Purpose : We evaluated the clinical features of Norovirus gastroenteritis compared with Rotavirus gastroenteritis in hospitalized children. Methods : We detected causative agents in 3,261 samples of children hospitalized with gastroenteritis symptoms at a single center of pediatrics between 2005 and 2006. Among 266 and 303 samples which tested positive for Norovirus and Rotavirus, we selected 73 and 182 samples of children with relatively pure gastroenteritis symptoms and retrospectively analyzed the corresponding medical records. Results : The male-to-female ratio of the Norovirus (+) and Rotavirus (+) groupswas 1.43:1 and 1.56:1 both groups were predominantly in males. The mean age of the Norovirus (+) and Rotavirus (+) groups was 36.7 and 24.4 months, respectively the children in the former group were older than the children in the latter group. The incidence in the Norovirus (+) group was more concentrated in the winter. The symptoms in the Norovirus (+), in decreasing order, included vomiting, diarrhea, and fever. The duration of vomiting, diarrhea, and fever was 2.1, 1.2, and 1.2 days. The maximum number of episodes of vomiting and diarrhea per day was 3.5 and 4.5, respectively. The severity score was 10.16. The symptoms inthe Rotavirus (+) group, in decreasing order, included diarrhea, vomiting, and fever. The duration of diarrhea, vomiting, and fever was 2.2, 4.3, and 2.2 days, respectively. The maximum number of episodes of vomiting and diarrhea per day was 3.3 and 6.5, respectively. The severity score was 11.9. The severity in the Norovirus (+) group was somewhat lower than the Rotavirus (+) group. The younger the child, the more severe the symptoms in the Norovirus (+) group. There was no difference between mono-and co-infection in severity and between the two groups regarding the hematologic findings. Conclusion : Based on the findings reported herein, additional studies about prophylaxis, as well as the epidemiology and clinical features of pediatric Norovirus gastroenteritis, are required. (Korean J Pediatr Infect Dis 2009;16:61-72)
The repopulating neutrophils and lymphocytes after allogeneic SCT have an important role, not only on the prevention of serious infections in the early transplantation period, but on killing the residual leukemic cells by graft versus leukemia (GVL) effect. Previous studies have suggested that earlier neutrophil recovery was associated with less infections and better survival, while earlier lymphocyte recovery was associated with a lower relapse and a better survival in adult patients. The aim of this study was to compare the impact of neutrophil and lymphocyte recovery after SCT on predicting the survival, relapse, and GvHD in children with hematologic malignancies. We retrospectively evaluated 69 children transplanted for ALL (n=34: CR1, 22; CR2, 10; > CR2, 2), AML (n=26: CR1, 19; secondary AML, 4; > CR1, 3), chronic leukemia (n=7: CML, 6; CEL, 1) and JMML (n=2) at the Chonnam National University Hospital between Jan. 1996 and Mar. 2008. Conditioning regimes were TBI-based (n=41), and non-TBI based (n=28). Stem cell sources were: BM (n=46), PBSCs (n=10), UCB (n = 12), and BM + PB (n=1). Matched sibling donor was used in 26, while unrelated donors in 43. Three AML patients who received the 2nd allogeneic SCTs following autotransplants were included. The patients were grouped according to the absolute neutrophil count (ANC) and absolute lymphocyte count (ALC) at D+21 and D+30. The best discriminating cutoff values for ANC and ALC were 1,000/μL and 500/μL, respectively. The groups were: Low ANC at D+21 (LNC21, n=25) vs. High ANC at D+21 (HNC21, n=44); Low ANC at D+30 (LNC30, n=15) vs. High ANC at D+30 (HNC30, n=54); Low ALC at D+21 (LLC21, n=28) vs. High ALC at D+21 (HLC21, n=41); Low ALC at D+30 (LLC30, n=19) vs. High ALC at D+30 (HLC30, n=50). The patients were 41 males and 28 females. The median age at transplant was 7.1 years (range, 0.4–18). The median day of neutrophil engraftment (≥ 1,000/μL) was D+21 for LLC21 vs. D+16 for HLC21 (P =.001); and D+20 for LLC30 vs. D+17 for HLC30 (P =.02), respectively. The median day of platelet engraftment (≥ 20,000/μL) was D+38 for LLC21 vs. D+19 for HLC21 (P =.04); and D+40 for LLC30 vs. D+22 for HLC30 (P =.07), respectively. The HNC21 and HNC30 group showed a better survival than LNC 21 and LNC30 group, but statistically not significant (69% vs. 58%; 67% vs. 59%, respectively). The HLC30 group exhibited a better 5 year overall survival (71% vs. 53%, P =. 04) and event free survival (72% vs 53%, P =. 06) than LLC30 group. The LNC21 group was associated with a high incidence of aGvHD (36% vs. 14%, P =. 03), but the incidence of Gr II-IV aGvHD and cGvHD was not different by the ALC counts. Relapse rate was not different between ANC and ALC groups. Six of 15 (40%) in LNC30 and 15 of 54 (28%) in HNC30 died, while 9 of 19 (47.4%) in LLC30 and 12 of 50 (24%) in HLC30 died (P = NS). In this study, we found that lymphocyte recovery ≥ 500/μL on D+30 was associated with better survival, faster myeloid and platelet engraftment without increasing the incidence of GvHD or mortality. Also faster neutrophil recovery ≥ 1,000/μL on D+21 was associated with a lower incidence of aGvHD. However, faster lymphocyte recovery was not translated into decreased relapse rate. Further studies incorporating larger number of cases and longer follow-up are warranted in children with leukemias.
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