Acute lymphocytic choriomeningitis: causes, symptoms, diagnosis, treatment

Causes of acute lymphocytic choriomeningitis

The causative agent of acute lymphocytic choriomeningitis is a filterable virus isolated by Armstrong and Lilly in 1934. The main reservoir of the virus is gray house mice, which excrete the pathogen with nasal mucus, urine and feces. Humans become infected by eating food products infected by mice, as well as by airborne droplets when inhaling dust. Acute lymphocytic choriomeningitis is often sporadic, but epidemic outbreaks are also possible.

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Symptoms of acute lymphocytic choriomeningitis

The incubation period of acute lymphocytic choriomeningitis is from 6 to 13 days. A prodromal period is possible (fatigue, weakness, catarrhal inflammation of the upper respiratory tract), after which the body temperature suddenly rises to 39-40 °C and within a few hours a pronounced meningeal syndrome develops with severe headache, repeated vomiting and (often) clouding of consciousness. A visceral or flu-like phase of infection is characteristic, preceding the development of meningitis. The temperature curve is two-wave, the beginning of the second wave coincides with the appearance of meningeal symptoms.

Sometimes congestive changes are found in the fundus. In the first days of the disease, transient paresis of the eye and facial muscles is possible. The cerebrospinal fluid is transparent, the pressure is significantly increased, pleocytosis is within several hundred cells in 1 μl, usually mixed (lymphocytes predominate), later lymphocytic. The content of protein, glucose and chlorides in the cerebrospinal fluid is within normal limits.

Diagnosis of acute lymphocytic choriomeningitis

Etiological diagnostics is performed by isolating the virus, as well as using the neutralization reaction and the complement fixation reaction. Differential diagnostics are performed with tuberculous meningitis, as well as with other acute meningitis caused by the viruses of influenza, mumps, tick-borne encephalitis, poliomyelitis, Coxsackie, ECHO, herpes.

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Treatment of acute lymphocytic choriomeningitis

Specific therapy for viral serous meningitis is aimed directly at the virion, which is in the stage of active reproduction and lacks a protective shell.

The principles of therapy for serous meningitis aimed at preventing or limiting the development of irreversible cerebral disorders are as follows: protective regimen, use of etiotropic drugs, reduction of intracranial pressure, improvement of blood supply to the brain, normalization of brain metabolism.

Patients with meningitis should be on bed rest until complete recovery (until the cerebrospinal fluid is completely normalized), despite normal body temperature and the disappearance of pathological symptoms. Tilorone (a drug that has a direct antiviral effect on DNA and RNA viruses, 0.06-0.125 g once a day for 5 days, then every other day for up to 14 days), recombinant interferons are used as etiotropic therapy. In severe cases, when vital functions are at risk, immunoglobulins are administered intravenously.

It is advisable to use antibiotics for serous viral meningitis only if bacterial complications develop. In the complex treatment of viral meningitis, a protective regimen for 3-5 weeks is mandatory. If necessary, detoxification and symptomatic therapy is prescribed. In case of intracranial hypertension (increased cerebrospinal fluid pressure >15 mm Hg), dehydration is used (furosemide, glycerol, acetazolamide).

A lumbar puncture is performed to unload the cerebrospinal fluid and slowly remove 5-8 ml. In severe cases (when meningitis or encephalitis is complicated by cerebral edema), mannitol is used. Sodium polydihydroxyphenylene thiosulfonate (0.25 g 3 times a day for up to 2-4 weeks), an antioxidant and third-generation antihypoxant, is highly effective. Since sodium polydihydroxyphenylene thiosulfonate also stimulates the antiviral activity of monocytes and inhibits the process of primary fixation of the virus on the cell membrane, its early and combined use with antiviral drugs (tilorone) not only promotes rapid relief of inflammatory changes in the cerebrospinal fluid, but also prevents the formation of residual manifestations.

In serous meningitis, it is necessary to use drugs that improve neurometabolism: nootropics [pyritinol, gamma-hydroxybutyric acid (calcium salt), choline alfoscerate, hopantenic acid, etc.] in combination with vitamins. In the acute period, intravenous administration of ethylmethylhydroxypyridine succinate is possible at 0.2 ml/kg per day for children and 4-6 ml/day for adults.

In the presence of focal symptoms, among neurometabolic agents, preference should be given to the central cholinomimetic choline alfoscerate (prescribed at a dose of 1 ml/5 kg of body weight intravenously by drip, 5-7 infusions, then orally at a dose of 50 mg/kg per day for up to 1 month).

After the acute period of serous meningitis or in the presence of residual manifestations, a course of treatment is carried out with polypeptides of the cerebral cortex of cattle at a dose of 10 mg/day intramuscularly, 10-20 injections 2 times a year, etc.

Prevention of acute lymphocytic choriomeningitis

Anti-epidemic measures are carried out in accordance with the peculiarities of the etiology and epidemiology of meningitis. In the case of acute lymphocytic choriomeningitis, the main attention is paid to the fight against rodents in residential and office premises, in the case of meningitis of other etiologies - to increasing the non-specific resistance of the organism, as well as specific prevention.