Lymphocytic choriomeningitis virus (LCMV), a human zoonosis caused by a rodent-borne arenavirus, has been associated with both postnatal and intrauterine human disease. Infection in man is acquired after inhalation, ingestion, or direct contact with virus found in the urine, feces, and saliva of infected mice, hamsters, and guinea pigs. Congenital LCMV infection is a significant, often unrecognized cause of chorioretinitis, hydrocephalus, microcephaly or macrocephaly, and mental retardation. Acquired LCMV infection, asymptomatic in approximately one third of individuals, is productive of central nervous system manifestations in one half of the remaining cases. Aseptic meningitis or meningoencephalitis are the predominant syndromes, although transverse myelitis, a Guillain-Barré-type syndrome, as well as transient and permanent acquired hydrocephalus have also been reported. Fatalities are rare. We report a patient with meningoencephalitis attributable to LCMV and discuss the spectrum of central nervous system disease, newer diagnostic modalities, and preventive strategies. lymphocytic choriomeningitis virus, aseptic meningitis, meningoencephalitis, zoonosis, hydrocephalus, arenavirus.
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1 March 2000
We thank Dr Berg for his comments demonstrating,as always, his astuteness and retention of lessons well-learned! We would emphasize that our article underscores the importance of investigation of all animal contact,whether direct or indirect,pet or feral, inside the house or without.
As an aside, having been a chief resident for Dr. Barton, I can attest that she asks [specific] questions regarding pets in the home during her history taking. I guess in addition to cats (Bartonella) and birds (Chlamydia) and fish (pseudomonas) we must condsider rodents after reading this interesting article.
We thank the letter's author for thoughtful comments. While we agree that pets have both psychological and physical benefits, they-as are virtually all good things-not without risk. Although the transmission of LCMV to humans may take place by direct contact with infected animal excreta and via aerosols, simple handwashing and wetting of surfaces to be swept, may minimalize the risk of infection. Human-to-human postnatal transmission has, incidentally, never been documented. Furthermore, the distribution of LCMV is highly variable within mouse populations and remains inadequately studied in these animals, as well as in hamsters and guinea pigs. The dual needs for further research, in addition to education of the public (and medical professionals) of the potential hazards of direct contact with infected rodents are obvious.
The case report and discussion of LCMV by Barton et al was excellent and in my mind a little unsettling. This is because of the prevalence of mice, hamsters, and guinea pigs as pets, not only in the home, but also in almost every preschool and elementary school in the nation.
Is this putting our children at risk unnecessarily? What about if the virus is brought home from school and pregnant mothers are exposed, possibly leading to intrauterine infection? I am sure that most parents and teachers are unaware of even the existence of LCMV and it's potentially serious consequences.
Additionally, for class pets, in today's litigious society, the legal ramifications must also be taken into account. If someone suffers serious complications as a result of exposure to the virus from a class pet, it is very possible the school or school system will be found to be liable.
Clearly pets do have positive impacts, especially with young children, such as helping to foster a sense of responsibility. However, the benefits must be balanced against the possible risks, however small, of serious neurological damage and even death, from LCMV and possibly other viruses as well.