title: Noroviruses as a Cause of Diarrhea in Immunocompromised Pediatric Hematopoietic Stem Cell and Solid Organ Transplant Recipients.
abstract: Case reports describe significant norovirus gastroenteritis morbidity in immunocompromised patients. We evaluated norovirus pathogenesis in prospectively enrolled solid organ (SOT) and hematopoietic stem cell transplant (HSCT) patients with diarrhea who presented to Texas Children's Hospital and submitted stool for enteric testing. Noroviruses were detected by real-time reverse transcription polymerase chain reaction. Clinical outcomes of norovirus diarrhea and non-norovirus diarrhea patients, matched by transplanted organ type, were compared. Norovirus infection was identified in 25 (22%) of 116 patients, more frequently than other enteropathogens. Fifty percent of norovirus patients experienced diarrhea lasting ≥14 days, with median duration of 12.5 days (range 1-324 days); 29% developed diarrhea recurrence. Fifty-five percent of norovirus patients were hospitalized for diarrhea, with 27% requiring intensive care unit (ICU) admission. One HSCT recipient developed pneumatosis intestinalis. Three HSCT patients expired ≤6 months of norovirus diarrhea onset. Compared to non-norovirus diarrhea patients, norovirus patients experienced significantly more frequent ICU admission (27% vs. 0%, p = 0.02), greater serum creatinine rise (median 0.3 vs. 0.2 mg/dL, p = 0.01), and more weight loss (median 1.6 vs. 0.6 kg, p < 0.01). Noroviruses are an important cause of diarrhea in pediatric transplant patients and are associated with significant clinical complications.
authors: Department of Medicine, Baylor College of Medicine, Houston, TX.
authors: X
authors: X
authors: Ye
authors: Department of Medicine, Baylor College of Medicine, Houston, TX.
authors: J N
authors: JN
authors: Van
authors: Department of Pediatrics, Baylor College of Medicine, Houston, TX.|Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX.|Texas Children's Hospital, Houston, TX.
authors: F M
authors: FM
authors: Munoz
authors: Department of Pediatrics, Baylor College of Medicine, Houston, TX.|Texas Children's Hospital, Houston, TX.|Department of Pathology, Baylor College of Medicine, Houston, TX.
authors: P A
authors: PA
authors: Revell
authors: Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN.
authors: C A
authors: CA
authors: Kozinetz
authors: Department of Pediatrics, Baylor College of Medicine, Houston, TX.|Texas Children's Hospital, Houston, TX.
authors: R A
authors: RA
authors: Krance
authors: Department of Medicine, Baylor College of Medicine, Houston, TX.|Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX.
authors: R L
authors: RL
authors: Atmar
authors: Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX.
authors: M K
authors: MK
authors: Estes
authors: Department of Medicine, Baylor College of Medicine, Houston, TX.|Texas Children's Hospital, Houston, TX.
authors: H L
authors: HL
authors: Koo
mesh_terms: D017250:Caliciviridae Infections / Q000276:immunology / Q000821:virology*; D002648:Child; D003967:Diarrhea / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology*; D005243:Feces / Q000737:chemistry / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D029322:Norovirus / Q000302:isolation & purification*; D016377:Organ Transplantation; D011379:Prognosis; D011446:Prospective Studies; D012367:RNA, Viral / Q000235:genetics; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D066027:Transplant Recipients
chemical_list: D012367:RNA, Viral
keywords: clinical research / practice; infection and infectious agents; infectious disease; intestinal disease: infectious; pediatrics; viral