Norovirus-associated hemolytic uremic syndrome in a renal transplant recipient

Gaur, Lovy; Gupta, Anurag; Shingada, Aakash; Bhalla, AK; Gupta, Ashwani; Malik, Manish; Bhargava, Vinant; Rana, Devinder Singh

doi:10.4103/1319-2442.248289

Cited by 4 publications

(8 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The authors reported that norovirus was found in her stool sample by enzyme immunoassay. This patient died after HUS [3]. The presence of an underlying renal pathology in these 2 adult cases resulted in a poor prognosis for the patients (Table 2).…”

Section: Discussionmentioning

confidence: 99%

Hemolytic Uremic Syndrome Associated with Norovirus Gastroenteritis: Case Report and Literature Review

Yılmaz

Yüksel

2022

Nephron

View full text Add to dashboard Cite

A previously healthy 3-year-old girl was admitted with fever, nonbloody diarrhea, vomiting for 3 days, and oliguria. Physical examination showed fatigue, pale appearance, hypertension, and mild periorbital edema. Laboratory examinations revealed anemia, thrombocytopenia, acute kidney injury, high LDH, and low haptoglobin levels. Urinalysis showed proteinuria and hematuria. Schistocytes and helmet cells were detected in the peripheral blood smear. There were no electrolyte imbalance and hypocomplementemia. Direct Coombs and viral panel were negative. Blood, urine, throat, and stool cultures were negative. Norovirus GII was positive in stool PCR, while other diarrheal agents were negative. The patient was diagnosed with norovirus gastroenteritis-induced hemolytic uremic syndrome (HUS). Furosemide was started for oliguria and hypertension, and blood pressure was controlled with oral nifedipine. On the 12th day of hospitalization, he was discharged with fully recover. To date, norovirus-associated HUS has been reported in 5 cases. Two of these are adult cases and the other three and our case are pediatric patients. In this case report and literature review, we observed that norovirus can cause HUS, especially in children, with a milder course than other types of HUS. The reason why it is more complicated in adult cases may be the presence of an additional underlying kidney disease. Since it was detected coincidentally in 1 case in the literature, it may be useful to screen for mutations in the complement pathway that may cause aHUS, if possible, in diarrhea-associated HUS caused by norovirus agents, but it was not present in our case.

show abstract

Section: Discussionmentioning

confidence: 99%

Hemolytic Uremic Syndrome Associated with Norovirus Gastroenteritis: Case Report and Literature Review

Yılmaz

Yüksel

2022

Nephron

View full text Add to dashboard Cite

show abstract

“…8 Em 2019, um novo agente foi confirmado como causador de SHU típica em crianças, o Novorírus 4 . Em adultos há dois relatos de casos suspeitos de SHU associada ao Norovírus, um homem de 82 anos relatado em 2008 e outro caso, em 2018, de uma mulher de 42 anos 9,10 . A transmissão da SHU-STEC se dá pela ingestão de alimentos contaminados como leite de vaca, carne crua ou outros alimentos que tenham contato com fezes de ruminantes.…”

Section: Discussionunclassified

“…Na SHU-STEC, o tratamento é de suporte e a base do tratamento consiste na hidratação precoce de acordo com volemia e função renal, transfusão sanguínea quando necessário e tratamento de complicações renais agudas, sequelas neurológicas e hipertensão. 1,3,10,18 O uso de antibióticos para o tratamento da infecção intestinal não é recomendado, pois eles podem aumentar o risco de desenvolver a SHU-STEC, apesar de ainda ser controverso na literatura esse risco aumentado. 1,25 O uso de Eculizumab e Plasmareférese não são rotineiramente recomendados para casos de SHU típica, mas podem ser utilizados em situações especiais, como as complicações neurólogicas.…”

