Year: 2016
Type: article
Study design: Observational Study
Abstract: Background. Norovirus is an emerging cause of prolonged gastroenteritis in solid organ transplant (SOT), hematopoietic stem cell transplant (HSCT) and hematologic malignancy (HM) patients. We studied the spectrum of norovirus disease in this population. Methods. We identified all adult immunocompromised patients with HM, HSCT or SOT in whom norovirus stool antigen or PCR testing was performed from 1 January 2012 to 28 April 2016 by reviewing laboratory data. Clinical characteristics of patients with positive norovirus testing were collected. Results. A total of 365 samples were tested for norovirus in 335 patients during the study. Thirty (9%) had at least one positive test including 10 HSCT, 4 HM and 16 SOT (1 heart, 5 lung, 10 kidney) patients. Median age was 60 years old (range, 25–79); 15 (50%) were men. Norovirus genotype was available in 26: genotype I (1), genotype II (25). Nausea and vomiting were present at illness onset in 20 (66%) and all had diarrhea. 27 (90%) required hospitalization and 12 (40%) had acute kidney injury. Median duration of norovirus-associated diarrhea was 27 days (interquartile range, 8–55) overall; 63 days (range, 6–390) in allogeneic HSCT versus 20 days (range, 2–89) in SOT recipients (P = 0.02, Mann-Whitney U test). Repeat norovirus testing remained positive in all patients with >3 months of diarrhea. Median weight loss in those with >3 weeks diarrhea was 4 kg (range, 0–15). Five (17%) required parenteral nutrition. Concurrent intestinal graft-versus-host disease occurred in 5 of 9 allogeneic HSCT recipients; 2 of 14 on mycophenolate had biopsy-proven enteric mycophenolate toxicity. Concurrent opportunistic infection occurred in 5: Candida esophagitis (1), sacral herpes simplex (1), probable pulmonary aspergillosis (1), recurrent CMV viremia (1), and Pneumocystis pneumonia (1). The latter two opportunists were attributed to poor oral absorption of antimicrobial drugs due to norovirus. Two HSCT recipients died after 4 and 7 months of norovirus-associated diarrhea but no deaths were attributed to norovirus. Conclusion. Norovirus causes prolonged diarrhea and morbidity in HM, HSCT and SOT patients. Allogeneic HSCT recipients had a longer duration of norovirus-associated diarrhea than SOT. Decreased absorption of prophylactic antimicrobials due to norovirus may lead to opportunistic infection. Disclosures. S. P. Hammond, Merck: Investigator, Research support. Ansun Biopharma: Investigator, Research support; F. M. Marty, Alexion: Scientific Advisor, Consulting fee. Ansun: Investigator, Research support. Astellas: Consultant and Investigator, Consulting fee and Research support. Basilea: Conference speaker, Speaker honorarium. Chimerix: Consultant and Investigator, Consulting fee and Research support. Gilead: Consultant and Investigator, Consulting fee and Research support. GlaxoSmithKline: Consultant and Investigator, Consulting fee and Research grant. LFB, S.A.: Consultant, Consulting fee. Merck: Consultant and Investigator, Consulting fee and Research support. Shire: Consultant and Investigator, Consulting fee and Research support. WHISCON: Investigator, Research support. Pfizer: Course speaker, Speaker honorarium. Fate Therapeutics: Scientific Advisor, Consulting fee.
Source: Open Forum Infectious Diseases
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2581821212