title: Prevalence of human norovirus and Clostridium difficile coinfections in adult hospitalized patients.
abstract: OBJECTIVE
  Human norovirus (HuNoV) and Clostridium difficile are common causes of infectious gastroenteritis in adults in the US. However, limited information is available regarding HuNoV and C. difficile coinfections. Our study was designed to evaluate the prevalence of HuNoV and C. difficile coinfections among adult patients in a hospital setting and disease symptomatology.
  
  
  METHODS
  For a cross-sectional analysis, 384 fecal samples were tested for the presence of C. difficile toxins from patients (n=290), whom the provider suspected of C. difficile infections. Subsequent testing was then performed for HuNoV genogroups I and II. Multinomial logistic regression was performed to determine symptoms more frequently associated with coinfections.
  
  
  RESULTS
  The final cohort consisted of the following outcome groups: C. difficile (n=196), C. difficile + HuNoV coinfection (n=40), HuNoV only (n=12), and neither (n=136). Coinfected patients were more likely to develop nausea, gas, and abdominal pain and were more likely to seek treatment in the winter season compared with individuals not infected or infected with either pathogen alone.
  
  
  CONCLUSIONS
  Our study revealed that patients with coinfection are more likely to experience certain gastrointestinal symptoms, in particular abdominal pain, suggesting an increased severity of disease symptomatology in coinfected patients.
authors.affiliation: Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Janelle N
authors.initials: JN
authors.lastname: Stokely
authors.affiliation: Department of Infectious Diseases, Consultant Laboratory for Noroviruses, Robert Koch Institute, Berlin, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Niendorf
authors.affiliation: Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Stefan
authors.initials: S
authors.lastname: Taube
authors.affiliation: Department of Infectious Diseases, Consultant Laboratory for Noroviruses, Robert Koch Institute, Berlin, Germany.
authors.forename: Marina
authors.initials: M
authors.lastname: Hoehne
authors.affiliation: Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Internal Medicine, Division of Infectious Diseases.
authors.forename: Vincent B
authors.initials: VB
authors.lastname: Young
authors.affiliation: Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Mary Am
authors.initials: MA
authors.lastname: Rogers
authors.affiliation: Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Christiane E
authors.initials: CE
authors.lastname: Wobus
keywords: C. difficile; coinfection; gastroenteritis; human norovirus