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The illness may begin with stiff neck, myalgia, headache, leukopenia, and thrombocytopenia. Other symptoms seen in some cases are rash, arthritis, parotitis, orchitis, and myocarditis. Hemorrhagic cases have been reported. The prognosis for full recovery is good even for severe cases. Infected pet hamsters and laboratory animals have caused outbreaks. The natural reservoir is the common house mouse. The virus is transmitted to humans by the oral, respiratory, or percutaneous routes by food or dust contaminated with urine, saliva, or feces from infected animals. [CCDM, p. 320-2] Occasionally, lymphadenopathy and a maculopapular rash accompany the initial fever. Orchitis, myocarditis, and arthritis are possible complications that usually resolve spontaneously within a couple of weeks. [PPID, p. 2094-5] Can be transmitted by an animal bite; [ID, p. 1424] After a flu-like illness in the first phase lasting 5 days to 3 weeks, patients improve. Some patients then relapse into fever, rash, headache, arthralgias, stiff neck, orchitis, parotitis, and hair loss. Patients with meningitis usually recover without sequelae, but 1/3 of patients with encephalitis have persistent neurological symptoms. [Merck Manual, p. 1623] A large case series showed that 35% of patients were asymptomatic, 50% had a flu-like illness, and 15% had typical lymphocytic choriomeningitis. Sore throat and vomiting were common. Chest pain and pneumonitis occurred less frequently. [ID, p. 2136] |
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