Laboratory Studies

Lymphocytic choriomeningitis virus (LCMV) infection is initially diagnosed based on a suggestive history that is confirmed by various laboratory investigations.^[9]

Complete blood cell (CBC) count may reveal leukopenia and thrombocytopenia early in the course of illness.

The preferred diagnostic modality is assessment of acute and convalescent immunoglobulin M (IgM) and immunoglobulin G (IgG) titers from both the serum and cerebrospinal fluid (CSF). The sensitivity of enzyme-linked immunosorbent assay (ELISA) is greater than that of immunofluorescence (IFA)–based assays. Complement fixation is insensitive and should not be used.^[15]

Immunohistochemical staining, virus culture, and reverse transcription-polymerase chain reaction (RT-PCR) of tissues may be useful.

Typical findings of lumbar puncture are as follows:^[9]

Elevated opening pressure, occasionally with papilledema
Protein concentration from 50-300 mg/dL (can exceed 600 mg/dL) ^[11]
Lymphocytic pleocytosis with several hundred cells/µL (range, 10 to >3000 cells/µL)
Hypoglycorrhachia (in fewer than one third of patients)

Treatment & Management

Armstrong C, Lillie RD. Experimental lymphocytic choriomeningitis of monkeys and mice produced by a virus encountered in studies of the 1933 St. Louis encephalitis epidemic. Public Health Res. 1933. 49:1019–1022. [Full Text].
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Childs JE, Glass GE, Korch GW, et al. Lymphocytic choriomeningitis virus infection and house mouse (Mus musculus) distribution in urban Baltimore. Am J Trop Med Hyg. 1992 Jul. 47(1):27-34. [QxMD MEDLINE Link].
Pedrosa PB, Cardoso TA. Viral infections in workers in hospital and research laboratory settings: a comparative review of infection modes and respective biosafety aspects. Int J Infect Dis. 2011 Jun. 15(6):e366-76. [QxMD MEDLINE Link].
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McKee KT Jr. Hemorrhagic fever virus. Infectious Diseases. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1998. 2249-65.
Seregin A, Yun Nadezhda, Paessler S. Lymphocytic Choriomeningitis, Lassa Fever, and the South American Hemorrhagic Fevers (Arenaviruses). Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015. 2031-2037.
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Oldstone MB. Lessons learned and concepts formed from study of the pathogenesis of the two negative-strand viruses lymphocytic choriomeningitis and influenza. Proc Natl Acad Sci U S A. 2013 Mar 12. 110(11):4180-3. [QxMD MEDLINE Link]. [Full Text].
Barton LL, Mets MB, Beauchamp CL. Lymphocytic choriomeningitis virus: emerging fetal teratogen. Am J Obstet Gynecol. 2002 Dec. 187 (6):1715-6. [QxMD MEDLINE Link].
Mathur G, Yadav K, Ford B, Schafer IJ, Basavaraju SV, Knust B, et al. High clinical suspicion of donor-derived disease leads to timely recognition and early intervention to treat solid organ transplant-transmitted lymphocytic choriomeningitis virus. Transpl Infect Dis. 2017 Aug. 19 (4):[QxMD MEDLINE Link].
Lapošová K, Lukáčiková Ľ, Ovečková I, Pastoreková S, Rosocha J, Kuba D, et al. Development and application of ELISA for the detection of IgG antibodies to lymphocytic choriomeningitis virus. Acta Virol. 2016 Jun. 60 (2):143-50. [QxMD MEDLINE Link].
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Author

Philip J McDonald, MD Fellow, Division of Infectious Diseases, Department of Internal Medicine, Detroit Medical Center, Wayne State University School of Medicine

Philip J McDonald, MD is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America, Michigan Infectious Disease Society, Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John L Brusch, MD, FACP Corresponding Faculty Member, Harvard Medical School

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Mark R Wallace, MD, FACP, FIDSA Infectious Disease Physician, Skagit Valley Hospital, Skagit Regional Health

Disclosure: Nothing to disclose.

Rupal M Mody, MD, MPH Staff Physician

Rupal M Mody, MD, MPH is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

Diane H Johnson, MD Assistant Director, Assistant Professor, Department of Internal Medicine, Division of Infectious Diseases, Winthrop-University Hospital, State University of New York at Stony Brook School of Medicine

Diane H Johnson, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Medical Women's Association, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Sections Lymphocytic Choriomeningitis Virus (LCMV) Infection
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Follow-up
Tables
References

Diagnosis	Season	Usual Source	Relative Bradycardia	Pharyngitis	Diarrhea	Parotitis	Orchitis	CSF Glucose level
LCMV infection	Fall/winter	Mouse, hamster	+	+/-	-	+/-	+/-	Normal or decreased
Typhoid fever	Year-round	Food, water	+	+	+ (late)	-	-	Normal
Enteroviral illness	Summer	Water	-	+	+	-	-	Normal
Arboviral illness^†	Summer	Mosquito	-	-	-	-	-	Normal
Leptospirosis	Summer/fall	Dogs, rats	-	-	-	-	-	Normal
Influenza	Winter	Person	-	+	-	-	-	Normal
Mumps	Winter/spring	Person	-	-	-	+	+/-	Normal or decreased

Lymphocytic Choriomeningitis Virus (LCMV) Infection Workup

Laboratory Studies

References

Tables

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