title: Norovirus gastroenteritis causes severe and lethal complications after chemotherapy and hematopoietic stem cell transplantation.
abstract: Norovirus (NV) infections are a frequent cause of gastroenteritis (GE), but data on this disease in immunocompromised patients are limited. We analyzed an NV outbreak, which affected immunosuppressed patients in the context of chemotherapy or HSCT. On recognition, 7 days after admission of the index patient, preventive measures were implemented. Attack rates were only 3% (11/334) and 10% (11/105) among patients and staff members, respectively. The median duration of symptoms was 7 days in patients compared with only 3 days in staff members (P = .02). Three patients died of the NV infection. Commonly used clinical diagnostic criteria (Kaplan-criteria) were unsuitable because they applied to 11 patients with proven NV-GE but also to 15 patients without NV-GE. With respect to the therapeutic management, it is important to differentiate intestinal GVHD from NV-GE. Therefore, we analyzed the histopathologic patterns in duodenal biopsies, which were distinctive in both conditions. Stool specimens in patients remained positive for NV-RNA for a median of 30 days, but no transmission was observed beyond an asymptomatic interval of 48 hours. NV-GE is a major threat to patients with chemotherapy or HSCT, and meticulous measures are warranted to prevent transmission of NV to these patients.
authors.affiliation: Medizinische Klinik III, Charité–Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, Germany. stefan.schwartz@charite.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwartz
authors.forename: Maria
authors.initials: M
authors.lastname: Vergoulidou
authors.forename: Eckart
authors.initials: E
authors.lastname: Schreier
authors.forename: Christoph
authors.initials: C
authors.lastname: Loddenkemper
authors.forename: Mark
authors.initials: M
authors.lastname: Reinwald
authors.forename: Martin
authors.initials: M
authors.lastname: Schmidt-Hieber
authors.forename: Willy A
authors.initials: WA
authors.lastname: Flegel
authors.forename: Eckhard
authors.initials: E
authors.lastname: Thiel
authors.forename: Thomas
authors.initials: T
authors.lastname: Schneider
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D017250:Caliciviridae Infections / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D003131:Combined Modality Therapy; D004279:DNA, Viral / Q000235:genetics; D004196:Disease Outbreaks; D005243:Feces / Q000821:virology; D005260:Female; D005759:Gastroenteritis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D006402:Hematologic Diseases / Q000150:complications* / Q000628:therapy / Q000821:virology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D029322:Norovirus / Q000235:genetics / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004279:DNA, Viral