title: Norovirus: a possible cause of pneumatosis intestinalis.
abstract: OBJECTIVE
  Pneumatosis intestinalis (PI) in children is associated with immunosuppression, mucosal disruption from trauma, obstructive pulmonary disease, congenital heart disease, and gastrointestinal infections. Our study is the first report of norovirus infection-associated PI.
  
  
  METHODS
  A retrospective review was performed in pediatric patients (older than 30 days) with PI from March 2005 to April 2009. Since December 2008, in addition to routine stool examinations, reverse-transcriptase polymerase chain reaction testing for calicivirus (norovirus and sapovirus), adenovirus, astrovirus, and enterovirus has been performed.
  
  
  RESULTS
  Twenty-seven patients with PI were identified. The median age was 1.4 (range 0.2-14.8 years). Seventeen patients (63.0%) were immunocompromised hosts. Pathogens were identified in 5 immunocompromised patients (5/27 and 5/8 since December 2008). Of note, norovirus was identified in 4 patients (80%, 4/5) during the cold weather season. The genotype of noroviruses in these patients was GII-4. Among 27 patients with PI, 10 patients (37.0%) developed PI in the spring and 11 (40.7%) in the winter. Twenty-four patients survived (88.9%, 24/27). None of the patients with norovirus or rotavirus infection died.
  
  
  CONCLUSIONS
  Our data suggest that norovirus infection may contribute to the development of PI in immunocompromised hosts.
authors.affiliation: Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea.
authors.forename: Mi Jin
authors.initials: MJ
authors.lastname: Kim
authors.forename: Yae-Jean
authors.initials: YJ
authors.lastname: Kim
authors.forename: Ji Hyuk
authors.initials: JH
authors.lastname: Lee
authors.forename: Jong Seung
authors.initials: JS
authors.lastname: Lee
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Kim
authors.forename: Doo Sung
authors.initials: DS
authors.lastname: Cheon
authors.forename: Hye Sook
authors.initials: HS
authors.lastname: Jeong
authors.forename: Hong Hoe
authors.initials: HH
authors.lastname: Koo
authors.forename: Ki Woong
authors.initials: KW
authors.lastname: Sung
authors.forename: Keon Hee
authors.initials: KH
authors.lastname: Yoo
authors.forename: Yon Ho
authors.initials: YH
authors.lastname: Choe
mesh_terms: D000293:Adolescent; D017250:Caliciviridae Infections / Q000150:complications* / Q000821:virology; D002648:Child; D002675:Child, Preschool; D003080:Cold Temperature; D005260:Female; D005838:Genotype; D006801:Humans; D016867:Immunocompromised Host; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007223:Infant; D008297:Male; D029322:Norovirus / Q000235:genetics; D011006:Pneumatosis Cystoides Intestinalis / Q000821:virology*; D012189:Retrospective Studies; D012621:Seasons