Lymphocytic Choriomeningitis—Emerging Trends of a Neglected Virus: A Narrative Review

Abstract

Lymphocytic choriomeningitis virus (LCMV) is a neglected rodent-borne zoonotic virus distributed worldwide. Since serologic assays are limited to several laboratories, the disease has been underreported, often making it difficult to determine incidence and seroprevalence rates. Although human clinical cases are rarely recorded, LCMV remains an important cause of meningitis in humans. In addition, a fatal donor-derived LCMV infection in several clusters of solid organ transplant recipients further highlighted a pathogenic potential and clinical significance of this virus. In the transplant populations, abnormalities of the central nervous system were also found, but were overshadowed by the systemic illness resembling the Lassa hemorrhagic fever. LCMV is also an emerging fetal teratogen. Hydrocephalus, periventricular calcifications and chorioretinitis are the predominant characteristics of congenital LCMV infection, occurring in 87.5% of cases. Mortality in congenitally infected children is about 35%, while 70% of them show long-term neurologic sequelae. Clinicians should be aware of the risks posed by LCMV and should consider the virus in the differential diagnosis of aseptic meningitis, especially in patients who reported contact with rodents. Furthermore, LCMV should be considered in infants and children with unexplained hydrocephalus, intracerebral calcifications and chorioretinitis. Despite intensive interdisciplinary research efforts, efficient antiviral therapy for LCMV infection is still not available.

Congenital lymphocytic choriomeningitis virus: A review

“…Concerning treatments, antiviral therapeutic options in human LCMV infection are currently very limited. The first antiviral drug repurposed for the treatment of transplantation‐associated LCMV infection in humans was ribavirin, but its efficiency is not totally proven 8 . Favipravir and umifenovir, which are both used for influenza, and which are currently being used and evaluated in clinical trials for the therapy of COVID19, are promising for LCMV treatment.…”

“…Human infection is marked by the presence of viremia, often associated with marked thrombocytopenia and leukopenia. About one‐third of immunocompetent children and adults who acquire LCMV are asymptomatic, one third present with nonspecific febrile disease while the remaining have central nervous system disease 8 . Rare fatal cases are reported, especially when the virus is transmitted via organ transplantation 9,10 …”

“…LMCV is mainly present in Europe and America 8 . Estimated seroprevalence in humans is low, between 0.3% and 6.8%, and is usually related to close contact with mice or hamsters 11,12 .…”

“…About one-third of immunocompetent children and adults who acquire LCMV are asymptomatic, one third present with nonspecific febrile disease while the remaining have central nervous system disease. 8 Rare fatal cases are reported, especially when the virus is transmitted via organ transplantation. 9,10 LMCV is mainly present in Europe and America.…”

“…9,10 LMCV is mainly present in Europe and America. 8 Estimated seroprevalence in humans is low, between 0.3% and 6.8%, and is usually related to close contact with mice or hamsters. 11,12 Thus, an overall seroprevalence of 6.8%, ranging from 3.9% in nonexposed populations to 9.8% in professionally exposed persons (forestry workers, hunters, and persons in frequent contacts with rodents) was documented in Croatia.…”