Rotavirus as a significant cause of prolonged diarrhoeal illness and morbidity following allogeneic bone marrow transplantation

Abstract

Summary:Infective diarrhoea is common among allogeneic stem cell transplant (SCT) recipients, frequently caused by viruses and may be difficult to differentiate from acute graftversus-host disease (GVHD). Viral pathogens may directly or indirectly impact upon transplant-related mortality. Rotavirus is one of the most common causes of diarrhoea worldwide, but one of the least studied causes of diarrhoea post SCT. In this retrospective study we describe 21 cases of confirmed rotavirus infection in allogeneic SCT recipients. Most of these cases may occur in clusters during the winter and spring period. Symptoms of rotaviral infection were diarrhoea (95%), vomiting (62%), abdominal pain (38%), weight loss and loss of appetite in 38 and 29% of the cases, respectively. Possible extraintestinal manifestations of rotavirus infection were observed. The duration of the symptoms in this series ranged from 4 days to 4 months with median of 15 days. Patients with rotavirus infection were invariably lymphopenic and/or on immunosuppression for GVHD. Of the patients diagnosed with rotavirus, 86% required hospitalisation. In 57% of the cases, other viral pathogens were isolated near to the rotavirus infection period. Rotavirus infection is an important cause of prolonged diarrhoea post SCT, causing significant morbidity and frequently requiring hospitalisation. Bone Marrow Transplantation (2005) 36, 691-694.

High day 28 ST2 levels predict for acute graft-versus-host disease and transplant-related mortality after cord blood transplantation

“…The ultimate aim of these studies is to ameliorate severe GVHD and further improve survival in CBT recipients. (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) …”

“…Twenty-eight patients had grade III-IV disease (22 grade III, 6 grade IV) for a cumulative incidence of 25% (95% CI, [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] by day 180. The GI tract (either upper and/or lower tract) was the organ most commonly affected in 56 of 69 (81%) patients, followed by the skin (36 of 69, 52%), and the liver was the least commonly involved (9 of 69, 13%).…”

Rice-based oral antibody fragment prophylaxis and therapy against rotavirus infection

“…Furthermore, severely immunocompromised individuals do not mount protective immunity when infected with RV and thus suffer chronic infection (19)(20)(21)(22), which can subsequently lead to extraintestinal spread with severe clinical consequences (19)(20)(21). There is still a need for alternative strategies that can be used in situations where the available vaccines are not indicated and/or to complement vaccination strategies in situations where efficacy of vaccination alone may not be sufficient.…”

Live (vaccines) from New York

“…42 However, the use of the rotavirus vaccine in immunocompromised patients is cautioned and there are documented cases of rotavirus infections following administration of the vaccine to infants with SCID. 43 The yellow fever vaccine can cause life-threatening complications, even in healthy individuals.…”

“…These vaccines include the live-attenuated intranasal influenza vaccine, [38][39][40] liveattenuated rotavirus vaccine [41][42][43] and yellow fever vaccine. 44 The use of the live-attenuated influenza vaccine is not recommended in HCT recipients because of the concern for prolonged viral shedding and respiratory symptoms due to the attenuated influenza strain.…”