Acute lymphocytic choriomeningitis: causes, symptoms, diagnosis, treatment

Causes of acute lymphocytic choriomeningitis

The causative agent of acute lymphocytic choriomeningitis is a filtering virus isolated by Armstrong and Lilly in 1934. The main reservoir of the virus is gray house mice that excrete the pathogen with nasal mucus, urine and feces. Infection of a person occurs due to the use of food products infected with mice, as well as airborne droplets when inhaled dust. Acute lymphocytic choriomeningitis is more often sporadic, but epidemic outbreaks are also possible.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]

Symptoms of acute lymphocytic choriomeningitis

The incubation period of acute lymphocytic choriomeningitis is from 6 to 13 days. Possible prodromal period (weakness, weakness, catarrh of the upper respiratory tract), after which the body temperature suddenly rises to 39-40 ° C and within several hours develops a pronounced shell syndrome with severe headache, repeated vomiting and (often) obscuration of consciousness. Characteristic visceral or influenza-like phase of infection, 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 there are stagnant changes in the fundus. In the early days of the disease, transitory pareses of the eye and facial muscles are possible. Liquor is transparent, the pressure is significantly increased, pleocytosis - within several hundred cells in 1 μl, usually mixed (lymphocytes predominate), later lymphocyte. The content of protein, glucose and chloride in the liquor is within normal limits.

Diagnosis of acute lymphocytic choriomeningitis

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

[13], [14], [15], [16]

Treatment of acute lymphocytic choriomeningitis

Specific therapy of viral serous meningitis is directed 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 formation of irreversible cerebral disorders are the following: a protective regime, the use of etiotropic drugs, a decrease in intracranial pressure, an improvement in the blood supply to the brain, and the normalization of brain metabolism.

Patients with meningitis should be on bed rest until the final recovery (before the complete normalization of the cerebrospinal fluid), despite the normal body temperature and the disappearance of pathological symptoms. As a means of etiotropic therapy, tilorone is used (a drug that exerts a direct antiviral effect on DNA and RNA viruses, 0,06-0,125 g once a day for 5 days, then every other day up to 14 days), recombinant interferons. In severe cases, with a threat to vital functions, immunoglobulins are administered intravenously.

To apply antibiotics in serous viral meningitis is advisable only with the development of bacterial complications. In the complex treatment of viral meningitis, a protective regime for 3-5 weeks is mandatory. If necessary, prescribe detoxification and symptomatic therapy. With intracranial hypertension (increased liquor pressure> 15 mm Hg), dehydration (furosemide, glycerol, acetazolamide) is used.

Conduct a discharge lumbar puncture with a slow elimination of 5-8 ml of CSF. In severe cases (with complication of meningitis or encephalitis with edema of the brain) use mannitol. Highly effective use of sodium polydihydroxyphenylenethiosulfonate (0.25 g three times a day to 2-4 weeks) is an antioxidant and antihypoxant III generation. Due to the fact that sodium polydihydroxyphenylenethiosulfonate also stimulates the antiviral activity of monocytes and inhibits the primary fixation of the virus on the cell membrane, its early and combined use with antiviral drugs (tilorone) contributes not only to rapid relief of inflammatory changes in CSF, but also prevents the formation of residual manifestations.

It is mandatory for serous meningitis to use drugs that improve neurometabolism: nootropics [pyrithinol, gamma-hydroxybutyric acid (calcium salt), choline alphoscerate, gopanthenic acid, etc.] in combination with vitamins. In an acute period, intravenous injection of ethylmethyl hydroxypyridine succinate 0.2 ml / kg daily for children and 4-6 ml / day for adults.

In the presence of focal symptoms among neurometabolic agents, central cholinomimetics of choline alfoscerate should be preferred (1 ml / 5 kg of body weight is administered intravenously, 5-7 infusions, then inside at a dose of 50 mg / kg per day for up to 1 month).

After an acute period of serous meningitis or in the presence of residual manifestations, a course of treatment with polypeptides of the cerebral cortex at a dose of 10 mg / day intramuscularly, 10-20 injections twice a year,

Prevention of acute lymphocytic choriomeningitis

Anti-epidemic measures are carried out in accordance with the features of the etiology and epidemiology of meningitis. When acute lymphocytic choriomeningitis occurs, the main attention is paid to the control of rodents in residential and office premises, with meningitis of another etiology - an increase in nonspecific resistance of the organism, as well as specific prevention.