Lymphocytic Choriomeningitis Virus: Reemerging Central Nervous System Pathogen

Abstract

ABSTRACT. Lymphocytic choriomeningitis virus (LCMV), a human zoonosis caused by a rodent-borne arenavirus, has been associated with both postnatal and intrauterine human disease. Infection in man is acquired after inhalation, ingestion, or direct contact with virus found in the urine, feces, and saliva of infected mice, hamsters, and guinea pigs. Congenital LCMV infection is a significant, often unrecognized cause of chorioretinitis, hydrocephalus, microcephaly or macrocephaly, and mental retardation. Acquired LCMV infection, asymptomatic in approximately one third of individuals, is productive of central nervous system manifestations in one half of the remaining cases. Aseptic meningitis or meningoencephalitis are the predominant syndromes, although transverse myelitis, a Guillain-Barré-type syndrome, as well as transient and permanent acquired hydrocephalus have also been reported. Fatalities are rare. We report a patient with meningoencephalitis attributable to LCMV and discuss the spectrum of central nervous system disease, newer diagnostic modalities, and preventive strategies. The devastating sequelae of congenital infection include chorioretinitis, hydrocephalus, microcephaly or macrocephaly, intracranial calcifications, mental retardation, and seizures. Acquired LCMV disease, however, has received relatively scant attention. 1,5 We report a patient with meningoencephalitis caused by LCMV to increase physician awareness of this potentially preventable infection. This case also illustrates the diagnostic conundrum LCMV infection may pose, when the initial history of illness does not elicit rodent exposure. CASE REPORTA 17-year-old girl was referred for admission to University Medical Center on December 26, 1998 with a 1-week history of headache, dizziness, nausea, vomiting, tactile fever, and cerebrospinal fluid (CSF) pleocytosis noted on lumbar puncture. The patient had ingested nonsteroidal antiinflammatory drugs with only temporary relief. She denied concurrent upper respiratory symptoms, diarrhea, or rash. At the referring institution a complete blood count, serum electrolytes, and lumbar puncture were performed. Hemoglobin was 14.2 g/dL; hematocrit was 40.2%; and white blood cell count was 16 500/mm 3 with 84% polymorphonuclear cells, 9% lymphocytes, and 7% monocytes; platelet count was 364 000/mm 3 . CSF contained 1 red blood cell and 9760 white blood cells/mm 3 (100% mononuclear cells). CSF protein was 231 mg/dL; glucose was 58 mg/dL; and serum glucose was 137 mg/dL. No organisms were seen on Gram stain. The patient received 1 g of ceftriaxone before transport. On admission to University Medical Center her temperature was 37.5°C, heart rate 80 beats per minute, respiratory rate 16 per minute, and blood pressure 108/68 mm Hg. She had normal fundoscopic and neurologic examinations with the exception of mild hyperreflexia. Her neck was supple with full range of motion.Additional questioning of the patient revealed significant exposure to cats, dogs, and mice at home. Viral cultures of nasopharyngeal, o...

Viral encephalitis

“…LCMV usually cause aseptic meningitis, but encephalitis may be diagnosed in about 5% to 34% of serologically confirmed LCMV cases 22 . Other neurological complications reported are ascending paralysis, bulbar syndromes, Parkinsonism features, and sensorineural hearing loss.…”

Diseases of the central nervous system caused by lymphocytic choriomeningitis virus and other arenaviruses

“…LCMV infection in a pregnant woman can spread to the fetus, resulting in abortion early in pregnancy (Deibel et al, 1975) or malformations, including hydrocephalus, intracranial calcifications, and chorioretinitis if the infection occurs later in pregnancy (Ackermann et al, 1974;Sheinbergas, 1975;Barton et al, 1993Barton et al, , 1996Wright et al, 1997;Marrie and Saron, 1998;Barton and Hyndman, 2000;Jamieson et al, 2006;Bonthius et al, 2007b). A study by Bonthius and colleagues (2007b) reports on 20 children with serologically confirmed congenital LCMV infection who were followed for up to 11 years.…”

Lymphocytic choriomeningitis infection of the central nervous system

“…Congenital LCMV infection acts as an abortifacient and a fetal teratogen commonly manifested as chorioretinitis, hydrocephalus and microcephaly or macrocephaly (5-9). Adult infection with LCMV can lead to the development of fever, malaise, headaches, seizure and in some cases fatal meningitis (3,(10)(11)(12)(13). Through the study of murine models of infection, a mechanistic understanding of LCMV induced immunopathology can be gained and applied to human disease.…”