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Lymphocytic Choriomeningitis Virus Infections in Hungary between 2017-2023-Investigation of the First Congenital
Anita Koroknai1, Anna Nagy1, Orsolya Nagy1,2
1National Reference Laboratory for Viral Zoonoses, National Center for Public Health and Pharmacy, 1097 Budapest, Hungary.
Abstract:
Lymphocytic choriomeningitis virus (LCMV) is a neglected rodent-borne arenavirus, primarily spread by common house mouse species. Acquired human infections range from asymptomatic to mild flu-like symptoms and self-resolving neurological diseases. In contrast, intrauterine LCMV infection is associated with high mortality and morbidity. Infection of the fetus often leads to fetal death, and surviving fetuses may develop vision impairment and central nervous system developmental disorders. LCMV is mainly diagnosed by serological methods using in-house indirect immunofluorescence assays. LCMV nucleic acid is detected by the nested RT-PCR method and confirmed by Sanger sequencing. In Hungary, 23 acquired lymphocytic choriomeningitis cases were diagnosed between 2017 and 2023. Ten out of 23 confirmed patients proved to be positive by the PCR method. Two cases of intrauterine LCMV infections were detected in 2019 and 2021, respectively. The IgG antibody titers measured in the infant's serum samples were much higher than the IgG titers of the maternal serum samples. Both IgM and IgA antibodies were detectable in the infants' sera. As the microbiological diagnosis of LCMV is rather challenging and the symptoms are very similar to the clinical picture of other common teratogenic pathogens such as cytomegalovirus or Toxoplasma gondii, intrauterine LCMV infections might still be underdiagnosed.
Insights
Lymphocytic choriomeningitis virus (LCMV) can cause severe fetal harm. Early diagnosis of intrauterine LCMV infection is crucial, as it is often underdiagnosed due to challenging detection methods and similar symptoms to other teratogenic pathogens.
Area of Science:
- Virology
- Infectious Diseases
- Public Health
Background:
- Lymphocytic choriomeningitis virus (LCMV) is a rodent-borne arenavirus with significant implications for human health, particularly during pregnancy.
- While acquired LCMV infections typically present with mild to moderate symptoms, intrauterine LCMV infection poses a severe risk, leading to high rates of fetal mortality and developmental disorders in survivors.
Purpose of the Study:
- To highlight the diagnostic challenges and underdiagnosis of intrauterine LCMV infections.
- To present recent case findings of intrauterine LCMV infections in Hungary.
- To emphasize the need for improved diagnostic strategies for LCMV, especially in pregnant individuals.
Main Methods:
- Serological methods, including indirect immunofluorescence assays, were used for LCMV diagnosis.
- LCMV nucleic acid detection was performed using nested RT-PCR and confirmed by Sanger sequencing.
- Analysis of patient and maternal serum samples for IgG, IgM, and IgA antibody titers.
Main Results:
- Between 2017 and 2023 in Hungary, 23 acquired LCMV cases were diagnosed, with 10 confirmed by PCR.
- Two cases of intrauterine LCMV infection were identified in 2019 and 2021.
- Infants in intrauterine infection cases showed significantly higher IgG antibody titers than their mothers, with detectable IgM and IgA antibodies.
Conclusions:
- Intrauterine LCMV infections are potentially underdiagnosed due to diagnostic complexities and overlapping symptoms with other teratogenic agents like cytomegalovirus and Toxoplasma gondii.
- The findings underscore the critical need for heightened awareness and improved diagnostic tools for LCMV, especially in cases of suspected congenital infections.
- Further research into LCMV pathogenesis and diagnostics is warranted to mitigate its impact on fetal development.
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