CNS Infections- Viral Meningitis- HHV 2 & LCMV

Question 1

Lymphocytic choriomeningitis virus (LCMV) is indicated when a patient presents with

Answer 1

genital herpes plus fever and an aseptic meningitis

called lymphocytic choriomeningitis

Question 2

LCM virus is an _____

Answer 2

arenavirus

-LMCV is a common agent of viral CNS illness in US

Question 3

Describe LMCV

Answer 3

1. Resistant to drying - important for understanding for transmission of virus to humans.
2. an enveloped virus with a helical nucleocasid containing an RNA genome

Question 4

At least 7 arenaviruses infect humans; the 2 most important are:

Answer 4

1. LCM

2. Lassa virus (causes Lassa fever)

Question 5

Whitewater Arroyo virus is passed by inhalation of ______ and causes hemorrhagic fever in humans

Answer 5

infected rat urine

Question 6

Animal reservoirs have a chronic, life-long viremia (they shed virus life-long in feces, urine):
–> List animals

Answer 6

1. Mice, especially the house mouse (Mus musculus), is the primary reservoir with a variable (3% → 40%) rates of infection.
2. Hamsters
3. Other rodents

Question 7

LMCV is spread from rodents to humans via:

Answer 7

1. direct contact with infected animals (i.e., infected pet)
2. inhalation of aerosols or dusts containing virus in urine, feces, tissues
3. ingestion of contaminated food

Question 8

Peak incidence of disease is in the ________ and humans inhale aerosols or dusts contaminated with the virus in rodent urine, feces, tissues.

Answer 8

winter (when infected mice come into houses)

Question 9

LMCV may cause systemic disease and death in __________. It is an often undetected cause of ________.

Answer 9

immunocompromised patients

sporadic and epidemic congenital infection

Question 10

CNS infection results in a prolonged inflammation, with a dense, perivascular infiltration of the meninges and all parts of the brain with ____________, this is called a _________.

Answer 10

macrophages and lymphocytes (T cells attack infected nerve cells)

lymphocytic pleocytosis

Question 11

LCMV is a significant and undiagnosed _________.

Answer 11

human teratogen

Question 12

LCMV has a 10→14 day incubation period and when symptoms start it has a biphasic course, presenting with:

Answer 12

“Grippe”, a flu-like illness of variable duration, short to persists for a long time (few days→ weeks → months), is the most common manifestation of LCMV disease

Question 13

After defervescence (the flu-like illness is resolving), the pateint may progress to _______ (~25% of all persons infected with LCMV develop this.

Answer 13

CNS disease

Question 14

CNS disease is a subacute meningitis (persists for several months) with classic triad of symptoms:

Answer 14

1. fever
2. headache
3. nuchal rigidity
   - ->a transient paralysis may also occur

Question 15

Other CNS syndromes rarely occur from LCMV and include:

Answer 15

1. Encephalitis (diffuse)
2. transverse myelitis
3. Guillain-Barré syndrome

Question 16

Prenatal infection (in utero) especially in first and second trimester can be teratogenic &/or result in:

Answer 16

• spontaneous abortion
• chorioretinitis
• microcephaly/macrocephaly
• hydrocephalus

Most (@75%) children that survive have serious neurological sequelae

Question 17

Differential

Answer 17

STORCH, enteroviruses, HBV-B19

Question 18

To diagnose:

Answer 18

• history of rodent contact
• CSF specimen + fluorescent antibody test
• acute & convalescent sera
• Virus recovery by animal inoculation can be done BUT is a laboratory hazard

Question 19

Treatment and prevention

Answer 19

Treatment is supportive, prolonged recovery (may take as long as 3 months)

Prevention is by rodent control – especially avoid careless handling/disposal of dead rodents