Characteristics and outcomes of patients diagnosed with norovirus gastroenteritis after allogeneic hematopoietic stem cell transplantation based on immunochromatography

Abstract

Norovirus gastroenteritis (NV-GE) is a highly transmittable disease that can lead to fatal outcomes in vulnerable populations including patients after hematopoietic stem cell transplantation (HSCT). Prompt detection of NV is therefore important for HSCT recipients. Immunochromatography (IC) can be used to easily and rapidly diagnose NV-GE by detecting NV antigens. In this study, we examined 642 stool specimens in patients who developed diarrhea after allogeneic HSCT between January 2007 and June 2011. NV was detected in 10 of 350 (2.9 %) HSCT recipients. The median onset of symptoms was 36 days (range 3-93) after HSCT. The median duration of symptoms was 42 days (3-135). A second or subsequent allogeneic HSCT was associated with a higher incidence of NV-GE (P = 0.034). Of four patients who underwent colonoscopy, two showed intestinal graft-versus-host disease (GVHD) histopathology, whereas the other two showed no evidence of GVHD, and thus no need for intensified immunosuppression. None of the patients died of NV-GE. In conclusion, IC may be useful in the differential diagnosis of diarrhea after allogeneic HSCT, and could enable the appropriate adjustment of immunosuppressive drugs and prompt preventive measures.

Chronic norovirus infection in primary immune deficiency disorders: an international case series

“…In a previous cohort study of 12 patients with CNI following HSCT, 2 patients died: 1 from unrelated complications and 1 from malnutrition (Roddie et al, 2009). In an additional study of 10 patients with CNI after HSCT, 5 patients died: 3 died due to disease progression without gastrointestinal symptoms, and 2 died due to graft-versus-host-related complications (Ueda et al, 2015). Yet additional investigations are lacking in terms of more specific predictors of disease progression and long-term outcomes in patients with PIDDs.…”

Chronic norovirus infection and common variable immunodeficiency

“…Similarly, two of 10 patients with noroviral enteritis died following HSCT in a Japanese centre, with a duration of symptoms up to 135 days (median 41). Infection was found to be more common after a second graft .…”

“…Chronic noroviral infection has also been reported in recipients of other solid organs, including heart , lung , pancreas and intestine , and also after bone marrow transplantation , where it presents a particular challenge as it may be misdiagnosed as intestinal graft‐ versus ‐host disease (GVHD) and lead to intensification of immunosuppression rather than reduction. Histological features of the two conditions overlap and there is no certainty that ongoing viral excretion represents symptomatic infection; furthermore, noroviral infection may accompany GVHD as a result of treatment with increased immunosuppression.…”

Norovirus Illnesses in Children and Adolescents

“…Typically, norovirus outbreaks in hospitalized children with immunocompromising conditions occur by community-acquired infection in an index patient followed by nosocomial transmission to other patients and hospital staff. 30–32 In both retrospective and prospective studies, children with norovirus infection after solid organ or stem cell transplantation are at risk for prolonged viral shedding, 33–37 diarrhea greater than 14 days, 33,34,36–40 and severe outcomes. 33,34,36,37,39,40 Hospitalizations from norovirus gastroenteritis in these studies did not follow the typical seasonal pattern of norovirus.…”