jones CA, Jeffery HE, Arbuckle SM, Graf N, Howard J, Morris JM. Viruses and other infections in stillbirth: what is the evidence and what should we be doing?. Pathology. 2008; 40 (2) :149-160.PubMed
• Sejvar JJ. The evolving epidemiology of viral encephalitis. Curr Opin Neurol. 2006; 19 (4) :350-357.PubMed

Acanthamoeba and Naegleria
Arboviruses
Dengue Fever Virus
Herpes Simplex Virus
Herpesvirus 6
Leptospira Species
Meningitis, Acute