Section: Discussionunclassified

Síndrome Hemolítico-Urêmica Típica em adulto

Castro

Medeiros

et al. 2021

R. Saúde

View full text Add to dashboard Cite

A Síndrome Hemolítico-Urêmica (SHU) pertence ao grupo das microangiopatias trombóticas (MAT) e afeta mais comumente crianças com menos de 6 anos de idade. A SHU pode ser classificada em dois tipos: Típica e atípica. A SHU típica é causada por bactérias principalmente a Escherichia coli produtoras de toxina shiga (STEC). O quadro clínico da SHU- STEC se apresenta inicialmente por uma gastroenterite e evolui para a tríade de anemia hemolítica não imune, trombocitopenia e injúria renal aguda. Este relato consiste no caso de uma paciente de 49 anos previamente saudável com um quadro de SHU típica que iniciou com uma infecção intestinal e após alguns dias evoluiu com anemia hemolítica não imune, trombocitopenia e insuficiência renal aguda. A base do tratamento é o de suporte e a paciente foi devidamente tratada com hidratação precoce, hemodiálise e transfusão sanguínea, entretanto, desenvolveu um quadro de sepse de foco abdominal e foi a óbito após 19 dias de internação na Unidade de terapia Intensiva. A SHU típica é uma doença rara e com relativa subnotificação em adultos, destacando a importância do reconhecimento precoce da doença, afim de notificar os casos em adultos estimulando estudos para melhorar o tratamento das evoluções desfavoráveis da doença principalmente por se manifestar de forma mais grave nessa faixa etária.

show abstract

“…Other RNA viruses associated with HUS and/or TTP include the coxsackie and echoviruses as well as the Influenza virus (H1N1) with several cases reported in children and adolescents [8]. Single case reports of HUS have been published for hepatitis A and rotavirus [6], and few for norovirus in adults [9, 10]. Cases of norovirus induced HUS are still rare in pediatric population but have been documented in 2 older children, a 9 year-old female and a 7-year-old male respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Norovirus antigen was identified in a fecal sample by enzyme immunoassay [9]. The second was a 42-year old female with chronic interstitial nephritis, who presented with worsening renal function and markers of nonimmune vascular hemolysis two years post renal transplant, and was found to have norovirus by enzyme immunoassay on fecal sample [10]. In our patient with HUS and severe AKI, Norovirus Gl/Gll was detected in 2 separate stool specimens by multiplex reverse transcriptase PCR, while all other gastrointestinal pathogens, including STEC, stx1/stx 2 were negative.…”

Section: Discussionmentioning

confidence: 99%

Norovirus: a novel etiologic agent in hemolytic uremic syndrome in an infant

et al. 2019

View full text Add to dashboard Cite

Background Hemolytic uremic syndrome is a rare thrombotic microangiopathy usually seen in infants and children below the age of 5 years. It usually follows a bout of bloody diarrhea caused by Shiga toxin producing E coli and is characterized by microangiopathic hemolytic anemia, thrombocytopenia and acute kidney injury. We report the first case of hemolytic uremic syndrome in an infant following Norovirus gastroenteritis. Case presentation A nine-month-old male infant, was admitted with an 8-day history of watery, non-bloody diarrhea, vomiting and decreased oral intake. Physical exam revealed normal blood pressure, pallor and generalized edema. Laboratory findings were significant for microangiopathic hemolytic anemia, thrombocytopenia and azotemia. Stool studies with Multiplex Qualitative reverse transcriptase PCR were positive for Norovirus GI/G II. His clinical course was unusually severe, complicated by oligoanuria and worsening uremia requiring peritoneal dialysis but with eventual complete recovery. Conclusions To our knowledge this is the first case of Norovirus associated HUS in an infant. Given the ubiquity of this virus as a major cause of diarrhea, together with the increased availability of Multiplex Qualitative PCR in reference laboratories, it is quite possible that we shall be seeing more such cases in the future.

show abstract

Norovirus-associated hemolytic uremic syndrome in a renal transplant recipient

Cited by 4 publications

References 0 publications

Hemolytic Uremic Syndrome Associated with Norovirus Gastroenteritis: Case Report and Literature Review

Hemolytic Uremic Syndrome Associated with Norovirus Gastroenteritis: Case Report and Literature Review

Síndrome Hemolítico-Urêmica Típica em adulto

Norovirus: a novel etiologic agent in hemolytic uremic syndrome in an infant

Contact Info

Product

Resources

About