Clinical Background
Lymphocytic choriomeningitis viral (LCMV) infection is prevalent among mice, and is an uncommonly diagnosed cause of illness in immunocompetent patients.
Epidemiology
- Incidence - <5% seropositivity in U.S. adults
- Transmission
- Rodents are the primarily reservoir
- Transmission to humans
- Aerosolization of excreta and secreta of the common house mouse, pet hamster and pet rats
- Recent reports of solid organ transplant transmission
Organism
- RNA virus in the Arenavirus 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 include orchitis, aseptic meningitis, transient alopecia and maculopapular rash
- Congenital infections (hydrocephalus, chorioretinitis, or TORCH-negative hydrocephalus) may cause stillbirths.
Treatment
See Also
Diagnosis
Diagnosis
- Indications for testing - immunocompromised patient with influenzal-like illness and associated meningitis
- Laboratory testing
- Antibody testing by CF of serum and CSF
Differential Diagnosis
- Arboviruses
- Bacterial meningitis
- Influenza
- Listeria
- Rickettsia
- Tickborne illness
- WNV
Tests generally appear in the order most useful for common clinical situations
| Test name: Lymphocytic Choriomeningitis (LCM) Antibody by CF
|
| ARUP #: 0050360 |
| Methodology: Complement Fixation
|
| Use: Identify LCM as pathogen for meningitis |
| Limitations: Complement Fixation (CF) antibodies to LCM take several weeks to develop, disappear within a few months, are generally of low titer and may not be detected in all cases with recent infections |
| Test name: Lymphocytic Choriomeningitis (LCM) Antibody by CF, CSF
|
| ARUP #: 0054450 |
| Methodology: Complement Fixation
|
| Use: Identify LCM as pathogen for meningitis |
| Limitations: Complement Fixation (CF) antibodies to LCM take several weeks to develop, disappear within a few months, are generally of low titer and may not be detected in all cases with recent infections |
References
General References
Bale JF Jr. Congenital infections. Neurol Clin.
2002;
20(
4):
1039-60, vii.
Barton LL, Mets MB. Congenital lymphocytic choriomeningitis virus infection: decade of rediscovery. Clin Infect Dis.
2001;
33(
3):
370-374.
Jamieson DJ, Kourtis AP, Bell M, Rasmussen SA. Lymphocytic choriomeningitis virus: an emerging obstetric pathogen?. Am J Obstet Gynecol.
2006;
194(
6):
1532-1536.
Kotton CN. Zoonoses in solid-organ and hematopoietic stem cell transplant recipients. Clin Infect Dis.
2007;
44(
6):
857-866.
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.
Sejvar JJ. The evolving epidemiology of viral encephalitis. Curr Opin Neurol.
2006;
19(
4):
350-357.
Medical Reviewers
Litwin, Christine, M.D. Medical Director, Immunology at ARUP Laboratories; Professor, Clinical Pathology, University of Utah
Comprehensive Review: September 2008
Last Update: September 2008
