title: Is there a role for oral human immunoglobulin in the treatment for norovirus enteritis in immunocompromised patients?
abstract: No treatment for NVE is available. Immunocompromised patients with NVE treated with OHIG (12 cases) were retrospectively identified and matched 1:1 by age and gender with immunocompromised patients with NVE not treated with OHIG (12 controls). Chi-squared test, t-test, bivariate conditional linear regression analyses, and Kaplan-Meier curve were performed. A total of 58.3% patients were small bowel transplant (SBT) recipients. Although not statistically significant, cases compared with controls were more likely to have had induction therapy (p = 0.25, OR = 65.3), higher peak tacrolimus levels (p = 0.43, OR = 1.04), SBT (p = 0.30, OR = 65.3), prior NVE (p = 0.42, OR = 2.0), TPN support (p = 0.42 OR = 2.0), and decrease in immunosuppression (p = 0.14, OR = 5.0). Treatment with OHIG favored resolution of diarrhea (p = 0.078, OR = 65.3) and decreased stool output seven days after treatment compared with controls (mean difference 11.95 mL/kg/day, p = 0.09). OHIG did not impact total time to resolution of diarrhea (mean 12.08 vs. 11.91 days; p = 0.63), length of hospital stay (p = 0.31, OR = 1.05), or cost of hospitalization (p = 0.32, OR = 1.0). We show a potential role of OHIG treatment for NVE. Resolution of diarrhea and decreased stool output were observed at seven days; no benefit was found for length of hospital stay or hospital cost.
authors: Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5400, USA. dflorescu@unmc.edu
authors: Diana F
authors: DF
authors: Florescu
authors: Elizabeth D
authors: ED
authors: Hermsen
authors: Joong Y
authors: JY
authors: Kwon
authors: Dalal
authors: D
authors: Gumeel
authors: Wendy J
authors: WJ
authors: Grant
authors: David F
authors: DF
authors: Mercer
authors: Andre C
authors: AC
authors: Kalil
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D001706:Biopsy; D017250:Caliciviridae Infections / Q000276:immunology* / Q000628:therapy*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005759:Gastroenteritis / Q000276:immunology* / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage / Q000627:therapeutic use*; D007165:Immunosuppression Therapy; D007223:Infant; D007422:Intestines / Q000637:transplantation; D007902:Length of Stay; D008297:Male; D029322:Norovirus / Q000378:metabolism*; D016559:Tacrolimus / Q000627:therapeutic use
chemical_list: D007136:Immunoglobulins; D016559:Tacrolimus