Overview.
Lymphocytic choroid plexus meningitis is an acute infectious disease caused by lymphocytic choroid plexus meningitis virus. The clinical manifestations of the disease are variable, and can be either latent infection or influenza-like, characterized by rapid onset, fever, headache, and myalgia. Typical manifestations are lymphocytic meningitis syndrome, and meningoencephalitis in severe cases. The disease is generally self-limiting and has a favorable prognosis.
Causes
Lymphocytic choroid plexus meningitis virus is an RNA virus, which belongs to the genus Saladovirus in the classification of viruses. It is an arboviral infection. Humans infected with this virus produce circulating antibodies with or without clinical symptoms.
Symptoms
1. Diversified clinical manifestations
The clinical manifestations of the disease are diverse, ranging from asymptomatic infection to influenza-like systemic disease, meningoencephalitis, and severe meningoencephalitis. However, there is no clear line of demarcation between the various types.
2. Influenza-like systemic symptoms
This is the most common clinical manifestation. The incubation period is generally 8 to 12 days, the onset of acute, fever can be as high as 39.5 ℃, accompanied by back pain, headache, generalized muscle pain; some patients with sore throat, cough and other symptoms of upper respiratory tract infections, a small number of patients may also have a rash, lymph node enlargement and pain, nausea, vomiting and diarrhea, and so on. The course of the disease is usually 2 weeks. In some patients, after a period of intermission, there may be a second attack, or even occasionally a third similar attack. However, the symptoms are often mild and short-lived, and most patients recover gradually, while some progress to meningitis. Patients with meningitis may begin with flu-like systemic symptoms, or they may begin with headache, stiff neck, vomiting, low back muscle pain, and other signs of meningeal irritation as the main features, but the condition is not as severe as that of suppurative meningitis. Cerebrospinal fluid examination is consistent with the characteristics of lymphocytic meningitis, and the course of the disease usually lasts 1 to 2 weeks, with changes in the cerebrospinal fluid slightly later than the recovery of symptoms.
3. Manifestations of meningoencephalitis
Occasionally, the lesion spreads to the cerebrospinal cord parenchyma, and meningoencephalitis appears. Patients may have personality changes, delirium, drowsiness, or even coma, as well as loss of sensation of cerebral nerves and peripheral nerves, dyskinesia, and changes in tendon reflexes; in severe cases, the patient may die.
Examination
1. Blood picture
Leukocyte count and classification count of peripheral blood are usually normal, with occasional anomalous lymphocytes and normal sedimentation rate.
2. Cerebrospinal fluid examination
During the acute febrile period, lymphocytic plexiform meningitis virus may be isolated from the patient’s blood or cerebrospinal fluid. Cerebrospinal fluid examination is normal in appearance, normal or slightly elevated pressure, lymphocytes can be as high as 80% to 90%, protein is often up to 1g/L, sugar can be normal or slightly lower, and chloride is normal.
3. Detection of viral antibody in double serum during acute and recovery period.
Detection of viral antibodies in both acute and recovery sera can help to identify acute infection.
4. Immunofluorescence
Antibodies can be detected early in the course of the disease, which is a rapid and sensitive diagnostic method.
5. Complement binding test
In cases where only a single serum specimen is available, highly potent complement binding antibodies may be indicative of recent infection.
Diagnosis
In addition to the history and clinical presentation, cerebrospinal fluid findings and evidence of viral isolation or serum antibody testing are required to make a definitive diagnosis.
Treatment
There is no specific treatment for this disease. Treatment is symptomatic and patients should be placed on bed rest. Severe headache and high intracranial pressure can be treated with dehydrating agents such as mannitol.