Lymphocytic choriomeningitis virus: an overview of a neglected neurotropic zoonosis

Lymphocytic choriomeningitis virus (LCMV), a rodent-borne mammarenavirus, is endemic worldwide and under-appreciated although it has neurotropism and potential for serious clinical disease. LCMV is commonly carried by the house mouse ( Mus musculus ), thus being distributed globally in urban and rural areas. Transmission occurs primarily through inhalation of aerosolised excreta from infected rodents or contaminated secretions, with additional routes including solid organ transplantation, rarely, and vertical transmission. In humans, LCMV infection may vary from an inapparent or self-limiting febrile disease to more severe diseases such as aseptic meningitis or meningoencephalitis especially in immunocompromised patients. Congenital infections have been reported to cause chorioretinitis, intracranial calcifications, a variety of neurologic malformations, intellectual disability, neurodevelopmental problems, and death of the foetus. To date, 88 congenital cases of LCMV infection have been documented in the literature, and 5 donor-derived transplant-associated clusters involving 17 recipients have been reported worldwide. The objective of this narrative review is to provide a comprehensive and up-to-date overview of LCMV. Specifically, the review summarizes current knowledge on its virological characteristics, epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment, and prevention. Particular attention is given to congenital infection, transplant-associated disease, and the evolving epidemiology of LCMV, with emphasis on its public health relevance within a One Health framework. Laboratory approaches and diagnostic challenges are also discussed, including relevant biosafety considerations. Finally, the review highlights persisting knowledge gaps and identifies priority areas for future research, surveillance, and public health action.