Devastating diarrhoea in a heart-transplanted patient

Ebdrup, Lotte; Böttiger, Blenda; Mølgaard, Henning; Laursen, Alex Lund

doi:10.1016/j.jcv.2010.11.007

Cited by 26 publications

(21 citation statements)

References 13 publications

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“…The most promising approach reported in the literature is the use of enteral Ig as it has been described successful in four immunocompromised patients: two children with small bowel transplantation [13] and two adults, one with cardiac [17] and the other with renal transplantation [11]. The failure of this strategy in our patient could be due to the profound level of immunosuppression and/or the mode of Ig administration (rhythm, period) although we administrated the same total dose as in reported successful experiences.…”

Section: Discussionmentioning

confidence: 99%

Norovirus-related chronic diarrhea in a patient treated with alemtuzumab for chronic lymphocytic leukemia

et al. 2014

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BackgroundNorovirus infection is increasingly recognized as an important cause of persistent gastroenteritis in immunocompromised hosts and can be a potential cause of morbidity in these populations.Case presentationHere, we report a case of norovirus-related chronic diarrhea occurring in a 62-year-old immunocompromised patient treated with alemtuzumab for chronic lymphocytic leukemia. Despite different therapeutic strategies including tapering of immunosuppressive therapy and immunoglobulin administration, diarrhea unfortunately did not resolve and lasted for a total of more than twelve weeks with prolonged norovirus fecal excretion.ConclusionsNorovirus infection can occur in the setting of alemtuzumab treatment, even as a single agent, and should be included in the differential diagnoses of acute and chronic diarrhea in these immunocompromised patients. Although the administration of oral immunoglobulin has been described as a promising efficient therapy, this was not the case in our patient. Clinical trials are thus clearly warranted to better define risk factors and efficient therapies for norovirus infection in immunocompromised populations.

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Section: Discussionmentioning

confidence: 99%

Norovirus-related chronic diarrhea in a patient treated with alemtuzumab for chronic lymphocytic leukemia

et al. 2014

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“…Several strategies have been tried in limited numbers of patients: oral or intravenous immunoglobulin, breast milk, ribavirin, and nitazoxanide. Several case series have suggested that oral human immunoglobulin improves diarrheal symptoms; however, a recent cohort study failed to demonstrate improvements in total time to resolution of diarrhea, length of hospital stay, or cost with administration of oral human immunoglobulin [40,53,62,63]. Systemic administration of immunoglobulin has also provided conflicting evidence on clinical impact [40].…”

Section: Norovirusmentioning

confidence: 99%

Diarrhea in solid organ transplant recipients

Angarone

Ison²

2015

Current Opinion in Infectious Diseases

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“…Unfortunately, there are no approved therapeutics or vaccines for controlling norovirus infections. Attempted methods to control chronic infection have included treatment with drugs effective against other diarrheal diseases (27), adjustment of the immunosuppressive drug type or dosage (28), and oral or enteral administration of human IgG (29)(30)(31)(32). Although reduction in immunosuppression coupled with IgG administration has shown promise for some transplant patients, IgG therapy has failed in other studies, and reduction of immunosuppression is not always possible.…”

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confidence: 99%

Within-Host Evolution Results in Antigenically Distinct GII.4 Noroviruses

Debbink

Lindesmith

Ferris

et al. 2014

J Virol

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Genogroup II, genotype 4 (GII.4) noroviruses are known to rapidly evolve, with the emergence of a new primary strain every 2 to 4 years as herd immunity to the previously circulating strain is overcome. Because viral genetic diversity is higher in chronic than in acute infection, chronically infected immunocompromised people have been hypothesized to be a potential source for new epidemic GII.4 strains. However, while some capsid protein residues are under positive selection and undergo patterned changes in sequence variation over time, the relationships between genetic variation and antigenic variation remains unknown. Based on previously published GII.4 strains from a chronically infected individual, we synthetically reconstructed virus-like particles (VLPs) representing early and late isolates from a small-bowel transplant patient chronically infected with norovirus, as well as the parental GII.4-2006b strain. We demonstrate that intrahost GII.4 evolution results in the emergence of antigenically distinct strains over time, comparable to the variation noted between the chronologically predominant GII.4 strains GII.4-2006b and GII.4-2009. Our data suggest that in some individuals the evolution that occurs during a chronic norovirus infection overlaps with changing antigenic epitopes that are associated with successive outbreak strains and may select for isolates that are potentially able to escape herd immunity from earlier isolates. IMPORTANCENoroviruses are agents of gastrointestinal illness, infecting an estimated 21 million people per year in the United States alone. In healthy individuals, symptomatic infection typically resolves within 24 to 48 h. However, symptoms may persist for years in immunocompromised individuals, and development of successful treatments for these patients is a continuing challenge. This work is relevant to the design of successful norovirus therapeutics for chronically infected patients; provides support for previous assertions that chronically infected individuals may serve as reservoirs for new, antigenically unique emergent strains; and furthers our understanding of genogroup II, genotype 4 (GII.4) norovirus immune-driven molecular evolution.

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Devastating diarrhoea in a heart-transplanted patient

Cited by 26 publications

References 13 publications

Norovirus-related chronic diarrhea in a patient treated with alemtuzumab for chronic lymphocytic leukemia

Norovirus-related chronic diarrhea in a patient treated with alemtuzumab for chronic lymphocytic leukemia

Diarrhea in solid organ transplant recipients

Within-Host Evolution Results in Antigenically Distinct GII.4 Noroviruses

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