Journal Article

Allogeneic Hematopoietic Stem Cell Transplantation and Norovirus Gastroenteritis: A Previously Unrecognized Cause of Morbidity

C. Roddie, J. P. V. Paul, R. Benjamin, C. I. Gallimore, J. Xerry, J. J. Gray, K. S. Peggs, E. C. Morris, K. J. Thomson and K. N. Ward

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 49, issue 7, pages 1061-1068
Published in print October 2009 | ISSN: 1058-4838
Published online October 2009 | e-ISSN: 1537-6591 | DOI: https://dx.doi.org/10.1086/605557
Allogeneic Hematopoietic Stem Cell Transplantation and Norovirus Gastroenteritis: A Previously Unrecognized Cause of Morbidity

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Background.A retrospective study of the clinical, epidemiologic, and virologic features of norovirus gastroenteritis in 12 adult allogeneic hematopoietic stem cell transplant (HSCT) recipients.

Methods.Norovirus infection was diagnosed by reverse-transcriptase polymerase chain reaction. Strains were genotyped by nucleic acid sequence of the most highly conserved region of the norovirus gene encoding the capsid S (shell) domain.

Results.Ten of 12 patients presented with vomiting of short duration, but diarrhea was present in all. The median time from onset to norovirus diagnosis was 1 month (range, 0.25–6.0 months). Eleven patients were receiving immunosuppression when norovirus infection was diagnosed: 8 for graft-versus-host disease (GVHD) in an organ other than gut, 1 for previous gut GVHD, and 2 for presumed gut GVHD that proved to be norovirus gastroenteritis. Six patients required enteral or parenteral nutrition for severe weight loss. In 10 patients, diarrhea lasted a median of 3 months (range, 0.5–14 months) and virus was shed at a high level throughout. The remaining 2 patients died after 4 months of diarrhea (one died of unrelated complications, and the other died of malnutrition). The noroviruses found were GII (untyped), GII-3, GII-4, and GII-7 in 1, 1, 9, and 1 patients, respectively. Eleven of the 12 patients had acquired their infection in the community. Phylogenetic analysis of the GII-4 strains demonstrated that all differed.

Conclusions.Noroviruses are a hitherto unsuspected cause of prolonged morbidity and mortality in adults after allogeneic HSCT. The use of reverse-transcriptase polymerase chain reaction to detect high viral load levels in feces distinguishes norovirus gastroenteritis from gut GVHD.

Journal Article.  4012 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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