Epidemiologic Notes and Reports Lymphocytic
Choriomeningitis -- Georgia
On December 31, 1983, a 58-year-old woman from Winder, Georgia,
was admitted to a hospital in Cincinnati, Ohio, with a 1-week
history
of malaise, diffuse myalgias, fever, and chills; a 1-day history of
vomiting, severe headache, stiff neck, and photophobia; and a
history
of exposure to mice in her home. Examination revealed a lethargic
but
arousable patient with a temperature of 38.5 C (101.3 F), and
nuchal
rigidity. The cerebrospinal fluid (CSF) contained 930 white blood
cells, with 69% lymphocytes. Lymphocytic choriomeningitis (LCM)
virus
was isolated from the CSF. The patient's recovery was
uncomplicated,
and she was discharged January 7, 1984.
On January 13, the Georgia Department of Human Resources and
CDC
visited the patient's home. Blood specimens were obtained from two
other household residents, and rodent traps were set inside and
outside the house. By the following morning, seven grey house mice
(Mus musculus) had been caught, six within the house and one in an
adjacent wooded area.
The two household residents had no detectable LCM antibodies by
indirect fluorescent antibody (IFA) testing. However, all six mice
trapped in the house had evidence of LCM virus infection; four mice
had IFA antibodies, and two were viremic and had virus antigen in
the
liver, as detected by direct FA staining of liver-touch
impressions.
On February 23, the patient's neighborhood was investigated. Blood
specimens were obtained from 13 persons in six nearby residences;
traps were set in five of those residences. Five mice were trapped
in
two of the houses. None of the specimens from humans or mice
showed
evidence of LCM virus.
Reported by W Bullock, MD, M Meier, MD, University of Cincinnati
Medical Center, Ohio; B Willingham, Barrow County Health Dept,
Winder,
RK Sikes, DVM, State Epidemiologist, Georgia Dept of Human
Resources;
Special Pathogens Br, Viral and Rickettsial Zoonoses Br,
Epidemiology
Office, Div of Viral Diseases, Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: LCM virus is a mouse-borne arenavirus that can
cause
three different forms of human illness: aseptic meningitis,
encephalitis, and an influenza-like illness. Inapparent infections
may also occur (1). Diagnosis requires the isolation of LCM virus
from CSF or blood using an appropriate cell-culture system, or
demonstration of either a fourfold rise in antibody titer between
acute- and convalescent-phase serum specimens or an IFA titer 1:128
or
higher in a single specimen in which immunoglobulin M (IgM)
anti-LCM
antibody is present.
This investigation points out that LCM should be considered in
sporadic cases of aseptic meningitis, especially in the winter.
Few
estimates exist of the exact incidence of LCM; however, in one
investigation, LCM was responsible for 8% of 1,568 cases of
clinically
diagnosed aseptic meningitis in the United States (2). The present
report emphasizes the previously described association of sporadic
cases with infected mice (3), and the previously described
observation
that the virus can remain localized to a single household.
In contrast, outbreaks of LCM in the general population have
generally been traced to contact with Syrian golden hamsters
(Mesocricetus auratus). In the United States (4) and Germany (1),
these have resulted from exposure in the home to pet hamsters
obtained
from breeders with infected stock. Outbreaks have also occurred
among
laboratory workers following the introduction of LCM virus into
hamster colonies through infected cell lines (5).
References
Ackermann WS, Blumenthal W, Helm EB, Keller K, Baldus O.
Syrische
Goldhamster als Ubertrager von Lymphozytarer Choriomeningitis.
Deutsch Med Woch 1972;45:1725-31.
Meyer HM Jr, Johnson RT, Crawford IP, Dascomb HE, Rogers NG.
Central nervous system syndromes of "viral" etiology. Am J Med
1960;29:334-47.
Farmer TW, Janeway CA. Infections with virus of lymphocytic
choriomeningitis. Medicine 1942;21:1-63.
Biggar RJ, Woodall JP, Walter PD, Haughie GE. Lymphocytic
choriomeningitis outbreak associated with pet hamsters:
fifty-seven cases from New York State. JAMA 1975;232:494-500.
Lewis AM Jr, Rowe WP, Turner HC, Huebner RJ.
Lymphocytic-choriomeningitis virus in hamster tumor: spread to
hamsters and humans. Science 1965;150:363-4.
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