Etiology and outcome of diarrhea after marrow transplantation: a prospective study.
OBJECTIVE
Acute diarrhea after marrow transplant is usually ascribed to acute graft-vs.-host disease (GVHD) or infection, with a reported 40%-50% incidence of infection. The aim of this study was to determine the incidence of acute diarrhea after transplantation, its causes, and its outcome.


METHODS
Two hundred ninety-six patients were followed up; patients with diarrhea were studied using standard evaluation of stool plus immunoelectron microscopy; assays for astrovirus, picobirnavirus, and Norwalk virus; and gene-probe methods for toxin-producing Escherichia coli. In 38 patients with diarrhea, intestinal biopsy specimens and duodenal fluid were also analyzed.


RESULTS
One hundred fifty acute diarrheal episodes developed in 126 patients (an incidence of 43%). Intestinal infection was found in 20 of 150 episodes: viruses (astrovirus, adenovirus, cytomegalovirus, and rotavirus) in 12 patients, nosocomially acquired bacteria (Clostridium difficile and Aeromonas) in 7 patients, and mixed infection in 1 patient. Acute GVHD was responsible for 72 of 150 episodes (48%). Clinical signs and symptoms of infection and GVHD were similar. In 58 of 150 episodes (39%), no clear etiology could be found for self-limited diarrhea.


CONCLUSIONS
Intestinal infection accounted for 13% and acute GVHD for 48% of diarrheal episodes. The most common infecting organisms were astrovirus, C. difficile, and adenovirus. Most cases of diarrhea after marrow transplant are not caused by infection.
Cox
G J
GJ
Fred Hutchinson Cancer Research Center, Seattle, Washington.
Matsui
S M
SM
Lo
R S
RS
Hinds
M
M
Bowden
R A
RA
Hackman
R C
RC
Meyer
W G
WG
Mori
M
M
Tarr
P I
PI
Oshiro
L S
LS
D000208:Acute Disease; D000258:Adenovirus Infections, Human / Q000150:complications; D000328:Adult; D001424:Bacterial Infections / Q000150:complications; D016026:Bone Marrow Transplantation; D016009:Chi-Square Distribution; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000150:complications; D006801:Humans; D015994:Incidence; D008297:Male; D001257:Mamastrovirus; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D014777:Virus Diseases / Q000150:complications