Successfully Treated Norovirus- and Sapovirus-Associated Diarrhea in Three Renal Transplant Patients

Abstract

Objectives To examine the burden of norovirus- and sapovirus-related diarrhea in renal transplant patients and to propose the use of nitazoxanide as a therapeutic option for treatment. Methods We reviewed three renal transplant patients with viral diarrhea requiring hospitalization due to acute renal failure and signs of graft rejection. All three patients were treated with nitazoxanide. We examined their clinical courses after therapy and compared time to resolution of symptoms and viral shedding. Results In all three renal transplant patients, improvement of diarrheal illness was witnessed within one week of nitazoxanide initiation. Conclusions Infectious diarrhea remains an underestimated yet significant cause of morbidity in solid organ transplant patients. Norovirus and sapovirus are often responsible for this presentation. Nitazoxanide was used as a treatment modality with success in reduction of symptoms, decreased duration of illness, and cessation of viral shedding.

Clinical Yield of a Molecular Diagnostic Panel for Enteric Pathogens in Adult Outpatients With Diarrhea and Validation of Guidelines-Based Criteria for Testing

“…This is particularly relevant for norovirus, sapovirus, and astrovirus, which have been associated with chronic diarrhea in immunocompromised patients [18–20]. Treatment of chronic norovirus and sapovirus gastroenteritis with nitazoxanide may also be beneficial, though we did not classify these as pathogens warranting antimicrobial therapy in this study [21].…”

A review on possible mechanistic insights of Nitazoxanide for repurposing in COVID-19

“…We now explain the pathways of SARS-CoV-2 entry and pathogenesis, systematically juxtaposing at each stage the role of nitazoxanide elucidating thereby the ability of the drug to exhibit direct antiviral action and host beneficial anti-inflammatory response to curb the cytokine storm. Importantly nitazoxanide is also reported to be useful in patients with co-morbidities ( Elaidy et al, 2018 ; Fan et al, 2019 ; Ghusson and Vasquez, 2018 ; Nitazoxanide in fibrosis, 2020).…”

Diarrhea in a Patient With Combined Kidney-Pancreas Transplant

“…Several recent case reports have described sapovirus infections leading to chronic, severe diarrhea in patients after kidney transplant. 6,7 The prevalence of posttransplant Quiz QUIZ sapovirus is unknown. Sapoviruses are nonenveloped, single-stranded positive-sense RNA viruses that belong to the Caliciviridae family along with norovirus.…”

“…Currently, evidence for its efficacy is limited to case reports. 6,7 Reducing mycophenolate dosage in response to posttransplant diarrhea is a common practice and has been shown to have some efficacy in patients with persistent diarrhea regardless of cause. However, caution should be used when opting for this treatment strategy, as reductions in mycophenolate dose have also been shown to be associated with rejection and decreased allograft survival.…”