Lymphocytic choriomeningitis in children

Lymphocytic choriomeningitis is an acute viral disease transmitted to humans from mouse-like rodents, with serous inflammation of the meninges and brain tissue with a benign course.

ICD-10 code

A87.2 Lymphocytic choriomeningitis.

Epidemiology

Lymphocytic choriomeningitis is an anthropozoonotic infection, the reservoir of which is mainly house mice. The spread of infection among mice occurs transplacentally or by inhalation of infected dust. Infected mice excrete the pathogen with urine, feces, nasal secretions, thereby infecting surrounding objects, including food and water sources. Humans become infected by alimentary and airborne routes. Transmission of infection is possible through direct contact, if the virus gets on damaged skin.

Benign lymphocytic choriomeningitis affects mainly children living in rural areas. Sporadic cases are usually recorded, but limited epidemic outbreaks are also possible. The greatest number of cases occurs in autumn and winter, which is associated with the migration of rodents to populated areas.

Prevention of lymphocytic choriomeningitis

Aimed at exterminating house mice and preventing contamination of food products. Active immunization has not been developed.

Causes of lymphocytic choriomeningitis

The pathogen belongs to the family of arenaviruses (Arenavindae, from Latin arena - sand), contains RNA, the virion has a diameter of 60-80 nm. The virus reproduces well in cell cultures obtained from the embryonic tissues of mice, chickens, in human amnion cells, etc.

Pathogenesis of lymphocytic choriomeningitis

The entry points for infection are the mucous membranes of the upper respiratory tract, gastrointestinal tract, or damaged skin. The virus multiplies in regional lymph nodes, then penetrates the blood and central nervous system. The virus has the greatest tropism for the soft meninges, vascular plexuses of the cerebral ventricles.

Morphologically, edema, hyperemia and lymphocytic infiltration in the soft meninges and adjacent areas of the brain matter are noted. Dystrophic and necrotic changes in nerve cells, diffuse perivascular infiltrates, acute edema and swelling of the brain matter with disturbances in cerebrospinal fluid dynamics are expressed.

Symptoms of lymphocytic choriomeningitis

The incubation period of lymphocytic choriomeningitis is from 5 to 12 days. The disease begins acutely, with a rise in body temperature to 39-40 °C, chills, severe headache, general weakness, fatigue, repeated vomiting. Most patients from the first days show hyperesthesia, sleep disturbance, stiff neck, positive Kernig and Brudzinsky symptoms. Weak catarrhal phenomena, photophobia, facial hyperemia, pain when moving the eyeballs, injection of the vessels of the sclera, conjunctiva are also noted. Meningeal syndrome reaches its maximum severity already in the first 1-2 days, in rare cases it can increase gradually, reaching a maximum on the 3-5th day of the disease. At the height of the disease, transient encephalitic symptoms are possible: paresis of the facial, oculomotor, abducens and other cranial nerves, pyramidal signs, stupor, rarely convulsive syndrome or loss of consciousness. Tension symptoms, radicular pain syndrome, optic neuritis are often positive. Increased intracranial pressure is noted during lumbar puncture. Pronounced lymphocytic cytosis, some increase in protein content, and a positive Pandy reaction are found in the cerebrospinal fluid. Changes in the blood are insignificant. Most often, slight leukopenia, lymphocytosis, and a moderate increase in ESR are detected.

Typical forms of lymphocytic choriomeningitis include lymphocytic choriomeningitis and choriomeningoencephalitis, while atypical forms include cases that occur as acute respiratory viral infections (without meningeal symptoms), as well as latent and subclinical forms.

Diagnosis of lymphocytic choriomeningitis

Based on the characteristic clinical picture of serous meningitis and the results of laboratory tests. In lymphocytic choriomeningitis, meningeal symptoms may persist even after normalization of body temperature, two-wave fever, encephalitic symptoms and damage to the cranial nerves often appear. In the acute period of the disease, the diagnosis can be confirmed by isolating the virus from the blood and cerebrospinal fluid. For this, the test material is injected into the brain of white mice or a cell culture is infected with subsequent identification of the virus in the CSC or RN, as well as in the RIF. An increase in the antibody titer in paired sera of the patient can be detected using the CSC or RN. A diagnostic increase in the titer of specific antibodies is noted on the 2nd-4th week of the disease.

Treatment of lymphocytic choriomeningitis

Symptomatic treatment is carried out, as with other serous meningitis.

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