Lymphocytic choriomeningitis in children

Lymphocytic choriomeningitis is an acute viral disease transmitted to a person from mouse rodents, with serous inflammation of the meninges and brain substance 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 transplacental way or by inhalation of infected dust. Infected mice excrete the pathogen with urine, faeces, nasal secretions, while infecting surrounding objects, including food and water sources. Infection of a person occurs alimentary and aerogenic. It is possible to transmit the infection by direct contact, in case of getting the virus on the damaged skin.

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

Prevention of lymphocytic choriomeningitis

It is aimed at destroying house mice and preventing food contamination. Active immunization is not developed.

Causes of lymphocytic choriomeningitis

The causative agent belongs to the family of arenoviruses (Arenavindae, from Latin arena - sand), contains RNA, the virion has a diameter of 60-80 nm. The virus multiplies well in cell cultures derived from embryonic tissues of mice, chickens, human amnion cells, and others.

Pathogenesis of lymphocytic choriomeningitis

The entrance gates of infection are mucous membranes of the upper respiratory tract, gastrointestinal tract or damaged skin. The virus multiplies in regional lymph nodes, then penetrates into the blood and CNS. The virus shows the greatest tropism to the soft medulla, the vascular plexuses of the ventricles of the brain.

Morphologically they note swelling, flushing and lymphocytic infiltration in the soft meninges and adjacent areas of the brain substance. Dystrophic and necrotic changes in nerve cells, diffuse perivascular infiltrates, the phenomena of acute swelling and swelling of the brain substance with disturbances of liquorodynamics 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, cognition, severe headache, general weakness, weakness, repeated vomiting. In most patients, hyperesthesia, sleep disturbance, stiff neck, positive symptoms of Kernig and Brudzinsky are manifested from the first days. They also note weak catarrhal phenomena, photophobia, flushing of the face, pain during movement of eyeballs, injection of vessels of sclera, conjunctiva. Meningeal syndrome reaches maximum severity in the first 1-2 days, in rare cases it can grow gradually, reaching a maximum of 3-5 days of the disease. At the height of the disease, transient encephalitic symptoms are possible: paresis of the facial, oculomotor, diverting and other cranial nerves, pyramidal signs, deafness, rarely convulsive syndrome or loss of consciousness. Often there are positive symptoms of tension, radicular pain syndrome, optic neuritis. With lumbar puncture, increased intracranial pressure is noted. In the cerebrospinal fluid, there is a marked lymphocytic cytosis, a slight increase in the protein content, a positive Pandi reaction. In the blood, changes are not very significant. More often, a small leukopenia, lymphocytosis, a moderate increase in ESR.

Typical forms of lymphocytic choriomeningitis include lymphocytic choriomeningitis and choriomeningoencephalitis, and atypical cases are cases of type ARE (without meningeal symptoms), as well as erased and subclinical forms.

Diagnosis of lymphocytic choriomeningitis

It is based on a characteristic clinical picture of serous meningitis and results of laboratory tests. With lymphocytic choriomeningitis, persistent preservation of meningeal symptoms can occur even after normalization of body temperature, double-wave fever, often there are encephalitic symptoms and cranial nerve damage. In the acute period of the disease, the diagnosis can be confirmed by isolation of the virus from the blood and cerebrospinal fluid. To do this, the test material is injected into the brain of white mice or infects a cell culture, followed by identification of the virus in the DSC or PH, as well as in the RIF. Increasing the antibody titer in the patient's paired sera can be detected with the help of DSC or PH. A diagnostic increase in the titer of specific antibodies is noted for 2-4 weeks of the disease.

Treatment of lymphocytic choriomeningitis

Conduct symptomatic treatment, as in other serous meningitis.

[1], [2], [3], [4], [5], [6], [7]